Chapter 18: Abdomen

31. Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe's lower quadrant feels empty and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe's symptoms? a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis e. Necrotizing enterocolitis

,ANS: A Intussusception refers to the prolapse of one segment of the intestine into another causing intestinal obstruction. Whereas a sausage-shaped mass may be palpated in the right or left upper quadrant the lower quadrant feels empty (positive Dance sign) it commonly occurs between 3 and 12 months of age. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

20. An examiner can recognize a friction rub in the liver by a sound that is: a. clicking gurgling and irregular. b. high pitched and associated with respirations. c. loud prolonged and gurgling. d. soft, low-pitched, and continuous. e. low pitched tinkling and unrelated to respirations.

,ANS: B An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

33. Given the high certainty that screening results in reduced mortality current recommendations include screening for colorectal cancer beginning at age 50 and continuing until age: a. 65. b. 70. c. 75. d. 80. e. 85.

,ANS: C In 2016 the U.S. Preventive Services Task Force (USPSTF) updated its previous recommendations based on a review of the evidence assessing both benefits and harms of screening. Given the high certainty that screening results in reduced mortality, the USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. Screening for colorectal cancer in adults ages 76 to 85 years should be an individual one, taking into account the patient's overall health and prior screening history. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

28. A 45-year-old man relates a several-week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination you review his laboratory work, anticipating a(n): a. elevated white blood cell count. b. decreased potassium level. c. positive Helicobacter pylori result. d. increased urine specific gravity. e. folate deficiency.

,ANS: C The patient's presenting symptoms suggest peptic ulcer disease. The supporting laboratory finding is the presence of H. pylori. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

32. In older adults overflow fecal incontinence is commonly caused by: a. malabsorption. b. parasitic diarrhea. c. Meckel diverticulum. d. fistula formation. e. fecal impaction.

,ANS: E Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

27. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most associated with: a. peptic ulcer disease. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture. e. diverticulitis.

,ANS: E No choice other than diverticulitis has all of these presenting symptoms. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

9. Mrs. G is 7 months' pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas such as: a. decreased movement through the colon and increased water absorption from stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and less nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool. e. increased absorption of nutrients and water in the colon.

ANS: A Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. The colon does not absorb nutrients, and a tighter sphincter tone is not related to pregnancy. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

19. Peritonitis often produces bowel sounds that are: a. decreased. b. increased. c. high pitched. d. absent. e. accentuated.

ANS: A Decreased bowel sounds occur with peritonitis and paralytic ileus. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

16. What condition is associated with striae that remain purplish? a. Cushing disease b. Diastasis recti c. Liver cirrhosis d. Recent pregnancy e. Intra-abdominal bleeding

ANS: A Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white striae associated with Cushing disease stay purplish. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

13. Which structure is located in the hypogastric region of the abdomen? a. Bladder b. Cecum c. Gallbladder d. Stomach e. Liver

ANS: A The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus. TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

6. The major function of the large intestine is: a. water absorption. b. food digestion. c. carbohydrate absorption. d. mucous absorption. e. glycogen breakdown.

ANS: A The major function of the large intestine is the absorption of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

11. The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it: a. only affects the GI tract. b. is one cause of malabsorption syndrome. c. is a curable condition with medical intervention. d. is the most frequent cause of diarrhea in general practice. e. is a common genetic disorder.

ANS: B Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent concerns. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

25. Failure to pass a meconium stool in the first 24 hours after birth along with abdominal distention is often the first sign of: a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios. e. Wilms tumor.

ANS: B Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

12. Infants born weighing less than 1500 g are at higher risk for: a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. cystic fibrosis. e. pancreatitis.

ANS: B Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants

17. Visible intestinal peristalsis may indicate: a. normal digestion. b. intestinal obstruction. c. increased pulse pressure of aorta. d. aortic aneurysm. e. paralytic ileus.

ANS: B Peristalsis is not usually visible and when detected may indicate an intestinal obstruction. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

3. The appendix is an extension of the: a. ileum. b. cecum. c. ascending colon. d. transverse colon. e. descending colon.

