PATHO Gastrointestinal System

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Chpts. 33-35

Which of the following types of diarrhea can be caused by an inability to digest lactose in dairy products?
A) Secretory
B) Neurogenic
C) Osmotic
D) Motility

Osmotic
Feedback: CORRECT
When an individual is unable to digest lactose, the unabsorbed molecules draw water into the lumen, resulting in osmotic diarrhea.

Which of the following disorders can result in lower gastrointestinal bleeding?

Cancer
Feedback: CORRECT
Colorectal cancer is a common cause of lower gastrointestinal bleeding.

Which of the following conditions is a complication of gastrointestinal bleeding?
A) Iron deficiency anemia
B) Polyps
C) Hypertension
D) Ascites

A) Iron deficiency anemia
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Blood loss in gastrointestinal bleeding can result in an iron deficiency due to the loss of iron in the hemoglobin.

The presence of digested dark blood in the stool is called:
A) melena.
B) hematochezia.
C) hematemesis.
D) occult bleeding.

A) melena.
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Melena is black, tarry stool that occurs when blood components are digested in the upper gastrointestinal tract.

Which of the following conditions can cause dysphagia?
A) Hiatal hernia
B) Achalasia
C) Gastroesophageal reflux
D) All of the above

D) All of the above
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Dysphagia, or difficulty swallowing, can be caused by hiatal hernia, achalasia, or gastroesophageal reflux.

Reflux esophagitis is defined as:
A) the autoimmune destruction of the esophageal lining.
B) dysplasia of the epithelial lining of the esophagus.
C) a congenital anomaly of the esophagus.
D) an inflammatory response to gastroesophageal reflux.

D) an inflammatory response to gastroesophageal reflux.
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Reflux esophagitis is an inflammatory response to the mucosal injury from acid and enzymes that occur with gastroesophageal reflux.

Common manifestations of gastroesophageal reflux disease (GERD) include:
A) nausea, vomiting, and weight loss.
B) diarrhea, abdominal cramping, and fever.
C) heartburn, dysphagia, and pain within one hour of eating.
D) back pain, ascites, and anorexia.

C) heartburn, dysphagia, and pain within one hour of eating.
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Heartburn, dysphagia, and pain within one hour of eating, along with acid regurgitation and chronic cough, are all manifestations of gastroesophageal reflux disease (GERD).

Complications associated with gastroesophageal reflux disease (GERD) include which of the following?
A) Esophageal ulcerations
B) Esophageal cancer
C) Esophageal strictures
D) All of the above

D) All of the above
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Esophageal ulcerations, strictures, and cancer are all complications associated with gastroesophageal reflux disease.

A hiatal hernia is a protrusion of the _____ through the ______.
A) stomach; diaphragm
B) duodenum; pyloric sphincter
C) small intestine; inguinal canal
D) rectum; anus

A) stomach; diaphragm
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A hiatal hernia is a protrusion of the stomach through the esophageal hiatus of the diaphragm

Paralytic ileus often occurs after:
A) gastroesophageal reflux resolves.
B) abdominal surgery.
C) pregnancy.
D) vomiting.

B) abdominal surgery.
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Paralytic ileus is a functional bowel obstruction caused by failure of motility and often occurs after abdominal surgery

Intestinal obstruction can lead to all of the following complications except:
A) hepatic failure.
B) dehydration.
C) peritonitis.
D) perforation.

A) hepatic failure.
Feedback: CORRECT
Hepatic failure is not a complication of intestinal obstruction.

The classic symptoms of a small bowel obstruction are:
A) nausea, dyspnea, and mid-back pain.
B) vomiting, severe abdominal pain, and abdominal distension.
C) constipation, pelvic pain, and dysuria.
D) fever, heartburn, and diaphoresis.

B) vomiting, severe abdominal pain, and abdominal distension.
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Symptoms of a small bowel obstruction include vomiting from vagal nerve stimulation, pain from bowel wall distention, and abdominal distension from accumulation of chyme or ascites.

The most common cause of chronic gastritis is:
A) viral infection.
B) bacterial infection.
C) parasitic infection.
D) fungal infection.

B) bacterial infection.
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The most common cause of chronic gastritis is chronic bacterial infection by Helicobacter pylori

Individuals with chronic gastritis are at risk for developing which of the following problems?
A) Gastric cancer
B) Achlorhydria
C) Gastrointestinal bleeding
D) All of the above

D) All of the above
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Chronic damage to the stomach mucosa can cause cellular changes that lead to gastric cancer, achlorhydria, and mucosal erosions that can result in gastrointestinal bleeding.

How does a chronic infection with Helicobacter pylori (H. pylori) lead to duodenal ulcers?
A) Chronic inflammation inhibits the proton pumps in the gastric lining.
B) Presence of bacteria in the stomach causes the pyloric sphincter to open prematurely, releasing acid into the duodenum.
C) H. pylori inhibits prostaglandins, leading to decreased mucus production.
D) H. pylori produces substances that are toxic to the duodenal mucosa.

