Chapter 32 Review

Mr. Simon Garfield recently was diagnosed with cancer of the GI tract. Cancer can develop in any of the gastrointestinal organs. Identify four of the primary causes or contributing factors in the development of GI system cancers.

Answers may include the following: • Cancer of the lip—pipe smoking • Cancer of the tongue or gums—chewing tobacco • Esophageal cancer—associated with chronic irritation caused by chronic esophagitis, alcohol abuse, or smoking • Gastric cancer—food preservatives, chronic use of nitrates, smoked foods; genetic association with chronic gastritis • Liver cancer—primary tumor caused by cirrhosis from viral hepatitis or chemical exposure • Pancreatic cancer—cigarette smoking • Colorectal cancer—genetic or familial link; diet high in fat, sugar, and red meat and low in fiber; usually occurs in patients over age 55

__________ is a malabsorption syndrome caused by an inherited defect in the patient's ability to metabolize gluten.

Celiac disease

Regional ileitis is also known as __________.

Chron's disease

A hard, impacted mass of feces in the colon is called a(n) __________.

Fecalith

__________ are varicose veins of the anus and rectum.

Hemorrhoids

Patients frequently call the physician's office because of GI system complaints. Based on what you have learned about asking specific questions about the patient's chief complaint, list three questions you would ask for the following signs and symptoms. a. Nausea and vomiting b. Diarrhea c. Constipation d. Abdominal pain

Nausea and vomiting—any questions relating to the following: Patient has pallor, diaphoresis, tachycardia Gastrointestinal irritation Pain or stress Inner ear disturbance Increased intracranial pressure Onset, frequency, duration of the problem Yellow or greenish color (indicates bile from the duodenum) Vomiting of undigested food (may be a sign of pyloric stenosis) Projectile vomiting (may indicate increased intracranial pressure) Vomitus that resembles coffee grounds (hematemesis) Diarrhea—any questions relating to the following: Infections or inflammation Allergies Malabsorption syndromes Onset, frequency, duration of the problem Dehydration (may occur if diarrhea is persistent; occurs more frequently in infants and older adults) Blood, mucus, or pus in the stool Steatorrhea (large, foul-smelling, greasy stools) Melena (tarry stools from bleeding higher in the digestive tract) Constipation—any questions relating to the following: Lack of dietary fiber Inadequate intake of fluids Lack of exercise Neurologic disorders (e.g., spinal cord injuries, multiple sclerosis) Side effect of medications (codeine, iron, antacids) Bowel obstructions or tumors Onset, frequency, duration of the problem Treatment and effectiveness of over-the-counter medications Diet and fluid intake Watery diarrhea (may indicate fecal impaction) Abdominal pain—any questions relating to the following: Ulcerative diseases Tumors Appendicitis Bowel obstruction Food poisoning Infections or inflammatory process Onset, frequency, duration Exact location (using either quadrants or abdominal regions) — Quality of the pain (e.g., burning, cramping, sharp, dull) — Severity of pain (scale of 1 to 10)

__________ is the wavelike, muscular movement of substances through the GI tract

Peristalsis

__________ occurs with an increased amount of pressure in the circulatory system.

Portal Hypertension

__________ is the medical term for a muscular ring at the distal end of the stomach that separates the stomach from the duodenum of the small intestine.

Pyloric sphincter

The gallbladder is located in the __________ of the abdomen.

RUQ (right upper quadrant)

The four abdominal quadrants and nine regions are used routinely to describe and document GI complaints, signs, and symptoms. List the four abdominal quadrants and name at least one organ located in each. Also name the nine regions.

The four abdominal quadrants and their organs are: RUQ—liver, gallbladder, duodenum LUQ—stomach, spleen, left lobe of liver, pancreas RLQ—cecum, appendix, right ovary and tube LLQ—descending colon, sigmoid colon, left ovary and tube The nine abdominal regions are: right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right inguinal, hypogastric, left inguinal.