ANS: B The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum. TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

2. The superior most part of the stomach is the: a. body. b. fundus. c. pylorus. d. cardiac orifice. e. pyloric orifice.

ANS: B The most superior aspect of the stomach is the fundus, followed by the body, and then the most distal part, the pylorus. TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

5. The majority of nutrient absorption takes place in the: a. stomach. b. small intestine. c. cecum. d. transverse colon. e. descending colon.

ANS: B Very little absorption takes place in the stomach most absorption takes place in the small intestine. The cecum and transverse colon are part of the large intestine and its major function is water reabsorption. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

18. After thorough inspection of the abdomen the next assessment step is to: a. percuss. b. palpate nonpainful areas. c. auscultate. d. perform a rectal examination. e. palpate painful areas.

ANS: C Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation is done first. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

29. Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis. e. intussusception.

ANS: C Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary

7. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: a. spleen. b. kidney. c. liver. d. pancreas. e. gallbladder.

ANS: C The liver is responsible for converting fat-soluble waste to water-soluble materials so the kidneys can excrete them as well as convert ammonia to urea. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

4. One major function of the liver is to: a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile. e. produce insulin.

ANS: C The liver plays a metabolic role it converts glucose to glycogen stores it and then converts glycogen back to glucose as needed by the body. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

1. Peristalsis of intestinal contents is under the control of: a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach. e. cerebellum.

ANS: C The movement of food and digestive products is regulated by the autonomic nervous system. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

14. When examining a patient with tense abdominal musculature a helpful technique is to have the patient: a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow. e. fully extend the legs.

ANS: C To help relax the abdominal musculature it is helpful to place a small pillow under the patient's head and under slightly flexed knees. The other choices increase muscle flexion. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

24. An umbilical assessment in the newborn that is of concern is: a. a thick cord. b. an umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus. e. visible nondistended superficial veins.

ANS: C What is expected is two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally spontaneously close by 2 years, and pulsations to the abdomen in the epigastric area are common. Nondistended superficial veins are usually visible in thin infants. TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal

10. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: a. decreased hydrochloric acid production. b. increased motility. c. decreased bile absorption. d. decreased motility. e. increased saliva secretion.

ANS: D A decrease in motility of the gastrointestinal (GI) tract is the most pronounced GI change in older adults. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

15. You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti. e. incisional hernia.

ANS: D A diastasis recti occurs when abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and most often occurs in repeated pregnancies and obesity. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

21. To correctly document absent bowel sounds one must listen continuously for: a. 30 seconds. b. 1 minute. c. 3 minutes. d. 5 minutes. e. 10 minutes.

ANS: D Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

30. The most common congenital anomaly of the gastrointestinal tract is: a. biliary atresia. b. meconium ileus. c. intussusception. d. Meckel diverticulum. e. pyloric stenosis.

ANS: D Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal

23. Percussion of the abdomen begins with establishing: a. liver dullness. b. spleen dullness. c. gastric bubble tympany. d. overall dullness and tympany in all quadrants. e. bladder fullness.

ANS: D Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

26. A patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course? a. Positive psoas sign b. Positive McBurney sign c. History of periumbilical pain d. Rebound tenderness e. Obturator muscle test

ANS: E Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

8. Which abdominal organs also produce hormones and function as endocrine glands? a. Kidney and liver b. Liver and gallbladder c. Stomach and spleen d. Gallbladder and pancreas e. Pancreas and kidney

ANS: E The pancreas produces pancreatic juices as well as insulin and glucagon the kidneys produce urine as well as the hormones rennin and erythropoietin. TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

22. When auscultating the abdomen which finding would indicate collateral circulation between the portal and systemic venous systems? a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Borborygmi e. Venous hum

ANS: E Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, and a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds. TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

it involves infection and inflammation that causes destruction of the bowel

and it becomes more apparent after feedings. Low birth weight does not relate to the development of hepatitis A, urinary urgency, cystic fibrosis, or pancreatitis. TOP: Discipline: Biostatistics MSC: Organ System: Gastrointestinal