Chapter 45 Disorders of GI Function LU

The pain associated with ________ is caused by stretching of the appendix during the early inflammatory process.

Appendicitis

What is a potential complication related to the development of Crohn's disease?

B. Fistula formation. (Complications include fistula formation, abdominal abscess formation, and intestinal obstruction, symptoms can be diarrhea and weight loss).

Diarrhea is described as a change in frequency of stool passage to where it is excessively frequent. Diarrhea can be acute or chronic and inflammatory or noninflammatory. What are symptoms of noninflammatory diarrhea? Mark all that apply.

B. Nonbloody stools C. Periumbilical cramps D. Nausea and/or vomiting.

Laboratory findings of hypochromic anemia and occult blood in the stools indicate ________.

Bleeding Ulcers

Infants and children commonly have GERD. Often it is asymptomatic and resolved on its own. What are the signs and symptoms of GERD in infants with severe disease?

C. Tilting of the head to one side and arching of the back.

_______ of the colon is one of the feared complications of ulcerative colitis.

Cancer

Gastric ______ is the second most common tumor in the world.

Carcinoma

Upper esophagus ends in a blind pouch.

Esophageal Atresia

The stomach lining is usually _______ to the acid it secretes, a property that allows the stomach to contain acid and pepsin without having its walls digested.

Impermeable

Ulcer crater erodes into adjacent organs.

Perforation

The _______ are believed to exert their effect through improved mucosal blood flow, decreased acid secretion, increased bicarbonate ion secretion, and enhanced mucus production.

Prostaglandins

Describe the progressions and remission of peptic ulcers.

A peptic ulcer can affect one or all layers of the stomach or duodenum. The ulcer may penetrate only the mucosal surface, or it may extend into the smooth muscle layers. Occasionally, an ulcer penetrates the outer wall of the stomach or duodenum. Spontaneous remissions and exacerbations are common. Healing of the muscularis layer involves replacement with scar tissue. Although the mucosal layers that cover the scarred muscle layer regenerate,the regeneration is often less than perfect, which contributes to repeated episodes of ulceration.

What is the most relevant risk factor for the development of peptic ulcer disease?

A. Untreated Helicobacter pylori infection.

Infection by Entamoeba Histolytica.

Abebiasis

Crohn disease is a recurrent inflammatory disease that can affect any are of the bowel. The characteristic of this disease is granulomatous lesions that are sharply demarcated from the surrounding tissue. As the nurse caring for a patin with newly diagnosed Crohn's disease, you would know to include what in your teaching?

...

What is the most common cause of paralytic ileus?

A. Abdominal surgery (Also accompanies inflammatory conditions of the abdomen, intestinal ischemia, pelvic fractures, and back injuries).(Obstruction of the intestine due to paralysis of the intestinal muscles).

A patient with IBS should have which of the following meals to decrease symptoms?

A. Bran muffins, fruits, and orange juice. (need adequate fiber intake, and avoid offending dietary substances such as fatty and gas producing foods).

Esophageal atresia is the most common congenital anomaly of the esophagus and is incompatible with life. The majority of children born with EA also have tracheoesophageal fistulae. What are the signs and symptoms of EA in a newborn?

A. Cyanosis and respiratory distress.

Steatorrhea is the result of the malabsorption of which dietary component?

A. Fat

The stomach secretes acid to begin the digestive process on the food that we eat. The gastric mucosal barrier works to prevent acids secreted by the stomach from actually damaging the wall of the stomach. What are the factors that make up the gastric mucosal barrier? Mark all that apply.

A. Impermeable epithelia cell surface covering. C. Characteristics of gastric mucus. E. Mechanisms for selective transport of hydrogen and bicarbonate ions.

Which conditions present with chronic diarrhea? Select all that apply.

A. Lactase deficiency C. Crohn's disease D. Fecal impaction E. Ulcerative colitis

Diverticulitis is the herniation of tissue of the large intestine through the muscular is layer of the colon. IT is often asymptomatic and is found in approximately 80% of people older than 85 years. Diverticulitis is often asymptomatic, but when symptoms do occur, what is the patients most common complaint?

A. Lower left quadrant pain with nausea and vomiting.

When comparing the symptomology of Crohn's disease with that of Ulcerative colitis, which are generally characteristic of only Crohn's disease? Select all that apply.

A. Perianal abscesses B. Fistulas (abnormal connection between an organ, vessel, etc to another structure) D. Strictures (narrowing of a body passage)

A patient in a nursing home complains to her nurse that she is not feeling well. When asked to describe how she feels, the patient states that she really is not hungry anymore and seems to have indigestion a lot. The nurse checks the patients chart and finds that her vital signs are normal but that she has lost weight over the past 2 moths. She also notes that there is a history of gastric cancer in the patients family. The nurse notifies the physician and expects to receive what orders? Mark all that apply.

