question

Anorexia

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lack of desire to eat despite despite physiologic stimuli that would normally produce hunger

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constipation must be individually defined because:

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patterns of bowel evacuation greatly differ among individuals

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constipation usually means:

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decrease in the number of bowel movements per week, hard stools, and difficult evacuation

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parietal pain arises from the:

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parietal peritoneum -this pain is more localized and intense than visceral pain

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T6 and L1

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nerve fibers from the peritoneum travel with peripheral nerves to the spinal cord -and the sensation of pain corresponds to skin dermatomes:

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With losses of more than 1000 ml or more:

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the heart rate is greater than 100 BPM and the systolic BP is less than 100 mm HG

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chronic antral gastritis

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involves the antrum only and is four times more common than fundal gastritis

question

chronic gastritis causes

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thinning and degeneration of the stomach wall & tends to occur in older adults

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endoscopy and biopsy may show long-standing inflammatory process and gastric atrophy indicating:

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chronic gastritis in an individual with no history of abdominal distress

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after gastrectomy, individuals develop anemia from:

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deficiencies in iron, folate and Vitamin B12

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ammonia formation may increase:

answer

hepatic encephalopathy

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liver dysfunction and collateral vessels that shunt blood around the liver to the systemic circulation permit neurotoxins and other harmful substances (i.e. ammonia) to be :

answer

absorbed from the GI tract to circulate freely to the brain

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hepatitis D (HDV)

answer

occurs in individuals with hepatitis B

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Hepatitis D depends of ______virus for its replication because of the coat of the delta virus consists of HBsAg molecules that are on the surface of it

answer

hepatitis B

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Hepatitis B

answer

virus that is a sexually transmitted disease

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Individuals with ______are at increased risk for chronic liver disease

answer

hepatitis C

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primary biliary cirrhosis

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an autoimmune disease of unknown etiology leading to destruction of small intrahepatic bile ducts

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the chemoreceptor trigger zone (CTZ) for vomiting is located in the

answer

medulla oblongata

question

the action of anti emetics, such as domperidone, and haloperidol is to ___the effects of ____.

answer

stimulate; dopamine (D2)

question

Dopamine receptors play a role in mediating:

answer

vomiting

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apomorphine, levodopa, and bromocriptine are dopamine (D2) agonists that cause:

answer

nausea and vomiting

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metoclopramide, domperidone and haloperidol are D2 antagonists and are:

answer

effective antiemetics

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______vomiting is caused by direct stimulation of the vomiting center by neurologic lesions involving the brainstem

answer

Projectile (i.e. increased intracranial pressure, tumors, or aneurysms involving the brainstem)

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normal bowel habits range from two or three evacuations/day to

answer

one per week

question

more than ____stools per day is considered abnormal

answer

three

question

the adult intestine processes approximately ____L of luminal content/day

answer

9; 2 L is ingested and the remaining 7 L consists of intestinal secretions

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a person who has cholera would be expected to have which type of diarrhea?

answer

secretory

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primary causes of secretory diarrhea are:

answer

bacterial enterotoxins (particularly those released by cholera or strains of E. coli & neoplasms such as gastrinoma or thyroid carcinoma)

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the type of diarrhea that is a result of unhydrolyzed (non absorbable substance) lactose is referred to as:

answer

osmotic

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lactose deficiency is the most common cause of osmotic diarrhea and loss of:

answer

pancreatic enzymes

question

what chemical mediators produce abdominal pain?

answer

histamine, bradykinin and serotonin

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edema and vascular congestion produce:

answer

abdominal pain by stretching

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ischemia caused by distention of bowel obstruction or mesenteric vessel thrombosis produces:

answer

abdominal pain

question

abdominal pain is best described as visceral pain that:

answer

is diffused, vague, poorly localized and dull

question

abdominal pain is usually felt near the:

answer

midline in the epigastrium (upper midabdomen), midabdomen or lower abdomen

question

Gastroesophageal reflux disease (GERD) is a result of:

answer

a zone of low pressure of the lower esophageal sphincter (LES)

question

normally the resting tone of the LES maintains a zone of:

answer

high pressure that prevents gastroesophageal reflux

question

Frank (bight red or burgundy) bleeding of the rectum is called:

answer

hematochezia

question

functional dysphagia is caused by:

answer

a neuromuscular disorder

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dysphagia interferes with:

answer

voluntary swallowing or peristalsis

question

reflux esophagitis

answer

a combination of factors that causes injury and an inflammation response to reflux

question

intussusception causes intestinal obstruction by:

answer

telescoping of part of the intestine into another usually causing strangulation of the blood supply

question

the most commonly occurring small intestinal obstruction is:

answer

adhesions

question

an intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing the:

answer

excessive loss of hydrogen ions normally absorbed from gastric juice

question

if the intestinal obstruction is at the pylorus or high in the small intestine what develops?

