GIT-1

A 45-year-old woman comes to the physician because of progressive difficulty swallowing solids and liquids over the past 4 months. She has lost 4 kg (9 lb) during this period. There is no history of serious illness. She emigrated to the US from Panama 7 years ago. She does not smoke cigarettes or drink alcohol. Cardiopulmonary examination shows a systolic murmur and an S3 gallop. A barium radiograph of the chest is shown. Endoscopic biopsy of the distal esophagus is most likely to show which of the following?

Absence of myenteric plexus neurons

A 25-year-old woman comes to the physician for routine follow-up evaluation. She has a history of poorly-controlledasthma, for which she uses albuterol and fluticasone inhalers. Her mother died at 66 years of complications from emphysema. Laboratory analysis shows decreased levels of a protease inhibitor that inhibits elastin degradation. Which of the labeled abdominal organs is most likely to be involved in the pathogenesis of this patient's condition?

B on the diagram

A 56-year-old woman comes to the physician because of a 2-year-history of intermittent upper abdominal pain that occurs a few hours after meals and occasionally wakes her up in the middle of the night. She reports that the pain is relieved with food intake. Physical examination shows no abnormalities. Endoscopy shows a 0.5 x 0.5 cm ulcer on the posterior wall of the duodenal bulb. A biopsy specimen obtained from the edge of the ulcer shows hyperplasia of submucosal glandular structures. Hyperplasia of these cells most likely results in an increase of which of the following?

Bicarbonate secretion

A 49-year-old man with alcohol use disorder is brought to the emergency department immediately after two episodes of coffee-ground emesis. His pulse is 116/min and blood pressure is 92/54 mm Hg. Physical examination shows a distended abdomen with shifting dullness. Skin examination shows jaundice, erythematous palms, and dilated veins in the anterior abdominal wall. After fluid resuscitation, he is given a drug that decreases portal venous pressure. The drug works by inhibiting the secretion of splanchnic vasodilatory hormones as well as blocking glucagon and insulin release. This drug is a synthetic analog of a substance normally produced in which of the following cells?

D cells

During a study on gastrointestinal hormones, a volunteer is administered the hormone secreted by S cells. Which of the following changes most likely represent the effect of this hormone on gastric and duodenal secretions?

D on the diagram

An investigator is studying the secretion of gastrointestinal hormones before and after food intake. She isolates a hormone that accelerates the emptying of gastric contents into the duodenal bulb. The isolated hormone is most likely which of the following?

Gastrin

An investigator is studying obesity in mice. Over the course of 2 weeks, mice in the experimental group receive a daily injection with a synthetic analog of an endogenous hormone. Compared to the control group, the hormone-injectedmice eat more and gain significantly more weight. Which of the following is the most likely explanation for the observed weight gain in the experimental group?

Ghrelin stimulation of the lateral hypothalamus

A 43-year-old man is brought to the emergency department 30 minutes after falling from the roof of a construction site. He reports abdominal and right-sided flank pain. His temperature is 37.1°C (98.8°F), pulse is 114/min, and blood pressure is 100/68 mm Hg. Physical examination shows numerous ecchymoses over the trunk and flanks and a tender right abdomen without a palpable mass. Focused assessment with sonography for trauma (FAST) shows no intraperitoneal fluid collections. His hemoglobin concentration is 7.6 g/dL. The most likely cause of his presentation is injury to which of the following organs?

Kidney

A 45-year-old man is brought to the emergency department because of severe abdominal pain for the past 2 hours. He has a 2-year history of burning epigastric pain that gets worse with meals. His pulse is 120/min, respirations are 22/min, and blood pressure is 60/40 mm Hg. Despite appropriate lifesaving measures, he dies. At autopsy, examination shows erosion of the right gastric artery. Perforation of an ulcer in which of the following locations most likely caused this patient's findings?

Lesser curvature of the stomach

A 62-year-old man with metastatic colon cancer comes to the emergency department because of a 2-week history of severe watery diarrhea, abdominal cramps, and lightheadedness. He is currently undergoing polychemotherapy and his symptoms began shortly after completion of his second treatment cycle. The physician starts treatment with a medication that inhibits gastrointestinal motility and causes splanchnic artery vasoconstriction. Which of the following medications was most likely administered?

Octreotide

A previously healthy 47-year-old woman comes to the emergency department because of a 2-week history of fatigue, abdominal distention, and vomiting. She drinks 6 beers daily. Physical examination shows pallor and scleral icterus. A fluid wave and shifting dullness are present on abdominal examination. The intravascular pressure in which of the following vessels is most likely to be increased?

Short gastric vein

A 54-year-old woman comes to the emergency department because of recurrent episodes of fatigue, nausea, palpitations, and diaphoresis for the past 2 months. Her symptoms usually improve after drinking juice but during the past week, she has also been having symptoms approximately 2 hours after meals. She has no history of serious illness and takes no medication. Abdominal examination shows no abnormalities. Her fasting serum glucose concentration is 46 mg/dL; both serum insulin concentration and serum C-peptide concentrations are increased. A contrast-enhancedCT scan of the abdomen shows a 2-cm, well-demarcated lesion in the pancreatic tail. The patient is scheduled to undergo laparoscopic tumor resection. Which of the following arteries is at greatest risk for injury during the procedure?

Splenic

A 78-year-old man comes to the emergency department because of a 4-hour history of abdominal pain. Abdominal examination shows guarding with diffuse rebound tenderness. A CT scan of the abdomen shows an infrarenal abdominal aortic aneurysm that extends up to the level of the L4 vertebra and a partial filling defect in the anterior wall of the aneurysm. Which of the following bowel regions is at greatest risk for requiring resection?

Splenic flexure, descending colon, and sigmoid colon

Two days after undergoing abdominal surgery for lysis of adhesions, a 52-year-old man has nausea and one episode of bilious vomiting. The patient's nausea is somewhat alleviated in the prone position. The patient has had a 70-kg (154-lb) weight loss since undergoing bariatric surgery 1 year ago. Physical examination shows abdominal distention. Sudden movement of the patient elicits a sloshing sound on auscultation of the abdomen. An upper gastrointestinal series of the abdomen with oral contrast shows no passage of contrast past the third segment of the duodenum. The obstruction in this patient is most likely caused by which of the following structures?

Superior mesenteric artery

A 32-year-old man with Crohn disease is admitted to the hospital to undergo intestinal resection. Microscopic examination of a cross-sectional microtome slice of a resected intestinal segment shows squamous mesothelial cells surrounding the entire slice. The microtome slice was most likely obtained from which of the following parts of the intestine?

Transverse colon