GI Modules

Place each stage of gastric cancer in the order of occurrence, starting with the first stage. A. Cancer has grown into the muscle layer, possibly spreading to more lymph nodes. B. Metastasis has occurred and other areas of the body are affected. C. Invasion has grown through all layers of the stomach and possibly spread to nearby organs and/or tissue. D. Cancer has grown in the lining of the stomach with a very small area of local lymph node invasion possible

1. D 2. A 3. C 4. B As cancer grows, it will begin in the mucosal glands of the stomach and will be limited to the lining of the stomach with small lymph node invasion. Stage II denotes growth into the muscle layer with spreading into more lymph nodes. Stage III is marked by invasion into all layers of the stomach and possibly nearby organs and/or tissue, with Stage IV resulting in metastasis to other distant areas and organs in the body.

Match the diseases to their causes 1. H. pylori and ingestion of preserved foods.________ 2. Bile reflux; excessive alcohol intake, coffee, smoking.________ 3. Salmonella, food allergies, and nonsteroidal anti-inflammatory drugs._______ 4. Unknown but seen post intestinal surgery and in patients with diabetes.______ A. Gastritis B. Gastroparesis C. Gastric cancer D. Gastric ulcer

1. H. pylori and ingestion of preserved foods. C. Gastric cancer 2. Bile reflux; excessive alcohol intake, coffee, smoking. D. Gastric ulcer 3. Salmonella, food allergies, and nonsteroidal anti-inflammatory drugs. A. Gastritis 4. Unknown but seen post intestinal surgery and in patients with diabetes. B. Gastroparesis

Match the disease to its prevalence. 1. Risk increases with age and is more prevalent in women. _______________ 2. Typically worsens and increases with age, common in children with H. pylori _________ 3. Only a small percent of new cases diagnosed each year since the past decade _________ 4. More common in women and in patients with diabetes and Parkinson's disease ________ A. Gastroparesis B. Gastric cancer C. Gastritis D. Hiatal hernia

1. Risk increases with age and is more prevalent in women. D. Hiatal hernia 2. Typically worsens and increases with age, common in children with H. pylori C. Gastritis 3. Only a small percent of new cases diagnosed each year since the past decade B. Gastric cancer 4. More common in women and in patients with diabetes and Parkinson's disease A. Gastroparesis

Which are predisposing factors for development of a hiatal hernia? (Select all that apply) A. Aging B. Trauma C. H. Pylori D. Diabetes E. Ulcerogenic drugs F. Factors that increase abdominal pressure

A. Aging The aging process is a predisposing factor as flaccidity and weakness of the diaphragm muscle are common. B. Trauma Trauma to the abdomen causes forceful pushing of the muscle up in to the thoracic cavity causing a hiatal hernia. F. Factors that increase abdominal pressure Factors that increase abdominal pressure, such as obesity, pregnancy, ascites, and tumors, can cause a forcing of the stomach/esophageal muscle to protrude through the diaphragm. H. pylori is a contributor to many gastric disorders but hiatal hernias are not due to this bacteria. Diabetes is not a predisposing factor for hernia as the hiatus is not affected by changes in blood sugar levels. Ulcerogenic drugs are responsible for irritating the gastric mucosa, not causing a protrusion into the thoracic cavity.

Which are typical locations of gastric cancer invasion? (Select all that apply) A. Antrum B. Fundus C. Duodenum D. Pyloric area E. Greater curvature

A. Antrum The lower portion of the stomach, the antrum, is a common area of cancer development. D. Pyloric area The pyloric area is a commonly diagnosed area of gastric cancer. The fundus is in the upper portion of the stomach and is not typically a location of gastric cancer, as irritation does not usually occur there. The duodenum is located just below the pyloric sphincter at the beginning of the small intestine and, therefore, not an area of gastric cancer. The greater curvature of the stomach is not a typical area for gastric cancer.