answer

metabolic alkalosis

question

the cardinal symptoms of small intestinal obstruction include:

answer

colicky pain caused by distention followed by vomiting

question

which inflammatory cytokines are released in chronic gastritis?

answer

TNF-alpha, IL-6, IL-10, and leukotrienes & cause damage gastric epithelium

question

the primary cause of duodenal ulcers is:

answer

Helicobacter pylori

question

A peptic ulcer may occur in all of the following areas except the:

answer

jejunum

question

Contributing factors of duodenal ulcers:

answer

-there are greater than usual number of parietal cells in the gastric mucosa -high serum gastrin levels remain in high longer than normal after eating -failure of the feedback mechanism occurs, whereas acid in the gastric antrum inhibits gastrin release -rapid gastric emptying overwhelms the buffering capacity of the bicarbonate-rich pancreatic secretion wrong: gastric emptying is slowed.

question

After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are a result of:

answer

a rapid gastric emptying and creation of high osmotic gradient in the small intestine that causes a sudden shift of fluid from the blood vessels to the intestinal lumen

question

rapid distention of the intestine produces a feeling of epigastric:

answer

fullness, cramping, nausea, vomiting and diarrhea

question

which of the following is consistent with dumping syndrome?

answer

usually responds well to dietary management

question

the desire to eat is stimulated by?

answer

agouti-related protein (AgRP) & Y (NPY) - both produced by one set of neurons

question

Eating behavior, energy metabolism, and body fat mass are regulated by the :

answer

hypothalamus

question

The arcuate nucleus (ARC) in the hypothalamus has two sets of neurons with opposing effects that interact to:

answer

regulate and balance food intake and energy metabolism

question

Symptoms characteristic of bulimia nervosa include:

answer

recurrent episodes of binge eating with fears of not being able to stop eating

question

the most common clinical manifestation of portal hypertension is _____bleeding.

answer

esophangeal varices

question

the most common manifestation of portal hypertension induced spleomegaly is:

answer

thrombocytopenia (decreased platelet count)

question

congestive splenomegaly can contribute to an:

answer

increased bleeding tendency

question

arterial vasodilation theory proposes that circulation nitric oxide or release of endotoxin from translocation of intestinal bacteria triggers:

answer

arterial vasodilation of the splanchnic organs early in the course of cirrhosis and -stimulates renal sodium retention through renin-angiotensin-aldosterone -increased sympathetic tone -changes in the intrarenal blood flow (decreased blood flow to the kidneys)

question

the accumulation of short-chain fatty acids, serotonin, tryptophan and false neurotransmitters probably contributes to:

answer

neural dearangement and is not associated with ammonia levels

question

what contribute to hepatic encephalopathy:

answer

-end products of intestinal protein digestions -digested blood leaking from ruptured varices -ammonia-forming bacteria in the colon

question

which are the early (prodromal) clinical manifestations of hepatitis?

answer

fatigue, fever, hyperalgia, and vomiting (these symptoms precede the onset of jaundice)

question

Hepatic fat accumulation is seen in which form of cirrhosis?

answer

Alcoholic

question

Biliary cirrhosis damage and inflammation leading to cirrhosis begin in the:

answer

bile canaliculi and bile ducts

question

Acute pancreatitis (acute hemorrhagic pancreatitis) is initiated by:

answer

intrapancreatic activation of proteases

question

Most common theory is that pancreatitis develops because of an injury or disruption of:

answer

pancreatic acinar cells which permits leakage of pancreatic enzymes (trypsin, chymotrypsin, and elastase) into pancreatic tissue

question

Activated proteolyses (trypsin and elastase) and lipase breakdown tissue and cell membranes causing:

answer

inflammation, edema, vascular damage, hemorrhage, necrosis and fibrosis

question

the mutation of which gene occurs in cancers of the stomach, colon, liver, gallbladder and pancreas?