D) H. pylori produces substances that are toxic to the duodenal mucosa.
Feedback: CORRECT
H. pylori bacteria produce ammonia and enzymes that can damage the duodenal mucosa.

Non-steroidal anti-inflammatory agents (NSAIDS) cause peptic ulcer by:
A) decreasing gastric bicarbonate production.
B) accelerating the proton pump in parietal cells.
C) inhibiting mucosal prostaglandin synthesis.
D) reducing mucosal blood flow.

C) inhibiting mucosal prostaglandin synthesis.
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NSAIDS are used to treat inflammatory pain and can increase the risk of peptic ulcer disease by inhibiting prostaglandin synthesis, which normally stimulates the production of gastric mucous.

In addition to NSAID use, possible risk factors for peptic ulcer disease include all of the following except:
A) smoking.
B) alcoholism.
C) psychological stress.
D) female gender.

D) female gender.
Feedback: CORRECT
Men have a higher incidence of duodenal ulcers than women, and gastric ulcers affect men and women equally.

Which type of ulcer is a stress ulcer that is associated with burn injuries?
A) Addison
B) Cushing
C) Curling
D) Retroperitoneal

C) Curling
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Curling ulcers are ischemic ulcers that occur following severe burn injuries.

Gastric ulcers are characterized by:
A) increased acid secretion.
B) regurgitation of bile.
C) pain with eating.
D) bloody diarrhea.

C) pain with eating.
Feedback: CORRECT
Gastric ulcers are often associated with pain upon eating because the presence of food stimulates acid and enzyme secretion, which causes further damage to the gastric mucosa and underlying tissue.

Severe trauma can result in stress ulcers that often first manifest with:
A) abdominal pain.
B) peritonitis.
C) severe bleeding.
D) dumping syndrome.

C) severe bleeding.
Feedback: CORRECT
The first sign of stress ulcers is often acute gastrointestinal bleeding.

Gastrectomy surgery commonly leads to a vitamin B12 deficiency anemia because:
A) vitamin B12 is absorbed in the stomach.
B) decreased HCl production affects vitamin B12 absorption.
C) pepsin is required for the conversion of vitamin B12 into its active form.
D) decreased intrinsic factor production results in decreased vitamin B12 absorption in the ileum.

D) decreased intrinsic factor production results in decreased vitamin B12 absorption in the ileum.
Feedback: CORRECT
The stomach secretes intrinsic factor, which is required for vitamin B12 absorption in the ileum.

Which of the following disorders is characterized by night blindness, osteopathy, and clotting disorders?
A) Post-gastrectomy syndrome
B) Gluten-sensitive enteropathy
C) Bile salt deficiency
D) Lactase deficiency

C) Bile salt deficiency
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Night blindness, osteopathy, and clotting disorders are caused by bile salt deficiency and the resulting malabsorption of fat soluble vitamins A, D, and K.

Which of the following disorders is characterized by the inability to digest all nutrients?
A) Pancreatic insufficiency
B) Gluten-sensitive enteropathy
C) Bile salt deficiency
D) Lactase deficiency

A) Pancreatic insufficiency
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Because the pancreas secretes lipase, proteases, and amylase, a decrease in pancreatic enzymes results in an inability to digest fats, proteins, and carbohydrates.

24. All of the following are characteristics of ulcerative colitis except:
A) iron deficiency anemia.
B) the presence of "skip" lesions.
C) diarrhea.
D) an increased risk of colon cancer.

B) the presence of "skip" lesions.
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Ulcerative colitis begins in the rectum and advances back through the colon in a continuous manner and does not "skip" parts of the mucosa.

Which of the following factors are known causes of ulcerative colitis?
A) Genetic predisposition
B) Autoimmune injury
C) Inflammation
D) All of the above

D) All of the above
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Ulcerative colitis often runs in families. Symptoms are related to autoimmune injury to the mucosal lining and the resulting inflammation.

Common characteristics of Chron disease include which of the following?
A) Significant blood loss in diarrhea
B) Gastroesophageal reflux
C) Vitamin B12 deficiency
D) Mucosal erosions of the rectum

C) Vitamin B12 deficiency
Feedback: CORRECT
Vitamin B12 malabsorption due to injury to the mucosa of the ileum is a common characteristic of Chron disease.

Diverticula are:
A) ulcers that form in the colon.
B) outpouchings of the colon's mucosa.
C) perforations of the colon wall.
D) areas where the colon wall is hypertrophied.

B) outpouchings of the colon's mucosa.
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Diverticula are sac-like outpouchings of the mucosa through the muscle layers of the digestive tract.