Which clinical manifestations of hiatal hernia are due to reflux of gastric contents? (Select all that apply) A. Belching B. Heartburn C. Slow motility D. Vomiting of undigested food E. Feeling of fullness after eating

A. Belching Belching is caused by excess gas guild-up due to the reflux of food into the esophagus. B. Heartburn Reflux of gastric contents into the esophagus results in heartburn. Slow motility is not common in hiatal hernia as this is typical of the lower area of the stomach, and not the esophagus and fundus of the stomach. Vomiting of undigested food is not typical of a hiatal hernia as this has to do with sluggish muscles in the body and antrum of the stomach. Feelings of fullness after eating are not typical of a hiatal hernia as this has to do with sluggish muscles in the body and antrum of the stomach.

Which are predisposing factors for gastric cancer? (select all that apply) A. Blood types A & O B. Chronic gastritis C. H. pylori infection D. Coffee consumption E. Excessive alcohol consumption

A. Blood types A and O Blood types A and O are at higher risk for developing gastric cancer. B. Chronic gastritis Chronic atrophic gastritis is a predisposing factor to gastric cancer as the lining of the stomach is affected, causing mutation in cellular structure. C. H. pylori infection The bacterium Helicobacter pylori has been linked to many gastric disorders and is known to increase the risk of gastric cancer. E. Excessive alcohol consumption Excessive alcohol consumption has been linked to many gastric disorders, especially gastric cancer. Coffee consumption has been linked to gastric ulcers, not gastric cancer.

Which processes are involved in the breakdown of the mucosal barrier leading to gastric ulcer formation? (Select all that apply) A. Diffusion of acid through the mucosal barrier B. Chronic inflammation causes the gastric mucosa to atrophy C. Cellular destruction and increased inflammatory reaction occur D. Initially, protrusion of the stomach upward through the diaphragm occurs E. The vagus nerve is damaged, causing slow motility and malabsorption of nutrients F. Histamine is triggered and release from the damaged mucosa, resulting in vasodilation and increased capillary permeability.

A. Diffusion of acid through the mucosal barrier. A breakdown in the mucosal barrier impedes the stomach's natural defenses and causes a diffusion of acid, causing injury. C. Cellular destruction and increased inflammatory reaction occur. Due to the impaired defense of the barrier, cellular destruction occurs that triggers an inflammatory response. F. Histamine is triggered and released from the damaged mucosa, resulting in vasodilation and increased capillary permeability. Histamine is triggered from the breakdown of the mucosal barrier and is a defense mechanism since the barrier defense is impeded. Atrophied mucosa is not a pathophysiological response of the breakdown of the mucosal layer for development of a gastric ulcer, but is associated with chronic gastritis. Protrusion of the stomach upward through the diaphragm is a hiatal hernia, not a gastric ulcer. The vagus nerve is damaged, causing slow motility and malabsorption of nutrients. This pathophysiology applies to gastroparesis and not gastric ulcers.

Which manifestations are associated with gastric cancer? (Select all that apply) A. Fatigue B. Hematemesis C. Anorexia and weight loss D. Vomiting of undigested food E. Excessive belching and flatulence F. A feeling of fullness after eating only small amounts

A. Fatigue Fatigue is common in patients with gastric cancer as the cancer "steals" the nutrients when ingested. C. Anorexia and weight loss Patients with gastric cancer often lose an interest in food and, therefore, lose weight as a result. F. A feeling of fullness after eating only small amounts Due to growing tumors in the stomach, there is often a feeling of fullness even when the patient has not eaten or has eaten only small amounts of food. Hematemesis is not a typical manifestation of gastric cancer, but can occur in gastric disorders that involve erosion of the mucosal lining. Vomiting of undigested food is not common in patients with gastric cancer as motility is not typically affected. Excessive belching and flatulence are due to excessive gaseous build-up and are typically correlated with hiatal hernias, not gastric cancer.

