PATHO CH 36

Celiac sprue is a malabsorptive disorder associated with a. inflammatory reaction to gluten-containing foods. b. megacolon at regions of autonomic denervation. c. ulceration of the distal colon and rectum. d. deficient production of pancreatic enzymes.

ANS: A Celiac disease (also called celiac sprue) is characterized by intolerance of gluten, a protein in wheat and wheat products. Current research suggests that celiac sprue is an immune disorder. The main pathologic finding is villus atrophy, with a decrease in the activity and amount of surface epithelial enzymes. Celiac sprue is not associated with ulceration of the distal colon and rectum. Celiac disease is an intolerance of gluten.

A patient with chronic gastritis would likely be tested for a. Helicobacter pylori. b. occult blood. c. lymphocytes. d. herpes simplex

ANS: A It is now known that H. pylori causes chronic, superficial gastritis in virtually all infected persons. Once established in the gastric mucosa, H. pylori sets up a destructive pattern of persistent inflammation. The presence of bloody stools is not generally seen in chronic gastritis. Lymphocytes are not tested in the presence of chronic gastritis. Herpes simplex is not a manifestation of chronic gastritis

Premature infants are at greater risk for developing a. necrotizing enterocolitis. b. pseudomembranous colitis. c. appendicitis. d. diverticular disease

ANS: A Necrotizing enterocolitis (NEC) is a disorder occurring most often in premature infants (less than 34 weeks' gestation) and infants with low birth weight (less than 5 lbs or 2.25 kg). This disorder is characterized by diffuse or patchy intestinal necrosis accompanied by sepsis. Pseudomembranous colitis is an acute inflammation and necrosis of the large intestine caused by Clostridium difficile, usually affecting the mucosa but sometimes extending to other layers. The most common cause of emergency surgery on the abdomen, appendicitis is an inflammation of the vermiform appendix. The prevalence of diverticular disease increases with age.

Acute right lower quadrant pain associated with rebound tenderness and systemic signs of inflammation are indicative of a. appendicitis. b. peritonitis. c. cholecystitis. d. gastritis

ANS: A The earliest manifestation of appendicitis is generalized periumbilical pain accompanied by nausea and, occasionally, diarrhea. The pain is often described as "migrating" or localizing to the lower right abdomen (McBurney's point) because of distention of the serosa from inflammatory edema, at which time fever usually manifests. Acute localized pain with rebound tenderness is not associated with peritonitis. Cholecystitis is not manifested by lower quadrant pain. Gastritis is not associated with symptoms of right lower quadrant pain and systemic inflammation

Ulcerative colitis is commonly associated with a. bloody diarrhea. b. malabsorption of nutrients. c. fistula formation between loops of bowel. d. inflammation and scarring of the submucosal layer of the bowel.

ANS: A Ulcerative colitis (inflammation and ulceration of the colon and rectal mucosa) is manifested as bloody diarrhea and abdominal pain. Ulcerative colitis is not associated with malabsorption of nutrients. Fistula formation in the bowel is related to Crohn disease. Acute inflammation of the intestinal wall may manifest as pseudomembranous enterocolitis or necrotizing enterocolitis

A disorder of the esophageal smooth muscle function where dysphagia is a symptom is (Select all that apply.) a. esophageal stricture. b. achalasia. c. esophageal tumors. d. Mallory-Weiss syndrome. e. hiatal hernia.

ANS: A, B, C Esophageal stricture, achalasia, and esophageal tumors are all disorders of the esophageal smooth muscle function that cause dysphagia. Manifestations of Mallory-Weiss syndrome include vomiting of blood and passing of large amounts of blood rectally after an episode of forceful vomiting. Hiatal hernia is a defect of the diaphragm, not the esophagus, even though hiatal hernia is associated with dysphagia.

Crohn disease is associated with what complications? (Select all that apply.) a. Perianal fissures b. Fistulae c. Green stool d. Abscesses e. Rectal pain

ANS: A, B, D Complications such as perianal fissures, fistulae, and abscesses are common in Crohn disease and may be the symptoms that lead individuals to seek health care. The stool may be bloody, and thus would be red or black, not green. In Crohn disease, abdominal pain is often constant and in the right lower quadrant of the abdomen.

What is a pathophysiologic mechanism involved in the development of diarrhea? (Select all that apply.) a. Osmotic diarrhea b. Excessive flatus c. Secretory diarrhea d. Exudative diarrhea e. Motility disturbances

ANS: A, C, D, E Osmotic diarrhea is because of increased amounts of poorly absorbed solutes in the intestine. Secretory diarrhea is usually because of toxins that stimulate intestinal fluid secretion and impair absorption. Exudative diarrhea (mucus, blood, protein) results from inflammatory processes. A decreased transit time in the small intestine results in diarrhea because the absorptive capacity of the large intestine is exceeded. Excessive gas in the intestine is not a mechanism for developing diarrhea.

Barrett esophagus is a a. gastrin-secreting lesion. b. preneoplastic lesion. c. benign condition. d. gastrin-secreting tumor.