Diverticulosis can be related to which of the following dietary problems?
A) Lactose deficiency
B) Diet high in refined foods
C) Iron deficiency
D) High fiber intake

B) Diet high in refined foods
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Diverticula form when there is not enough stool bulk, which is related to a diet high in refined foods, and when there is weakening of the wall of the colon.

Appendicitis usually presents with pain that manifests in which abdominal quadrant?
A) Right upper
B) Right lower
C) Left upper
D) Left lower

B) Right lower
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Most individuals with appendicitis present with periumbilical pain that increases in intensity over several hours and then "moves" to the right lower quadrant.

Which of the following nutritional disorders is characterized by consumption of large amounts of food (binging) followed by self-induced vomiting and/or the use of laxatives (purging)?
A) Obesity
B) Anorexia nervosa
C) Bulimia nervosa
D) Kwashiorkor

C) Bulimia nervosa
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Binging and purging behaviors are typical of bulimia nervosa

Although the term hepatitis describes any inflammatory process affecting the liver, it is usually used to describe liver inflammation due to:
A) bacterial infection.
B) viral infection.
C) prescription drug toxicity.
D) street drug toxicity.

B) viral infection.
Feedback: CORRECT
Most causes of hepatitis are viral in origin.

Which of the following types of hepatitis is acquired from ingesting contaminated food and manifests acutely with fever, abdominal pain, and jaundice, but does not usually result in fulminant liver failure?
A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) All of the above

A) Hepatitis A
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Hepatitis A is acquired from ingesting contaminated food and manifests acutely with fever, abdominal pain, and jaundice. Individuals with hepatitis A generally make a full recovery.

The most common cause of liver cirrhosis are hepatitis C and:
A) alcoholism.
B) cocaine abuse.
C) overdose of antibiotic medications.
D) liver cancer.

The most common cause of liver cirrhosis are hepatitis C and:
A) alcoholism.
Feedback: CORRECT
High alcohol consumption causes liver injury and inflammation resulting in fibrosis and scarring of the liver.

The most common cause of portal hypertension is:
A) renal failure.
B) liver cirrhosis.
C) congestive heart failure.
D) esophageal varices.

B) liver cirrhosis.
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The most common cause of portal hypertension is liver cirrhosis. The obstruction of blood flow in the liver leads to increased venous pressures in the hepatic portal vein

Which of the following symptoms is associated with hepatic encephalopathy?
A) Ascites, bleeding disorders, and immunosuppression
B) Peripheral edema, dyspnea, and weight gain
C) Decreased urinary output, increased serum creatinine, and elevated liver enzymes
D) Memory loss and confusion, progressing to coma

D) Memory loss and confusion, progressing to coma
Feedback: CORRECT
Hepatic encephalopathy results in abnormal neurotransmitter function and neuronal injury. Manifestations include mental status changes such as memory loss and confusion. As the condition develops, the patient will become comatose.

Jaundice related to biliary duct obstruction is manifested by which of the following laboratory alterations?
A) Decreased unconjugated bilirubin
B) Increased unconjugated bilirubin
C) Decreased conjugated bilirubin
D) Increased conjugated bilirubin

D) Increased conjugated bilirubin
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In cases of bile duct obstruction, the liver conjugates bilirubin but is unable to secrete it into the bile that is backed up. The conjugated bile seeps back into the plasma and deposits in the skin and other surface tissues, causing jaundice.

Tissue damage in acute pancreatitis is caused by:
A) leakage of pancreatic enzymes into pancreatic tissue.
B) hydrochloric acid reflux into the pancreatic duct.
C) autoimmune destruction of the pancreas.
D) insulin toxicity.

A) leakage of pancreatic enzymes into pancreatic tissue.
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Tissue damage in acute pancreatitis is caused by leakage of pancreatic enzymes into pancreatic tissue and the resulting autodigestion of the gland.

The most common cause of chronic pancreatitis is:
A) narcotic addiction.
B) gall stones.
C) alcohol abuse.
D) diabetes mellitus.

C) alcohol abuse.
Feedback: CORRECT
Chronic pancreatitis is most often associated with chronic alcohol abuse.

Which of the following risk factors increases a person's chance of developing esophageal cancer?
A) Smoking
B) Alcohol
C) Gastroesophageal reflux
D) All of the above

D) All of the above
Feedback: CORRECT
Smoking, alcohol, and gastroesophageal reflux leading to Barett esophagus all increase the risk of developing esophageal cancer, which has very poor survival rates.

Which of the following symptoms is most specific to colon cancer?
A) Nausea and jaundice
B) Abdominal pain and hematochezia
C) Epigastric pain and vomiting
D) Heartburn and dysphagia

B) Abdominal pain and hematochezia
Feedback: CORRECT
Abdominal pain and hematochezia, along with weight loss, changes in bowel movements, and bowel obstruction, are symptoms of colon cancer.

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