Which gastric disorder is characterized by an inflammatory process that causes the gastric mucosa lining to become hyperemic and edematous? A. Gastritis B. Hiatal hernia C. Gastroparesis D. Gastric cancer

A. Gastritis Gastritis is denoted by an inflamed, hyperemic, edematous gastric mucosal lining. Hiatal hernia affects the esophagus from protrusion of the stomach. Gastroparesis affects motility of the stomach. Gastric cancer is typically in the form of adenocarcinoma, which stems from mutation in the mucosal gland cells.

Which gastric disorders have been linked to an infection due to the bacterium Helicobacter pylori? (Select all that apply) A. Gastritis B. Gastric ulcer C. Hiatal hernia D. Gastroparesis E. Gastric cancer

A. Gastritis H. pylori is a bacterium that is able to adapt to the hard environment of the acidic stomach and therefore invades the gastric mucosa, causing inflammation. B. Gastric ulcer The combination of stomach acid and H. pylori cause irritation, resulting in sores and ulcerations. E. Gastric cancer Due to its colonization manifestation, H. pylori is considered the strongest known risk for gastric cancer. Hiatal hernias are not the manifestation of bacterial infections. Gastroparesis is not caused by bacterial infections.

Which description is appropriate for vomitus that appears as "coffee grounds" due to inclusion of blood containing undigested proteins? A. Hematemesis B. Dark brown color C. Yellow or greenish stained D. Recurrent vomiting of undigested food.

A. Hematemesis Hematemesis is vomitus with blood that appears like coffee grounds, which is brown and granular due to particles of undigested protein in the blood. Dark brown vomitus typically indicates content from the lower intestine being forced up due to a blockage. Bile from the duodenum will produce a vomitus that is yellow or greenish in tint. Vomitus that has undigested food particles is indicative of gastric-emptying issues such as that seen in gastroparesis.

Which characteristics are typical of H. pylori and its role in gastric disorders? (Select all that apply) A. Is able to withstand highly acidic stomach conditions B. Exists as a gram-positive spore until it reaches the colon C. Is usually considered a normal flora (bacteria) found in the large intestine D. Has been linked to gastric disorders such as gastritis, gastric ulcers, and gastric cancer E. Is spiral shaped, allowing penetration deep in the mucosa where it cannot be destroyed

A. Is able to withstand highly acidic stomach conditions H. pylori is a strong bacterium that secretes cytotoxins, which allows it to withstand harsh acidic living conditions, such as those found in the stomach. D. Has been linked to gastric disorders such as gastritis, gastric ulcers, and gastric cancer Through various research, especially that of Marshall and Warren (Nobel Prize recipients), H. pylori has been linked to many gastric disorders causing gastritis, peptic (gastric) ulcers, and gastric cancer. E. Is spiral-shaped, allowing penetration deep in the mucosa where it cannot be destroyed The spiral shape of H. pylori allows for easy penetration through the mucosal layer, protecting it against immunity so it cannot be destroyed. Clostridium is a gram-positive bacteria that remains in spore form until it reaches the colon. E. Coli is a bacteria that is considered normal flora in the colon.

Which clinical manifestations are associated with gastroparesis in a patient who is already experiencing nausea and bloating? (Select all that apply) A. Reflux B. Early Satiety C. Hematemesis D. Iron deficiency E. Vomiting of undigested food

A. Reflux Due to the sluggish muscle movement preventing food from moving through the digestive tract, reflux is common, as is vomiting of undigested food. B. Early satiety Early satiety is caused by slowed movement or paralysis of gastric muscle preventing food from moving through the stomach. E. Vomiting of undigested food The sluggish muscle movement prevents food from moving through the digestive tract so that food is often undigested and vomited. Hematemesis, vomiting of blood is not typical in gastroparesis and is seen in more erosive-type disorders. Iron deficiency anemia is typically seen in gastric cancer, not gastroparesis.

