Ch 42, Nursing Management: Upper Gastrointestinal Problems

4 (A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care. )

A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? 1 Chest pain relieved with eating or drinking water 2 Back pain three or four hours after eating a meal 3 Burning epigastric pain 90 minutes after breakfast 4 Rigid abdomen and vomiting following indigestion

1, 4, 5 (Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection; therefore, it should be avoided. NSAIDs should not be taken over a long period of time, because they are a potent gastric irritant. )

A nurse is teaching a patient about prevention of peptic ulcers. What instructions should the nurse give the patient? Select all that apply. 1 Avoid smoking. 2 Consume raw uncooked food. 3 Use nonsteroidal antiinflammatory drugs (NSAIDs) for treatment of pain. 4 Wash hands thoroughly with soap after using the restroom and before eating. 5 Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider

4 (Diffuse superficial mucosal injury or discrete deeper ulcers in the fundus and body portions of the stomach indicate stress-related mucosal disease (SRMD), which may occur as a complication of major trauma or burns. Gastric ulcers are characterized by burning or gaseous pain in the epigastric region. Duodenal ulcers are characterized by burning or cramplike pain in mid-epigastric region. Stomach cancer is characterized by early satiety, abdominal pain, and weight loss.)

A patient presents with severe abdominal burns. Diagnostic tests reveal a discrete, deep ulcer in the fundus of the stomach. The nurse expects that the patient will be diagnosed with what? 1 Gastric ulcer 2 Duodenal ulcer 3 Stomach cancer 4 Stress-related mucosal disease (SRMD)

2 (A tissue biopsy involves examining tissue removed from the stomach to detect gastric carcinoma. Radiology is not the best method because superficial mucosa is generally involved and changes will not show up clearly on x-ray examination. Rapid urease testing is used to detect the presence of urease in Helicobacter pylori infections. An endoscopic ultrasound is used to stage the disease of stomach cancer.)

A patient presents with suspected gastric carcinoma. The nurse anticipates that what diagnostic test will be prescribed? 1 Radiology 2 Tissue biopsy 3 Rapid urease testing 4 Endoscopic ultrasound

2 (Coffee ground vomitus indicates that blood has been in the stomach for some time, which is a manifestation of hematemesis (a type of upper gastrointestinal bleeding). Melena is characterized by black tarry stools caused by digestion of blood in the gastrointestinal (GI) tract. Occult bleeding requires a guaiac test for detection. A Mallory-Weiss tear indicates esophageal bleeding.)

A patient presents with upper gastrointestinal (GI) bleeding. During the patient's assessment, the nurse notes coffee ground vomitus. How should the nurse classify the finding? 1 Melena 2 Hematemesis 3 Occult bleeding 4 Mallory-Weis tear

2 (Weight loss, dumping syndrome, and impaired wound healing are all consequences of a total gastrectomy. Total gastrectomy involves the resection of the lower esophagus, removal of the entire stomach, and anastomosis of the esophagus to the jejunum. Pyloroplasty consists of surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach. Partial gastrectomy involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum or jejunum. Esophagojejunostomy is the anastomosis of the esophagus with the jejunum.)

A patient with stomach cancer presents with weight loss, dumping syndrome, and impaired wound healing. The nurse suspects that which surgical treatment may have caused the patient's symptoms? 1 Pyloroplasty 2 Total gastrectomy 3 Partial gastrectomy 4 Esophagojejunostomy

3 (Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Urinary retention, tinnitus, and a sensation of falling are not considered common adverse effects of promethazine. )

After administering a dose of promethazine, the nurse explains that which common temporary adverse effect may occur? 1 Urinary retention 2 Tinnitus 3 Drowsiness 4 Sensation of falling

1 (To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distension or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs. )

Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome? 1 Divide meals into six small feedings. 2 Take fluids along with meals. 3 Use concentrated sweets like honey, jam, and jelly. 4 Reduce protein and fats in the diet.