You have learned a great deal about infectious viral hepatitis in this chapter. Explain the mode of transmission and typical signs and symptoms of the following types of viral hepatitis: a. HAV b. HBV c. HCV d. HDV

a. HAV—Transmission: Fecal-oral route (food or water contaminated by feces from infected person); contaminated raw shellfish; infected household members or sexual partners. S&S: Fatigue, weakness, anorexia; some patients have joint pain, hepatomegaly, lymphadenopathy, jaundice. b. HBV—Transmission: Blood and body fluids; placental transfer. S&S: General malaise, joint swelling, pruritic rash, hepatomegaly, anorexia, nausea, vomiting, dark yellowish brown urine, jaundice; may become chronic. c. HCV—Transmission: Blood and body fluids; most frequent type of posttransfusion hepatitis. S&S: Acute onset of fever, chills, malaise, nausea, vomiting; frequently becomes chronic. d. HDV—Transmission: Blood and body fluids; seen only in patients with hepatitis B. S&S: Similar to HBV; increases the severity of HBV disease.

Day care workers and clients, institutionalized residents, and individuals traveling to infected areas are considered high risk for which of the following? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. All of the above

a. Hepatitis A

For each of the following diagnostic procedures of the GI system, list at least three instructions that should be included in patient teaching on how to prepare for the procedure: a. UGI b. Barium enema c. Colonoscopy d. Fecal occult blood screening

a. UGI: Eat a low-fiber diet 2 to 3 days before the test; NPO after midnight; no smoking before the test; no medications after midnight unless approved by the physician; for test, remove all metal objects; patient will swallow a carbonated powder that creates carbon dioxide in the stomach, aiding visualization of the stomach mucosa; stool will be chalky and lightly colored for 24 to 72 hours after the test; cathartics are given after the examination to aid excretion of barium. b. Barium enema: No dairy products, follow liquid diet 24 hours before the test; take bowel preparation as supplied by radiology department; give enemas until clear in the morning; no breakfast; for test, air is insufflated into colon after instillation of barium to aid visualization of the colonic mucosa; mild laxative or enema is given after procedure to remove barium; stools will be light colored for 24 to 72 hours after test. c. Colonoscopy: Clear liquid diet for 48 hours before the test; laxatives; enemas until clear or 1 gallon of Colyte the day before; large intestine must be completely cleansed; vital signs are monitored before and during procedure; procedure is done with IV sedation in a hospital or outpatient clinic; may have presedation injection of Demerol and Versed; after test, must drink large amount of fluids to prevent dehydration from test preparation; patients with valvular heart disease should have prophylactic antibiotics. d. Fecal occult blood screening: No aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for 7 days before the test; no more than 250 mg of vitamin C per day; do not eat red meat, including processed meat or cold cuts; do not eat raw fruits and vegetables, especially melons, radishes, turnips, and horseradish, for 72 hours before the stool collections to prevent a false-positive result.

Peptic ulcers caused by H. pylori bacteria are treated with which of the following medications? a. Antibiotics and proton pump inhibitors b. NSAIDs c. Prednisone d. Antiemetics and antibiotics

a. antibiotics and proton pump inhibitors

The condition of having gallstones is called A. cholelithiasis. B. cholecystitis. C. cholecystogram. D. cholecystectomy.

a. cholelithiasis

All of the following are symptoms of Crohn's disease except a. diaphoresis. b. melena. c. diarrhea. d. Anorexia.

a. diaphoresis

Which of the following diseases is often asymptomatic and discovered during a routine x-ray? a. Gallstones b. Cirrhosis c. Hernia d. Diverticular disease

a. gallstones

Which of the following best describes a protrusion of the stomach through the esophageal opening? a. Hiatal hernia b. Sliding hiatal hernia c. Paraesophageal hiatal hernia d. None of the above

a. hiatal hernia

Which of the following is not a part of the colon? A. Ileum B. Cecum C. Splenic flexure D. Sigmoid

a. ileum

The most common site for pain associated with irritable bowel syndrome is a. left lower quadrant. b. right lower quadrant. c. left upper quadrant. d. right upper quadrant.

a. left lower quadrant

You are responsible for conducting patient education in preparation for a three-time stool collection for occult blood. What foods should the patient avoid? a. Red meat b. Dairy products c. Canned vegetables d. Caffeine

a. red meat

Seven days before an occult blood stool test, the patient should do which of the following? a. Stop taking aspirin and NSAIDs b. Not take any more than 250 mg of vitamin C a day c. Not eat red meat d. Not eat raw fruits and vegetables e. All of the above

a. stop taking aspirin and NSAIDs

The surgical joining together of two normally distinct organs, such as connecting the stomach to the ileum, is called a(n) __________.