answer

TP53 tumor-supproser gene & p21

question

Clinical manifestations of cecum cancer and ascending colon are:

answer

pain, palpable mass in the lower right quadrant, anemia, and dark red or mahogany-colored blood mixed with the stool NOT Constipation

question

Alterations in immunoglobulin G production have been found in individuals with:

answer

Crohn disease

question

Inflammation begins at the base of the crypts of Lieberkuhn in the large intestine, primarily the left colon, with infiltration and realease of inflammatory cytokines from neutrophils, lymphocytes, plasma cells, macrophages, eosinophils, and mast cells (does not skip sections)

answer

Ulcerative colitis

question

Diabetic neuropathy causes this type of diarrhea with decreased transit time

answer

motility

question

upper GI tract bleeding

answer

-bleeding from esophagus, stomach, or duodenum - Mallory-Weis tear of the esophagus --> esophageal varicose (triggered by alcoholism)

question

lower GI tract bleeding

answer

-below the duodenum -from the jejunum, ileum, colon, or rectum -colo-rectal cancer, hemorrhoids

question

hematemesis

answer

vomiting of blood

question

GERD is the reflux of ______from the stomach to the esophagus

answer

chyme

question

intestinal obstruction

answer

any condition that prevents the flow of chyme through the intestinal lumen of failure of normal intestinal motility in the absence of an obstructing lesion

question

ileus

answer

an obstruction of the intestines

question

Risk factors of duodenal ulcers:

answer

-hypersecretion of stomach acid and pepsin -overuse of NSAID (> 65 yrs) -high gastrin levels -acid production by cigarette smoking

question

Gastric ulcer primary defect:

answer

an increased mucosal permeability to hydrogen ions -gastric secretion tends to be normal or less than normal

question

Dumping syndrome:

answer

clinical complication of partial gastrectomy or pyloroplasty- the rapid emptying of chyme from a surgically created, residual stomach into the small intestine -bariatric patients -created a diverted stomach into small intestine (little or no holding capacity) --> lost the prepping time to digest

question

maldigestion

answer

failure of the chemical processes of digestion; don't have the right chemicals to break down the food

question

malabsorption

answer

failure of the intestinal mucosa to absorbed digested nutrients; short bowel syndrome = not enough bowel length to absorb nutrients

question

bile salts are needed to:

answer

emulsify fat

question

conjugated bile salts are synthesized from:

answer

cholesterol in the liver

question

bile salt deficiency can result from:

answer

liver disease and bile obstructions (gall stones)

question

problems with bile salt deficiency:

answer

poor intestinal absorption of lipids causes fatty stools, diarrhea, and loss of fat-soluble vitamins

question

symptoms of Ulcerative Colitis include:

answer

diarrhea (10-20/day), bloody stools, cramping --> increased colon cancer risk

question

appendicitis

answer

-inflammation of the vermiform appendix (out pouching of appendix) possible causes: obstruction, ischemia, increased intraluminal pressure, infection, ulceration -S/S: REBOUND TENDERNESS; epigastric and pain in right lower quadrant -most serious complication is proliferation which can lead to peritonitis

question

Leptin

answer

causes decrease in appetite when full

question

marasmus

answer

severe malnutrition leading to energy deficiency

question

kwashiorkor

answer

protein malnutrition

question

retching

answer

-strong involuntary effort to vomit -the lower esophageal sphincter and body of the stomach relax but the duodenum and antrum of the stomach go into spasm -food is forced from the stomach into the esophagus but because the upper esophageal sphincter is closed, chyme does not enter the mouth - results in no throw up - food drops back into the stomach

question

motility diarrhea can be caused by:

answer

-resection of the small intestine, -surgical bypass of an area of the intestine or -fistula formation between loops of the intestine

question

referred pain is:

answer

pain that is well localized, felt in the skin or deeper tissues that share a central common afferent pathway with the affected organ

question

occult bleeding of GI is

answer

slow, chronic blood loss that results in iron-deficiency anemia as iron stores in the bone marrow are slowly depleted

question

aspirin and other anti-inflammatory drugs are known to cause:

answer

acute gastritis

question

why do aspirin and other antibiotics cause acute gastritis?

answer

because they inhibit prostaglandins that normally stimulate the secretion of the protective mucus

question

acute gastritis does what to the epithelium?

answer

erodes the epithelium

question

Chronic fundal gastritis is the more severe type of gastritis because :

answer

-the gastric mucosa degenerates extensively. -etiolgy: autoimmune

question

In chronic fundal gastritis, the loss of chief cells and parietal cells diminishes secretion of:

answer

-pepsinogen -hydrochloric acid & -intrinsic factor

question

Chronic fundal gastritis is conducive of pernicious anemia because:

answer

the loss of the intrinsic factor affects ( decreases) absorption of vitamin B12

question

chronic antral gastritis major etiologic factor:

answer

Helicobacter pylori

question

Chronic antral gastritis response to infection is:

answer

-infiltration of neutrophils and release of inflammatory cytokines that damage the gastric epithelium -inflammation and gastric atrophy may develop without hx of abdominal distress

question

Irritable bowel syndrom (IBS)

answer

functional disorder characterized by -lower abdominal pain, -predominant or alternating diarrhea/constipation, -gas, -bloating and - nausea

question

Cholelithiasis - gallstone formation; most common type of stone

answer

cholesterol and

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