ANS: B Barrett esophagus is a complication of chronic GERD and represents columnar tissue replacing the normal squamous epithelium of the distal esophagus. It carries a significant risk for esophageal cancer. Patients with Barrett esophagus should undergo regular endoscopic screening for cancer, along with pharmacologic control of their reflux. Barrett esophagus carries a significant risk for esophageal cancer and does not secrete gastrin.

Fecal leukocyte screening would be indicated in a patient with suspected a. lactose intolerance. b. enterocolitis. c. laxative abuse. d. giardiasis.

ANS: B Enterocolitis is manifested by diarrhea (often bloody), abdominal pain, fever, leukocytosis, and rarely, colonic perforation. Lactose intolerance would not be a cause of leukocytosis. Leukocyte screening would not be a factor in laxative use or abuse. Suspected giardiasis would not be a reason to screen fecal leukocytes.

A patient who should be routinely evaluated for peptic ulcer disease is one who is a. taking six to eight tablets of acetaminophen per day. b. being treated with high-dose oral glucocorticoids. c. experiencing chronic diarrhea. d. routinely drinking alcoholic beverages.

ANS: B Glucocorticoids released in response to stress may have a role in the promotion of excess acid production or the destruction of gastric mucosal defenses. Therefore, a patient taking high-dose glucocorticoids would be at higher risk of developing peptic ulcer disease. Acetaminophen is not a risk factor for development of peptic ulcer disease. Chronic diarrhea is not a symptom of peptic ulcer disease. There is little evidence of a pathogenic role for alcohol, spicy foods, and caffeine in the development of peptic ulcer disease.

Which symptom suggests the presence of a hiatal hernia? a. Nausea b. Heartburn c. Diarrhea d. Abdominal cramps

ANS: B Individuals with hiatal hernia are predisposed to GERD and may experience symptoms such as heartburn, chest pain, and dysphagia. Nausea and abdominal cramps are not symptoms that suggest hiatal hernia. Hiatal hernia is not manifested by diarrhea.

A patient receiving chemotherapy may be at greater risk for development of a. gastroesophageal reflux. b. stomatitis. c. esophageal varices. d. Mallory-Weiss syndrome.

ANS: B TEST BANK FOR PATHOPHYSIOLOGY 6TH EDITION BY BANASIK NURSINGKING.COM NURSINGKING.COM Stomatitis is defined as an ulcerative inflammation of the oral mucosa that may extend to the buccal mucosa, lips, and palate. Among its many causes are pathogenic organisms, including bacteria and viruses; mechanical trauma; exposure to such irritants as alcohol, tobacco, and other chemical substances; certain medications, particularly chemotherapeutic agents. Gastroesophageal reflux disease is not related to chemotherapy. Patients taking chemotherapy are not at greater risk for developing esophageal varices. Chemotherapy is not a risk factor for Mallory-Weiss syndrome.

Esophageal varices represent a complication of ________ hypertension. a. primary b. pregnancy-induced c. portal d. secondary

ANS: C Esophageal varices represent a complication of portal hypertension, which in Western society is generally the result of cirrhosis as a result of alcoholism or viral hepatitis. Primary hypertension is not manifested by esophageal varices. Pregnancy-induced hypertension is unrelated to esophageal varices. Esophageal varices are not a complication of secondary hypertension.

An urgent surgical consult is indicated for the patient with acute abdominal pain and a. vomiting. b. CVA tenderness. c. absent bowel sounds. d. borborygmi.

ANS: C Functional bowel obstructions are characterized by the absence of bowel sounds. Uncorrected obstruction may lead to intestinal wall edema, ischemia, and necrosis. Vomiting with abdominal pain is not a cause for urgent surgical consult. CVA tenderness in the presence of abdominal pain is not an indicator for urgent surgical consult. Acute abdominal pain with hyperactive bowel sounds does not indicate the need for an urgent surgical consultation.

Epigastric pain that is relieved by food is suggestive of a. pancreatitis. b. cardiac angina. c. gastric ulcer. d. dysphagia

ANS: C Manifestations of peptic ulcer disease include epigastric burning pain that is usually relieved by the intake of food (especially dairy products) or antacids. Pancreatitis is not manifested by epigastric pain. Epigastric pain is not a symptom of cardiac angina. Dysphagia is not associated with epigastric pain relieved by food.

An early indicator of colon cancer is a. rectal pain. b. bloody diarrhea. c. a change in bowel habits. d. jaundice.

ANS: C The manifestations of colon cancer depend on the anatomic location and function of the bowel segment containing the tumor. Early manifestations may include a change in bowel habits. Later in the progression of tumor growth, a sensation of rectal fullness and a dull ache may be felt in the rectum or sacral region. Although no signs of obstruction are present, black, tarry stools, which signify bleeding into the intestinal lumen, are a significant finding. Jaundice is not an early indicator of colon cancer.