anastomosis

The incubation period for Escherichia coli foodborne illness is typically a. 4-6 hours. b. 24-72 hours. c. 8-48 hours. d. 2-4 days. e. 12-36 hours.

b. 24-72 hours

A patient reporting abdominal pain points to the area of the stomach; what would you note in the chart to indicate this location? A. LLQ B. LUQ C. RLQ D. RUQ

b. LUQ

Colon cancer can be visualized during a(n) a. EGD. b. colonoscopy. c. barium enema. d. CT scan.

b. colonoscopy

Signs and symptoms of which of the following diseases include loose, semi-formed stool; melena if the ulcers break through blood vessels; pain or tenderness in the right lower quadrant; anorexia; weight loss; anemia; and fatigue? a. Ulcerative colitis b. Crohn's disease c. Appendicitis d. Irritable bowel syndrome

b. crohn's disease

The first part of the small intestine, where food enters from the stomach, is the A. cecum. B. duodenum. C. jejunum. D. ileum.

b. duodenum

To which specialist would a patient most likely be referred if a routine physical examination revealed an abnormality in the lower portion of the descending colon? A. Internist B. Gastroenterologist C. Oncologist D. Pathologist

b. gastroenterologist

Characteristics of which of the following include weight loss, jaundice, and is usually advanced when diagnosed? a. Liver cancer b. Pancreatic cancer c. Colorectal cancer d. Gastric cancer

b. pancreatic cancer

In digestion, which of the following is secreted in the stomach and begins the digestion of protein? a. Amylase b. Pepsinogen c. Intrinsic factor d. Bile

b. pepsinogen

The most common procedure or treatment for food poisoning is to A. induce vomiting. B. prevent dehydration. C. give an antidote. D. assess for damage of the intestinal lining.

b. prevent dehydration

Malabsorption problems are expected in patients after weight loss surgery because of which of the following? a. Patients stop eating nutritious food. b. The duodenum is bypassed, so nutrients are not completely broken down. c. Vitamin supplements cannot be absorbed. d. GERD develops.

b. the duodenum is bypassed, so nutrients are not completely broken down

The absorption of nutrients is the primary role of the a. stomach. b. villi. c. large intestine. d. duodenum.

b. villi

Pouches or tunnels in the large intestine that can trap seeds are called a. Crohn's disease. b. duodenal ulcers. c. diverticuli. d. diverticulitis.

c. diverticuli

Patients who have undergone bariatric surgery may have which of the following complications if they return to a diet high in simple sugars? a. GERD b. Diverticulitis c. Dumping syndrome d. Crohn's disease

c. dumping syndrome

Patients with diverticulosis are encouraged to avoid which of the following? a. A diet high in roughage b. Gluten products c. Foods with kernels or seeds d. A diet high in sugar or salt

c. foods with kernels or seeds

Sclerotherapy is the treatment of choice for which of the following disorders? a. Inguinal hernia b. Gangrenous areas of the intestine c. Hemorrhoids d. Cancer of the liver

c. hemorrhoids

The muscular action that moves food along the gastrointestinal tract is called A. ingestion. B. digestion. C. peristalsis. D. mastication.

c. peristalsis

If the result of occult blood screening is positive, the patient A. has a serious condition that demands immediate medical attention. B. has tested positive for cancer of the lower intestinal tract. C. should have further tests to determine the cause. D. has a large amount of blood leaving the body during elimination.