Which are clinical manifestations of a gastric ulcer? (Select all that apply) A. Weight loss B. Pernicious anemia C. Feelings of early satiety D. Pain 1-2 hours after meals E. Occasional nausea and vomiting F. Burning or gaseous in high left epigastrium, and back and upper abdomen

A. Weight loss Weight loss is common in gastric ulcers due to increased pain upon ingestion of food, as well as malabsorption of nutrients. D. Pain 1-2 hours after meals Due to sensitivity in the stomach mucosal lining, specifically ulcerative lesions, pain is common after ingestion of foods due to the activation of HCl and pepsin produced during the digestive process. E. Occasional nausea and vomiting Occasional nausea and vomiting are triggered due to visceral pain fibers, which are connected to the autonomic nervous system, stimulating the vomiting reflex. F. Burning or gaseous pressure in high left epigastrium, and back and upper abdomen Referred pain results when visceral and somatic nerves converge at one spinal cord level, and the source of the visceral pain is then perceived as the same as that of the somatic nerve. Pernicious anemia is not a common manifestation of gastric ulcer, but is a manifestation of chronic gastritis. Early satiety is not a common manifestation of gastric ulcers but is common in gastroparesis and gastric cancer.

Which are clinical manifestations of hiatal hernias? (Select all that apply) A. Fever B. Belching C. Dysphagia D. Heartburn E. Iron deficiency anemia F. Persistent, sub-sternal chest pain

B. Belching Belching is common in patients with hiatal hernias due to trapped food and gas build-up in the "pouch." C. Dysphagia Inflammation of the esophagus and food collected in the pouch compresses the esophagus, making it difficult to swallow. D. Heartburn Heartburn is common due to reflux of gastric contents into the esophagus. F. Persistent, substernal chest pain Inflammation or distention of the pouch causes persistent, substernal chest pain common in hiatal hernia patients. Fever is a manifestation of acute gastritis when an infection is present. Iron deficiency anemia is a manifestation of gastric cancer.

Which gastric disorder primarily causes a breakdown in the mucosal barrier and normally occurs in the antrum of the stomach? A. Gastritis B. Gastric ulcer C. Hiatal hernia D. Gastric cancer

B. Gastric ulcer The gastric mucosal barrier is there to protect the stomach and can easily engage in self-regeneration. In gastric ulcers, this membrane is broken down, allowing for gastric acids and secretions to be diffused through the gastric wall. Gastritis is the result of inflammation of the gastric lining. Hiatal hernia does not occur in the antrum of the stomach, thus this would not be a description of this disorder. While gastric cancer can occur in the antrum, cancer involves DNA mutation and not primarily the breakdown of the mucosal barrier

Which are the primary causes of gastritis? A. Excess intra-abdominal pressure and trauma B. H. pylori, viral infections, allergies, spicy/irritating foods C. Mostly idiopathic but has been linked to diabetes and neurological disorders D. Diet high in preserved foods, blood type ad geographical location

B. H. pylori, viral infections, allergies, spicy/irritating foods Bacterial and viral infections, especially H. pylori infestation, as well as spicy foods, allergies, and nonsteroidal anti-inflammatory drugs are all causes of gastritis. Intra-abdominal pressure is often the result of obesity and pregnancy, and causes other gastric disorders and discomfort, not gastritis. Gastritis can be linked to many causes so it would not be considered idiopathic. Gastroparesis is linked to diabetes and neurological disorders. A diet high in preserved foods, blood type, and geographical location are all associated with gastric cancer, not gastritis.

Which manifestation of chronic gastritis is due to a lack of intrinsic factor for absorption, resulting in vitamin B12 depletion? A. Hematemesis B. Pernicious anemia C. Gastric mucosal atrophy D. Gnawing epigastric discomfort

B. Pernicious anemia Chronic gastritis results in a lack of intrinsic factor for absorption of vitamin B12 and, therefore, results in pernicious anemia. Hematemesis occurs in acute gastritis and involves gastric ulceration and bleeding, not a lack of intrinsic factor. Mucosal atrophy is found in chronic gastritis, which results in a loss of secretory glands, not reabsorption issues. Gnawing epigastric discomfort is caused by chronic mucosal and muscularis inflammation, not a lack of intrinsic factor.