A. Schedule a barium x-ray and an endoscopy. C. Order cytologic studies to be done during the endoscopy.

A 39 year old caucasian woman presents at the clinic with complaints of epigastric pain that is cramplike, rhythmic, and just below the xiphoid. She states that it wakes her up around 1 am and that she is not sleeping well because of it. She further states that this is her third paindul episode in the past year. The nurse suspects the patient has a peptic ulcer and expects to receive what orders from the physician?

A. Schedule patient for a compete metabolic panel and a complete blood count.

What is hypothesized to be a cause of inflammatory bowel disease (ulcerative colitis and Crohn's disease)?

According to the urgently accepted hypothesis, this normal state of homeostasis is disrupted in inflammatory bowel disease, leasing to unregulated and exaggerated immune responses against bacteria in the normal intestinal flora of genetically susceptible individuals. Thus, as in many other autoimmune disorders, the pathogenesis of Chrone's disease and ulcerative colitis involves a failure of immune regulation, a genetic predisposition, and an environmental trigger, especially microbial flora.

Difficulty passing food into the stomach.

Achalasia

_______ is most commonly associated with local irritants such as aspirin or other nonsteroidal anti-inflammatory agents, alcohol, or bacterial toxins.

Acute Gastritis

Benign neoplasms that arise from the mucosal epithelium of the intestine.

Adenomatous polyps

Autoimmune gastritis results from the presence of _________ to components of gastric gland parietal cells and intrinsic factor.

Autoantibodies

Taking into consideration all risk factors for colorectal cancer, which of the following patients would have the highest risk for developing the condition?

B. A 64 yr old female whose mother had colorectal cancer. (Patients older than 50 and with a family history are at greatest risk, taking 4-6 aspirins per week has been shown to decrease the risk, and peptic ulcers and IBS have not been found to be related.)

Irritable bowel syndrome is believed to be present in 10-15% of the population in the US. What is its hallmark symptom?

B. Abdominal pain relieved by defecation with a change inconsistency or frequency of stools.

A patient who is diagnosed with inflammatory diarrhea is having multiple small stools that are bloody and has a fever. Which of the following bacteria is most likely associated with the symptoms of inflammatory diarrhea?

B. C. Difficile (bacterium most likely associated with inflammatory diarrhea is C. Diff and E. Coli).

A patient diagnosed with Zollinger-Ellison syndrome would exhibit which of the following symptoms?

B. Diarrhea with fatty deposits. (ZE syndrome causes patients to have diarrhea from hypersecretion or from the inactivation of intestinal lipase and impaired fat digestion, these result in steatorrhea).

Hiatal hernias can cause severe pain if the hernia is large. Gastroesophageal relax is a common comorbidity of hiatal hernia, and when this occurs, what might the hernia do?

B. Retard esophageal acid clearance.

A patient suspected of having strangulation of the bowel with complete obstruction would require which of the following treatments to most effectively prevent complications?

B. Surgical procedure to release bowel. (NG tube to decompress the bowel may assist with comfort but will not resolve the strangulation).

Peritonitis is an inflammatory condition of the lining of the abdominal cavity. What is one of the most important signs of peritonitis?

B. Translocation of extracellular fluid into the peritoneal cavity.

Which disorders are grouped under the term inflammatory bowel disease? Select all that apply.

B. Ulcerative colitis C. Crohn's disease (Crohn's disease affects any part of the GI tract, Ulcerative colitis affects the colon and rectum).

The complications of _________ result from massive fluid loss or destruction of intestinal mucosa.

Bacterial Enterocolitis

Squamous mucosa that lines the esophagus gradually is replaced by columnar epithelium.

Barrett Esophagus

There is considerable evidence linking gastroesophageal reflux with _______.

Bronchial Asthma

Which symptom is often observed in cases of peritonitis?

C. Abdominal rigidity. (Abdomen is rigid and becomes board like because of reflex muscle guarding, typically becomes tachycardiac, has an increased WBC count, and breathes shallow).

Celiac disease commonly presents in infancy as failure to thrive. It is an inappropriate T-cell mediated immune response, and there is no cure for it. What is the treatment of choice for celiac disease?

C. Removal of gluten from the diet.

How does diet expose a patient to colon cancer?

Cause of colon cancer is unknown, but attention has focused on dietary fat intake, refined sugar intake, fiber intake, and adequacy of such protective micronutrients as vitamins A, C, and E in the diet. IT has been hypothesized that a high level of fat in the diet increased the synthesis of bile acids in the liver, which may be converted to potential carcinogens by the bacterial flora in the colon. Bacterial organisms in particular are suspected of converting bile acids to carcinogens, their proliferation is enhanced by a high dietary level of refined sugars. Dietary fiber is believed to increase stool bulk, and thereby dilute and remove potential carcinogens. Refined diets often contain reduced amounts of vitamins A, C, and E, which may act as oxygen free radical scavengers.