c. should have further tests to determine the cause

Which of the following is(are) categorized as proton pump inhibitors? a. Nexium b. Tagamet c. Prevacid d. A and C

d. A and C

Which of the following types of infectious hepatitis is(are) transferred via blood and body fluids? a. HAV b. HBV c. HEV d. A and C

d. A and C

Patients with which of the following must be monitored for possible chronic hepatitis and the development of a carrier state? a. Hepatitis B b. Hepatitis C c. Hepatitis D d. All of the above

d. all of the above

Diverticulitis, pancreatitis, and pyloric stenosis are disorders of which body system? A. Respiratory system B. Reproductive system C. Urinary system d. Digestive system

d. digestive system

Blood vessels that surround the villi of the small intestine carry absorbed materials through the portal circulation to which organ? a. Heart b. Kidneys c. Brain d. Liver

d. liver

Which anatomic structure is at the distal end of the gastric mucosa? a. Esophagus b. Cardiac sphincter c. Jejunum d. Pyloric sphincter

d. pyloric sphincter

Helicobacter pylori infection has been discovered to be a possible cause of A. cold sores. B. food poisoning. C. colitis. D. stomach ulcers.

d. stomach ulcers

Ulcerative colitis differs from Crohn's disease in what way? a. It cannot be cured by surgery. b. The disease typically recurs at the site of a previous ulcer. c. Scar tissue at the site may cause a bowel obstruction. d. Ulcers form on the surface of the colon, starting in the rectum and spreading proximally.

d. ulcers form on the surface of the colon, starting in the rectum spreading proximally

Constipation can be treated with a. a low-fiber diet. b. a bland diet. c. a BRAT diet. d. water

d. water

All age groups can be diagnosed with GERD; however, it is seen most frequently in adults and is associated with which of the following? a. Smoking b. Pregnancy c. Overweight d. Alcohol use e. All of the above

e. all of the above

A disease or condition that is specific to a particular geographic location is said to be __________ to that region.

endemic

A patient whose stool tests positive for occult blood will also complain of hematemesis.

false

A very serious type of infectious hepatitis for pregnant women is hepatitis G.

false

Ascites is associated with patients who have chronic kidney disease.

false

Crohn's disease can be cured surgically.

false

Diverticuli of the colon are considered precancerous.

false

Hepatitis can be caused only by infection.

false

Imodium is an antiemetic that may be prescribed for a patient with food poisoning.

false

OSHA requires employers to make the hepatitis B vaccine available to employees at a reduced price.

false

Polyps are caused by herniations of the lining of the colon and are associated with chronic constipation.

false

The hepatitis A virus is transmitted through contaminated blood and body fluids.

false

The hepatitis B vaccine is given in four doses 6 months apart.

false

The most frequently used position for patients undergoing a sigmoidoscopy procedure in the physician's office is the knee-chest position.

false

Ulcerative colitis causes localized ulcer formation in the colon.

false

Ulcerative colitis frequently is described as regional ileitis, because the ulcers typically are restricted to the ileum.

false

The acronym GERD stands for __________.

gastroesophegeal reflux disease

The medical term for enlargement of the liver is __________

hepatomegaly

Any disorder or enlargement of the lymph nodes is called __________.

lymphadenopathy

Congenital __________, which typically is seen in first-born male infants, causes a problem with narrowing at the distal end of the stomach.

pyloric stenosis

The appendix is located in the __________ region of the abdomen.

right inguinal

A patient who has anorexia has lost the appetite for food.

true

A possible complication of Crohn's disease is the development of fistulas between the original location of the ulcer and a nearby organ.

true

Acute appendicitis frequently is caused by an impacted fecalith.

true

Advanced cirrhosis of the liver can lead to portal hypertension.

true

Chronic viral hepatitis can occur with hepatitis B, C, and D

true

Cirrhosis of the liver may be caused by excessive fat deposits in liver tissue.

true

Cytoprotective medications help protect the tissues lining the stomach and small intestine and are used in the treatment of H. pylori infections of the GI system.

true

Dietary restrictions for the collection of an occult stool sample should be followed for 72 hours before the specimen is collected.

true

Endemic disease is widespread in a particular geographic area.

true

Hemorrhoids are the enlargement of veins either internally or externally in the rectal area.

true

Hepatitis carriers can be asymptomatic but infectious.

true

IBS is most frequently diagnosed in young women.

true

Individuals who work in day care settings are at greater risk of becoming infected with hepatitis A because of its route of transmission.

true

One of the signs of a suspected peptic ulcer is a drop in hemoglobin.

true

Patients who have had bariatric surgery need routine injections of vitamin B12.

true