3 (Metoclopramide (Reglan) is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea. )

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted? 1 Decreased blood pressure 2 Absence of muscle tremors 3 Relief of nausea and vomiting 4 No further episodes of diarrhea

3 (H. pylori infection is highest in underdeveloped countries and in people of low socioeconomic status. Infection likely occurs during childhood with transmission from family members to the child, possibly through a fecal-oral or oral-oral route. Syphilis, cytomegalovirus, and Mycobacterium species also are causes of chronic gastritis, but are not as common as H. pylori. )

Linked to stomach cancer and non-Hodgkin's lymphoma, what is a common cause of gastritis? 1 Syphilis 2 Cytomegalovirus 3 Helicobacter pylori 4 Mycobacterium species

4 (Vomitus with a "coffee ground" appearance is related to gastric bleeding, in which blood changes to dark brown as a result of its interaction with hydrochloric acid. The primary health care provider needs to be notified immediately about this change in the patient's condition. Asking the patient about the timing of the last meal and monitoring the patient are appropriate, but not the priority. The nurse should not offer water just in case the patient may have to have a diagnostic study that requires nothing by mouth (NPO) status. )

The nurse is assisting a patient who has been admitted with severe abdominal pain. Suddenly, the patient vomits a large amount of emesis that looks similar to coffee grounds. Which action by the nurse is a priority? 1 Ask the patient about the timing of the last meal. 2 Offer the patient sips of water to prevent dehydration. 3 Monitor the patient for any further episodes of nausea and vomiting. 4 Notify the primary health care provider about the patient's condition.

3 (Tachycardia, lower abdomen pain, nausea, and vomiting are the clinical manifestations of perforation, a complication of peptic ulcer disease. A laparoscopy involves a simple closure with an omentum graft, which will repair the perforation with appropriate source control and limit the parietal cell acid secretion. Billroth I involves a partial gastrectomy where two-thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy involves severing the vagus nerve either totally or selectively. Pyloroplasty consists of surgical enlargement of the pyloric sphincter. )

The nurse is caring for a patient who presents with tachycardia, lower abdominal pain, and nausea and vomiting. Upon clinical examination, the primary health care provider identifies a rigid and board-like abdomen. Which surgical therapy is beneficial for the patient? 1 Billroth I 2 Vagotomy 3 Laparoscopy 4 Pyloroplasty

1, 4 (Patients with stomach cancer experience weight loss, dyspepsia, and intestinal gas discomfort. Asking the patient about blood transfusions in the past, whether the patient has illnesses like liver cirrhosis, and if the patient has a religious preference that prohibits the use of blood will help in the assessment of upper gastrointestinal bleeding and other conditions, but they are not specific to stomach cancer. )

The nurse is conducting a health interview for a patient with suspected stomach cancer. Which questions are relevant in determining the diagnosis? Select all that apply. 1 "Do you experience unexplained weight loss?" 2 "Have you received blood transfusions in the past?" 3 "Do you have other illnesses, such as liver cirrhosis?" 4 "Do you have dyspepsia or intestinal gas discomfort?" 5 "Do you have a religious preference that prohibits the use of blood?"

3 (The symptoms of duodenal ulcers occur when gastric acid comes in contact with the ulcers. With meal ingestion, food is present to help buffer the acid. Symptoms of duodenal ulcers occur generally two to five hours after a meal. The pain is described as "burning" or "cramplike." It most often is located in the midepigastric region beneath the xiphoid process. Duodenal ulcers also can produce back pain. The discomfort generally associated with gastric ulcers is located high in the epigastrium and occurs about one to two hours after meals. The pain is described as "burning" or "gaseous." If the ulcer has eroded through the gastric mucosa, food tends to aggravate rather than alleviate the pain. For some patients, the earliest symptoms are caused by a serious complication, such as perforation. Pain and burning two to five hours after meals are not symptoms of esophagitis or chronic gastritis. A patient with a gastric ulcer will experience pain one to two hours after meals. )

The nurse is obtaining a health history from a patient who comes to the office for evaluation of gastric distress. The patient indicates that the symptoms occur two to five hours after meals, and the pain is "burning" and sometimes like a cramp in the midepigastric region, just below the xiphoid process. Based on these descriptions, the nurse suspects that the patient has which disorder? 1 Esophagitis 2 Gastric ulcer 3 Duodenal ulcer 4 Chronic gastritis

4 (Rabeprazole is a proton pump inhibitor that provides relief of gastric discomfort and heartburn by neutralizing gastric acid. This medication would not be effective in the treatment of abdominal pain, flatulence, or constipation. )

The patient has a prescription for rabeprazole. The nurse would assess the effectiveness of the medication by noting whether the patient obtained relief from which symptom? 1 Abdominal pain 2 Flatulence 3 Constipation 4 Heartburn