Which type of hernia causes the junction of the stomach and esophagus to be above the diaphragm? A. Rolling B. Sliding C. Inguinal D. Paraesophageal

B. Sliding A sliding hernia causes the junction of the stomach and esophagus to be above the diaphragm. In a rolling hernia, the junction between the esophagus and stomach remains in normal position (below the diaphragm). An inguinal hernia does not pertain to the stomach or hiatal hernia. In a paraesophageal hernia, also known as a rolling hernia, the junction between the esophagus and stomach remains in a normal position (below the diaphragm).

Which gastric disorder can include the presence of Helicobacter pylori bacteria as well as fever and headache, along with anorexia, nausea, vomiting, and epigastric pain? A. Sliding hernia B. Rolling hernia C. Acute gastritis D. Gastroparesis

C. Acute gastritis Acute gastritis manifests with typical gastric symptoms such as nausea, vomiting, and anorexia, but also includes fever and headache when H. pylori is present. Fever and headache, as well as anorexia, nausea and vomiting, are not typical symptoms of hernias. Gastroparesis is not associated with H. pylori, fever, or headache; rather, it is associated with abdominal pain and bloating, and reflux.

Which gastric disorder causes the gastric mucosa to atrophy with loss of gastric secretions and parietal cells as a result of H. pylori infection? A. Acute gastritis B. Gastroparesis C. Chronic gastritis D. Sliding hiatal hernia

C. Chronic gastritis Chronic gastritis can erode and atrophy the gastric mucosa, resulting in a loss of parietal cells and gastric secretions from an H. pylori infection. Acute gastritis results in inflammation, redness, and edema, but does not involve secretory glands, atrophy, and achlorhydria from loss of parietal cells. Gastroparesis is slowed or absent motility of the stomach from vagas nerve damage, not from loss of parietal cells or an H. pylori infection. A sliding hiatal hernia does not involve pathophysiological changes in the gastric mucosa with loss of parietal cells or an H. pylori infection.

Which gastric disorder is described by slowed motility due to sluggish muscle movement from vagus nerve damage, which alters the passage of food through the digestive tract? A. Gastritis B. Gastric ulcer C. Gastroparesis D. Gastric cancer

C. Gastroparesis The pathophysiology of gastroparesis includes slow motility due to sluggish muscle movement in the stomach from vagus nerve damage. Gastritis is inflammation of the stomach lining. Gastric ulcer is a lesion in the stomach area. Gastric cancer develops from chronic gastritis, H. pylori, and other environmental factors that cause the mucus glands to mutate, resulting in adenocarcinoma

Which motility disorder is commonly seen in female patients or in patients with diabetes? A. Gastritis B. Gastric ulcer C. Gastroparesis D. Gastric cancer

C. Gastroparesis While the exact etiology of gastroparesis is still unknown, diabetes is considered the most common cause of the motility disorder, gastroparesis, and it affects more women than men. Gastritis affects both genders and has a higher incidences in children diagnosed with H. pylori. Gastric ulcers are not typical to diabetes and have been found to be diagnosed more commonly in men, whereas gastroparesis is diagnosed more in women. Gastric cancer is not limited to those patients with diabetes or women and can affect any patient with predisposing factors.

Which gastric disorder is the most common abnormality found on X-ray? A. Gastritis B. Gastric ulcer C. Hiatal hernia D. Gastroparesis

C. Hiatal hernia This protrusion of the stomach through the diaphragm and into the thoracic cavity is more common in women than men and is the most diagnosed abnormality found on abdominal X-rays. Gastritis is not the most common abnormality found on X-ray but often affects children with H. pylori. Gastric ulcers are typically diagnosed in men rather than women, and are not the most common abnormality found on X-rays. Gastroparesis is more common in women, but is not the most common disorder found on X-rays. It is found more often in patients with diabetes.