Intestinal obstruction designates an impairment of movement of intestinal contents in a __________ direction.

Cephalocaudal

________ diarrhea is often associated with condition such as inflammatory bowel disease, irritable bowel syndrome, malabsoprtion syndrome, endocrine disorders, or radiation colitis.

Chronic Diarrhea

_____ is denoted by the absence of grossly visible erosions and the presence of chronic inflammatory changes leading eventually to atrophy of the glandular epithelium of the stomach.

Chronic Gastritis

What is the relationship between Helicobacter pylori infection and the development of stomach cancer?

Chronic infection with Helicobacter pylori appears to serve as a cofactor in some types of gastric carcinomas. The bacterial infection causes gastritis, followed by atrophy, intestinal metaplasia, and carcinoma. The sequence of cellular events depends on both the presence of the bacterial proteins and the host immune response, the later being influenced by the host genetic background. However, the vast majority of people with H. pylori will not develop gastric cancer, and not all H. pylori infection increase the risk of gastric cancer, suggesting that other factors must be involved.

Hallmark symptom of Crohn's Disease.

Cobblestone appearance

Ulcerative colitis is confined to the __________ and the _________.

Colon and Rectum

________ provides a means for direct visualization of the rectum and colon.

Colonoscopy

______ abnormalities of the esophagus require early detection and correction because they are incompatible with life.

Congenital

______ can be defined as the infrequent and/or difficult passage of stools.

Constipation

________ disease is a recurrent, granulomatous type of inflammatory response that can affect any area of the gastrointestinal tract.

Crohn's Disease

The term inflammatory bowel disease is used to designate two related inflammatory intestinal disorders: ___________ disease and _________.

Crohn's Disease and Ulcerative Colitis

A patient diagnosed with acute gastritis is most likely to have a history of which of the following?

D. Arthritis treated with high levels of non steroidal anti-inflammatory agents. (acute gastritis is most often associated with local irritants and NSAIDs, alcohol, or bacterial toxins.)

One of the accepted method of screening for colorectal cancer is testing for occult blood in the stool. Because it is possible to get a false-positive result on these tests, you would instruct the patient to do what?

D. Avoid non steroidal anti-inflammatory drugs for 1 week prior to testing.

Helicobacter pylori gastritis has a prevalence in more that 50% of American adults older than 50 years and is believed to be caused by a previous infection when the patient was younger. What can chronic gastritis caused by H. pylorus cause?

D. Gastric atrophy

What is the normal symptom in the early stages of appendicitis?

D. Vague pain that is referred to the epigastric or periumbilical area. (Early stages 2-12 hrs, abdominal pain is vague, and the patient experiences nausea, in later stage pain becomes localized to the lower right quadrant and becomes more severe).

Rotavirus is a common infection in children younger than 5 years. Like other diseases, rotavirus is most severe in children younger than 24 months. What is a symptom of rotavirus infection?

D. Vomiting that disappears around the second day.

The usual definition of _________ is excessively frequent passage of stools.

Diarrhea

_______ is a complication of diverticulosis in which there is inflammation and gross or microscopic perforation of the diverticulum.

Diverticulitis

______ is a condition in which the mucosal layer of the colon herniated through the muscular is layer.

Diverticulosis

Difficulty in swallowing.

Dysphagia

_______ can result from disorders that produce narrowing of the esophagus, lack of salivary secretion, weakness of the muscular structures that propel food bolus, or neural networks coordinating the swallowing mechanism.

Dysphagia

The ________ functions primarily as a conduit for passage of food and liquid from the pharynx to the stomach.

Esophagus

______ is the retention of hardened or puttylike stool in the rectum and colon, which interferes with normal passage of feces.

Fecal Impaction

Tubelike passages that form connections between different sites in the gastrointestinal tract.

Fistulas

What is gastroesophageal reflux disease? What is the mechanism of damage?

GERD is believed to be associated with a weak or incompetent lower esophageal sphincter that allows reflux to occur, the irritant effects of the refluxate, and decreased clearance of the refluxed acid from the esophagus after it has occurred. In most cases, reflux occurs during transient relaxation of the esophagus. Gastric distention and meals high in fat increase the frequency of relaxation. Delayed gastric emptying may also contribute to reflux by increasing gastric volume and pressure with greater chance for reflux. Esophageal mucosal injury is related to the destructive nature of the refluxate and the amount of time it is in contact with mucosa. Acidic gastric fluids (pH <4) are particularly damaging.

______ refers to inflammation of the gastric mucosa.

Gastritis

Backward movement of gastric contents into the esophagus.

Gastroesophageal Reflux

The most frequent symptom of ______ is heartburn.

Gastrosophageal Reflux Disease

Celiac disease is an immune-mediated disorder triggered by ingestion of ________ containing grains.