2 (Ondansetron is an antiemetic. The nurse would inquire as to its effectiveness in reducing the patient's nausea. Ondansetron will not treat headaches, pain, or leg cramps. )

The patient history indicates the patient was taking ondansetron at home before admission. The nurse inquires as to the effectiveness of this medication in treating which symptom? 1 Headache 2 Nausea 3 Pain 4 Leg cramps

2 (Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of gastrointestinal discomfort, such as with heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain. )

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL orally. The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has resolved? 1 Diarrhea 2 Heartburn 3 Constipation 4 Lower abdominal pain

2 (Pantoprazole is a proton-pump inhibitor which decreases acid production in the stomach. It minimizes damage to the gastric mucosa while the patient is on bed rest and hospitalized after surgery. Pantoprazole will not prevent gas pains and will not prevent stomach bleeding from surgery. Heartburn is not a side effect of diabetes. )

The postoperative patient states that he or she has never taken pantoprozole in the past. The patient asks why he or she is getting this medication if the patient has never had heartburn. What is the best response by the nurse? 1 "The stress of surgery is likely to cause stomach bleeding if you do not receive it." 2 "This will reduce the amount of acid in your stomach until you can eat a regular diet again." 3 "This will prevent the heartburn that occurs as a side effect of your diabetes." 4 "This will prevent gas pains from the excess air in your small intestine."

2 (Alcohol increases the amount of stomach acid produced so it should be avoided. Milk may exacerbate PUD, so two to three glasses would not be recommended. There is no reason to puree or mince food, and a current diet is likely to be altered to minimize symptoms. )

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? 1 "You'll need to drink at least two to three glasses of milk daily." 2 "It would likely be beneficial for you to eliminate drinking alcohol." 3 "Many people find that a minced or pureed diet eases their symptoms of PUD." 4 "Your medications should allow you to maintain your present diet while minimizing symptoms."

1 (Lifestyle modifications to prevent the recurrence of gastritis include refraining from consuming alcohol and cigarette smoking. Alcohol directly irritates the gastric mucosa, and nicotine from cigarette smoke inhibits neutralization of gastric acid. A bland diet (reduced spices and seasonings) is recommended to prevent the recurrence of gastritis. Alcohol should be eliminated from the diet, not merely reduced. Advising the patient to take acetaminophen and ibuprofen (Motrin) is incorrect, because ibuprofen should not be taken by the gastritis patient. )

To prevent the recurrence of gastritis, what instruction should the nurse provide to the patient? 1 Stop smoking and do not consume alcoholic beverages. 2 Consume a soft diet with moderate spices and seasonings. 3 Stop smoking and consume alcoholic beverages in moderation. 4 Take acetaminophen and ibuprofen for pain

4 (A barium contrast study is used to diagnose gastric outlet obstruction in patients with peptic ulcer disease. An endoscopy is performed to determine the degree of ulcer healing after the treatment of ulcer. A urea breath test is a noninvasive method used to detect active infection. Rapid urease testing is used to check for a Helicobacter pylori infection. )

Which diagnostic test is best suited to diagnosing gastric outlet obstruction? 1 Endoscopy 2 Urea breath test 3 Rapid urease testing 4 Barium contrast study

2 (Urease activates the immune response with body antibody production and the release of inflammatory cytokines, resulting in mucosal edema. Pepsin is an enzyme released in the stomach that degrades food particles into peptides. Bile salts are released by liver cells, which bind with cholestyramine and cause gastric irritation. Serum amylase levels determine pancreatic function.)

Which enzyme activates the immune response with antibody production and the release of inflammatory cytokines? 1 Pepsin 2 Urease 3 Bile salts 4 Serum amylase

4 (Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety. Nizatidine is a histamine (H2)-receptor blocker that causes abdominal pain, headache, diarrhea, and constipation. Sucralfate is an antiulcer medication that causes constipation. Omeprazole is a proton pump inhibitor that causes nausea, abdominal pain, headache, diarrhea, and flatulence.)

Which medication for peptic ulcer disease causes hallucinations? 1 Nizatidine 2 Sucralfate 3 Omeprazole 4 Metoclopramide

3 (Prokinetic agents such as domperidone increase gastric motility and gastric emptying. Droperidol is a butyrophenone that blocks neurochemicals triggering nausea and vomiting. Scopolamine is an anticholinergic that blocks cholinergic pathways to the vomiting center, but does not increase gastric motility and emptying. Dexamethasone is a corticosteroid used in the management of acute and delayed chemotherapy-induced vomiting.)