Which describes the association between pain and time since last meal ingested in gastric ulcer disease? A. A sense of fullness in the abdomen leads to anorexia, ultimately leading to pain. B. Nausea and vomiting are clinical manifestations that are seen in patients with gastric ulcers. C. Pain is often associated with indigestion that is typically seen one to two hours after eating a meal. D. Anorexia and indigestion cause referred pain in the abdomen after a patient has eaten certain foods.

C. Pain is often associated with indigestion that is typically seen one to two hours after eating a meal. Patients with gastric ulcers often experience pain one to two hours after eating due to indigestion caused by excessive HCl acid and pepsin production. Abdominal pain associated with gastric ulcers is not due to a sense of fullness leading to anorexia as this is typical of other gastric disorders, especially gastroparesis and gastric cancer. Nausea and vomiting may be seen in patients with gastric ulcers, but are not a contributing factor to abdominal pain, which is caused by HCl acid and pepsin production. Anorexia and indigestion are common manifestations of many gastric disorders, but do not necessarily cause referred pain after eating certain foods. Abdominal pain associated with gastric ulcers is specific to digestive enzyme production.

Which clinical manifestation is typical in chronic gastritis but is not seen in acute gastritis? A. Anorexia B. Vomiting C. Pernicious anemia D. Epigastric pain or discomfort

C. Pernicious anemia The lack of intrinsic factor for absorption of vitamin B12, which is essential in the synthesis of red blood cells, results in pernicious anemia in patients with chronic gastritis. Anorexia is found in both acute and chronic gastritis.. Vomiting is typical in acute gastritis. Epigastric pain is a manifestation found in both acute and chronic gastritis.

Which pathophysiological response is associated with hiatal hernia? A. Mutated mucus glands B. Erosion of mucus lining forming ulcer C. Sluggish gastric muscles causing slow motility D. Protrusion of the stomach though the diaphragm

D. Protrusion of the stomach through the diaphragm Hiatal hernia is associated with a protrusion of the stomach through the diaphragm. Gastric cancer is typically caused by mutated mucus glands. Gastric ulcers develop from erosion of the mucus lining. Gastroparesis is caused by sluggish gastric muscles causing slow motility.

Which description of gastroparesis is accurate? A. A portion of the stomach moves up into the chest cavity B. A pouch forms in the top part of the stomach, causing reflux C. The gastric cells are growing out of control and creating a mass in the layers of the stomach D. The nerve that normally controls muscle movement of the stomach is not allowing food to move through as it should

D. The nerve that normally controls muscle movement of the stomach is not allowing food to move through as it should. The vagus nerve is damaged in gastroparesis, causing food to move slowly through the digestive tract (slow motility) as stomach muscles are sluggish or have become "paralyzed." When the stomach protrudes up through the diaphragm, this is indicative of a hiatal hernia. A pouch is involved in the process of a hiatal hernia. When mucosal glands mutate, this is indicative of adenocarcinoma, not a paresis-type disorder.

Which clinical finding predisposes a patient to gastroparesis? A. There is a history of gastroparesis in the family B. The bacterium H. pylori is present in testing C. The patient has a previous diagnosis of chronic gastritis D. The patient has diabetes and a history of recent intestinal surgery

D. The patient has diabetes and a history of recent intestinal surgery. Patients who have diabetes, neurological disorders, and/or have had intestinal surgery are at a higher risk for developing gastroparesis. Gastroparesis has not been linked to genetic predisposition. H. pylori is a contributing factor in many gastric disorders, but gastroparesis has not been linked to this particular bacterium. Chronic gastritis has not been linked to the etiology of gastroparesis.