The most common cause of mechanical bowel obstruction is a. volvulus. b. intussusception. c. adhesions. d. fecal impaction

ANS: C The most frequent contributing factors for bowel obstructions are previous abdominal surgery with adhesions and congenital abnormalities of the bowel. Intestinal obstruction can be caused by volvulus. Intussusception can be related to bowel obstruction, but the most common cause is surgical adhesions. Mechanical bowel obstructions can be related to fecal impaction, but this is not the most common cause

. What clinical finding would suggest an esophageal cause of a client's report of dysphagia? a. Nasal regurgitation b. Airway obstruction with swallowing c. Chest pain during meals d. Coughing when swallowing

ANS: C Two types of pain occur in the esophagus: (1) heartburn (also called pyrosis) and (2) pain located in the middle of the chest, which may mimic the pain of angina pectoris. Heartburn is caused by the reflux of gastric contents into the esophagus and is a substernal burning sensation that may radiate to the neck or throat. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through their mouth and nose or aspirate when they attempt to swallow. Airway obstruction with swallowing would be an oropharyngeal cause of dysphagia. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through his or her mouth and nose or aspirate when he or she attempts to swallow.

What finding would rule out a diagnosis of irritable bowel syndrome in a patient with chronic diarrhea? a. Negative stool leukocytes b. Intermittent constipation c. Abdominal pain and distention d. Bloody stools

ANS: D Bloody stools are not a symptom of irritable bowel syndrome. A person with irritable bowel syndrome would have negative stool leukocytes. The manifestations of IBS may vary greatly, with some persons experiencing only diarrhea or constipation and others experiencing an alternating pattern of both. In addition to cramping abdominal pain, manifestations such as nausea and mucus in the stool may also be present.

What finding should prompt further diagnostic testing in a child presenting with diarrhea? a. Periumbilical discomfort b. Greenish, watery diarrhea c. Frequent, large-volume diarrhea d. Blood and mucus in the stools

ANS: D Both ulcerative colitis and Crohn disease have their onset most commonly in childhood and young adulthood, with obviously profound implications. Stools may contain blood or mucus. Periumbilical discomfort, watery diarrhea, and frequent, large-volume diarrhea are not causes for further diagnostic testing.

Dumping syndrome is commonly seen after __________ procedures. a. appendectomy b. intestinal biopsy c. colonoscopy d. gastric bypass

ANS: D Dumping syndrome is a term used to describe the literal dumping of stomach contents into the proximal portion of the small intestine because of impaired gastric emptying. Interestingly, dumping seems to occur only with Roux-en-Y gastric bypass procedures. Dumping syndrome is not related to procedures involving appendectomy. Intestinal biopsies do not produce a dumping effect. Colonoscopies are not related to dumping syndrome.

A silent abdomen 3 hours after bowel surgery most likely indicates a. peritonitis. b. mechanical bowel obstruction. c. perforated bowel. d. functional bowel obstruction

ANS: D Functional obstruction or ileus refers to the loss of propulsive ability by the bowel and may occur after abdominal surgery or in association with hypokalemia, peritonitis, severe trauma, spinal fractures, ureteral distention, and the administration of medications such as narcotics. Peritonitis may be associated with functional obstruction. Mechanical obstructions are because of adhesions, hernia, tumors, impacted feces, volvulus (twisting), or intussusception (telescoping). Perforated bowel is a rare condition sometimes associated with Crohn disease.

Proton pump inhibitors may be used in the management of peptic ulcer disease to a. increase gastric motility. b. inhibit secretion of pepsinogen. c. neutralize gastric acid. d. decrease hydrochloric acid (HCl) secretion

ANS: D Proton pump inhibitors are generally given to block acid secretion in individuals with peptic ulcer disease. The major treatment objectives for PUD are to encourage healing of the injured mucosa by reducing gastric acidity and to prevent recurrence. Proton pump inhibitors are not used to inhibit secretion of pepsinogen. Gastric acid is not neutralized by the use of proton pump inhibitors

Rupture of esophageal varices is a complication of cirrhosis with portal hypertension and carries a high ________ rate. a. cure b. morbidity c. insurance d. mortality

ANS: D Rupture of esophageal varices is a dreaded complication of cirrhosis with portal hypertension and carries a high mortality rate. Rupture of esophageal varices does not carry a high cure rate. Varices will affect more than half of cirrhotic patients, and approximately 30% of them experience an episode of variceal hemorrhage within 2 years of the diagnosis of varices. Insurance is not a factor in the rupture of esophageal varices.

Constipation in an elderly patient can be best treated by a. maintaining a low-fiber diet. b. maintaining the current level of activity. c. fecal disimpaction. d. increasing fiber in the diet.

ANS: D The presence of cellulose, the carbohydrate component of dietary fiber that is indigestible in the human intestine, may be effective in promoting regular peristaltic movement in the GI tract by forming bulk within the intestinal lumen to stimulate propulsion. Dietary factors, particularly a diet low in fiber, have been shown to contribute to constipation. In elderly persons, the slowed rate of peristalsis that occurs with the aging process, coupled with a decreased level of physical activity, may promote chronic constipation. These factors may eventually contribute to the development of fecal impaction, a condition in which a firm, immovable mass of stool becomes stationary in the lower GI tract