Which medication increases gastric motility and gastric emptying? 1 Droperidol 2 Scopolamine 3 Domperidone 4 Dexamethasone

2 (Sucralfate provides cryoprotection for the esophagus, stomach, and duodenum by forming a protective layer and serves as a barrier against acids, bile salts, and enzymes. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease. Cimetidine is a histamine blocker that provides ulcer healing. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs.)

Which medication is prescribed for cryoprotective drug therapy? 1 Tofranil 2 Sucralfate 3 Cimetidine 4 Misoprostol

1, 2 (Aspirin and fluoxetine are ulcerogenic drugs that inhibit the synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. These medications increase the risk of ulcer development. Misoprostol, bethanechol, and metoclopramide are used in gastroesophageal reflux disease and peptic ulcer drug therapy.)

Which medications increase the risk of ulcer development? Select all that apply. 1 Aspirin 2 Fluoxetine 3 Misoprostol 4 Bethanechol 5 Metoclopramide

2 (Staphylococcus causes gastritis. H. pylori causes stomach cancer. Candida albicans causes oral candidiasis. Fusiform bacteria cause Vincent's infection )

Which microorganism causes gastritis? 1 Helicobacter pylori 2 Staphylococcus 3 Candida albicans 4 Fusiform bacteria

2 (An endoscopy with balloon dilations is used in the treatment of pyloric obstruction. A vagotomy is the severing of the vagus nerve either totally or selectively to decrease gastric acid secretion. A gastrojejunostomy involves a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the jejunum. Gastroduodenostomy is a partial gastrectomy with removal of two-thirds of the stomach and an anastomosis of the gastric stump to the duodenum.)

Which surgical therapy is used to treat pyloric obstruction? 1 Vagotomy 2 Endoscopy 3 Gastrojejunostomy 4 Gastroduodenostomy

2 (Perforation results in spillage of gastric or duodenal contents into the upper peritoneal cavity. The patient experiences sudden upper abdominal pain because the spillage causes irritation of pain receptors in the visceral and parietal layers of the peritoneum. The body then attempts to protect the area by contracting the abdominal muscles, resulting in a rigid, boardlike abdomen. Pyrosis, a painful and burning sensation in the esophagus, just below the breastbone, is usually associated with regurgitation of gastric acid, also known as heartburn. Bright-red emesis may be present as a result of hemorrhage from the gastric ulcer but is not as common as the rigid, boardlike abdomen. Clay-colored stools are associated with hepatic disease, such as hepatitis, not gastric ulcer perforation. )

A patient has what is suspected to be a gastric ulcer perforation. Which symptom does the nurse expect will be present? 1 Pyrosis 2 Rigid abdomen 3 Bright-red emesis 4 Clay-colored stools

4 (The immediate focus of management for a patient with a perforation is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. An NG tube is inserted into the stomach to provide continuous aspiration and gastric decompression to stop spillage through the perforation and thereby prevent peritonitis. Administering nitrates to such a patient will not be helpful in relieving the condition. Administration of pain medications and preparations for laparoscopic surgery are done later. )

A patient is admitted to the hospital with a severe duodenal ulcer. The patient suddenly complains of severe pain spreading over the entire abdomen, likely due to a perforation. What should be the most immediate intervention by the nurse, if prescribed? 1 Administer nitrates. 2 Administer pain medication. 3 Prepare for laparoscopic surgery. 4 Insert a nasogastric (NG) tube into the stomach.

3 (The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. Fecal vomitus would be experienced with a total bowel obstruction. Bilious vomitus or undigested food may be seen with various gastrointestinal disturbances, such as gallbladder disease, gastroenteritis, or gastritis. )

A patient with a peptic ulcer begins vomiting. The nurse would expect and be concerned with which type of vomitus? 1 Fecal 2 Bilious 3 "Coffee ground" 4 Undigested food

2 (Xerostomia is dryness of the mouth. Scopolamine is an anticholinergic (antimuscarinic) medication that causes xerostomia. Granisetron is a serotonin (5-HT3) antagonist that causes diarrhea. Perphenazine causes constipation, dry mouth, rashes, and sedative effects. Domperidone causes anxiety, hallucinations, tremors, and dyskinesias. )

Which antiemetic medication causes xerostomia as a side effect? 1 Granisetron 2 Scopolamine 3 Perphenazine 4 Domperidone

3 (Metoclopramide is classified as a cholinergic and antiemetic medication. If it is effective, the patient's nausea should resolve. Metoclopramide is not effective in the treatment of migraine, vertigo, or diarrhea. )

After administering a dose of metoclopramide to the patient, the nurse determines that the medication has not been effective when which symptom is noted? 1 Migraine headache 2 Vertigo 3 Vomiting 4 Diarrhea

4 (Nonsteroidal antiinflammatory drugs (NSAIDs) may disrupt the production of prostaglandins, which are required for the protection of the stomach's mucosal lining, and result in upper gastrointestinal bleeding. Antacids are used as an adjunct therapy for the treatment of peptic ulcers. Anticholinergic drugs are used occasionally to treat peptic ulcer disease. Tricyclic antidepressants are used to reduce gastric acid secretions associated with peptic ulcer disease.)

The nurse identifies that a patient is at risk for upper gastrointestinal bleeding based on the patient's history of taking medications in what drug class? 1 Antacids 2 Anticholinergics 3 Tricyclic antidepressants 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)

3 (Radiation therapy is concurrently used with chemotherapy to reduce recurrence and as a palliative measure to decrease tumor mass. This combination therapy provides temporary relief of obstruction. Endoscopic ultrasounds and computed tomography are used to stage the disease. Biopsies are used to perform a histologic examination. Peritoneal spread of cancer is determined by laparoscopy.)

The nurse identifies that radiation therapy is used concurrently with chemotherapy for cancer treatment for what reason? 1 To stage the disease 2 To examine histology 3 To reduce tumor mass 4 To determine peritoneal spread

2 (Dry toast or crackers may alleviate the feeling of nausea and prevent further vomiting. Water is the initial fluid of choice. Extremely hot (hot coffee) or cold liquids (iced tea) and fatty foods (hamburgers) generally are not well tolerated. )

The nurse is caring for a patient treated with intravenous (IV) fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, the nurse understands that which food choice would be most appropriate? 1 Iced tea 2 Dry toast 3 Hot coffee 4 Plain hamburger

2

The patient has a new prescription to receive omeprazole 20 mg daily. Available are 40 mg tablets. How many tablets should the nurse administer? 1 0.25 tablet 2 0.5 tablet 3 1.5 tablets 4 2 tablets

3 (30 mL)

The patient has a prescription for amoxicillin 750 mg by mouth. Available is 125 mg/5 mL. How many milliliters should the nurse administer? 1 0.3 mL 2 13 mL 3 30 mL 4 3 mL

3 (A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. A vagotomy is the severing of the vagus nerve totally or selectively. A pyloroplasty is the surgical enlargement of the pyloric sphincter in order to facilitate easy passage of contents from the stomach. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum)

What surgical procedure involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum? 1 Vagotomy 2 Pyloroplasty 3 Billroth I operation 4 Billroth II operation

1 (Small amounts of blood in gastric secretions and stools indicate occult blood, and the guaiac test is used to detect traces of blood in the feces. Liver enzyme studies are performed to detect any liver problems. A complete blood count (CBC) test is used to detect anemia, which is secondary to ulcer bleeding. Serum amylase determination helps to determine pancreatic function.)

Which laboratory test is beneficial for diagnosing the presence of a small amount of blood in gastric secretions and stools? 1 Guaiac test 2 Liver enzyme studies 3 Complete blood count (CBC) 4 Serum amylase determination

1 (Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that causes gastritis by decreasing prostaglandin in the lining of the stomach. Amoxicillin is used in the treatment of H. pylori infections. Lansoprazole and metronidazole are used in the treatment of gastritis.)

Which medication causes gastritis? 1 Aspirin 2 Amoxicillin 3 Lansoprazole 4 Metronidazole

3 (Cirrhosis and pancreatitis are the pathophysiologic conditions associated with duodenal ulcers. Shock, sepsis, and large hiatal hernia are conditions that cause gastritis.)

Which pathophysiologic condition is associated with duodenal ulcers? 1 Shock 2 Sepsis 3 Cirrhosis 4 Large hiatal hernia.