Gluten

Most common cause of chronic gastritis in the United States.

Helicopter pylori

The most common complications of peptic ulcer are _________, perforation and penetration, and gastric outlet ________.

Hemorrhage and Obstruction

_______ is characterized by protrusion of he stomach through the esophageal hiatus of the diaphragm.

Hiatal Hernia

_______ is the major physiologic mediator for hydrochloric acid secretion.

Histamine

Presence of an excess of gastrin in the blood.

Hypergastrinemia

What is the mechanism of diverticulosis formation?

In a matter similar to the small intestine, bands of circular muscle constrict the large intestine. As the circular muscle contracts at each of these points (approximately every 2.5cm), the lumen of the bowel becomes constricted, so that it is almost occluded. The combined contraction of the circular muscle and the lack of a continuous longitudinal muscle layer cause the intestine to bulge outward into pouches called haustra. Diverticula develop between the longitudinal muscle bands of the haustra, in the area where the blood vessels pierce the circular muscle layer to bring blood back to the mucosal layer. An increase in the intraluminal pressure in the haustra provides the force for creating these herniations. The increase in pressure is believed to be related to the volume of the colonic contents. The scantier the contents, the more vigorous are the contractions and the greater the pressure in the haustra.

Symptoms of reflux esophagitis in an ________ include evidence of pain when swallowing, hematemesis and anemia due to esophageal bleeding, heartburn, irritability, and sudden or inconsolable crying.

Infant

_______ is commonly associated with acute or chronic inflammation or intrinsic disease of the colon, such as ulcerative colitis or Crohn disease.

Inflammatory Diarrhea

______ is a functional gastrointestinal disorder characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities.

Irritable Bowel Syndrome

Characteristics of ulcerative colitis are the lesions that form in the crypts of _________ in the base of the mucosal layer.

Lieberkuhn

Tears in the esophagus at the esophagogastric junction.

Mallory-Weiss Syndrome

Toxin-producing bacteria or other agents that disrupt the normal absorption of secretory process in the small bowel commonly cause___________.

Noninflammatory Diarrhea

_________ deficiencies are common in Crohn disease because of diarrhea, steatorhea, and other malabsorption problems.

Nutritional

Swallowing is painful.

Odynophagia

Water is pulled into the bowel by the hyperosmotic nature of its contents.

Osmotic Diarrhea

_______ obstruction results from neurogenic of muscular impairment of peristalsis.

Paralytic

______ is a term used to describe a group of ulcerative disorders that occur in areas of the upper gastrointestinal tract that are exposed to acid-pepsin secretions.

Peptic Ulcers

Ulcer erodes through all layers of the stomach.

Perforation

________ involves mucosal injury to the esophagus, hyperemia, and inflammation.

Reflux Esophagitis

What are typical characteristics of irritable bowel syndrome?

Results from deregulation of intestinal motor and sensory functions modulated by the central nervous system. Irritable bowel syndrome is characterized by persisten or recurrent symptoms of abdominal pain, altered bowel function, and varying complaints of flatulence. A hallmark of irritable bowel syndrome is abdominal pain that is relieved by defecation and associated with a change in consistency or frequency of stools. Abdominal pain is usually intermittent, cramping, and in the lower abdomen.

Causes diarrhea in children.

Rotavirus

Peritonitis is an inflammatory response of the _______ that lines the abdominal cavity and covers the visceral organ.

Serous Membrane

Describe how the gastric mucosal barrier functions to protect the stomach from its own secretions.

Several factors contribute to the protection of the gastric mucosa, including an impermeable epithelial cell surface covering, mechanisms for the selective transport of hydrogen and bicarbonate ions, and the characteristics of gastric mucus. The gastric epithelial cells are connected by tight junctions that precent acid penetration, and they are covered with an impermeable hydrophobic lipid layer that prevents diffusion of ionized water-soluble molecules. As long as the secretions of Hydrogen and Bicarbonate Ions are equal mucosal injury does not occur. Water insoluble mucus forms a thin, stable gel that adheres to the gastric mucosal surface and provide protection from the proteolytic (protein-digesting) actions of pepsin. It also forms an unstirred layer that traps bicarbonate, forming an alkaline interface between the luminal contents of the stomach and its mucosal surface. The water-soluble mucus is washed from the mucosal surface and mixes with the luminal contents, its viscid (sticky) nature makes it a lubricant that prevents mechanical damage to the mucosal surface.

Stools contain excess fat.

Steatorhheic

Persons at high risk for development of ________ include those with large surface area burns, trauma, sepsis, acute respiratory distress syndrome, severe liver failure, and major surgical procedures.

Stress Ulcers

Most squamous cell esophageal carcinomas are attributable to ________ and __________.

Tobacco and Alcohol

Esophagus is connected to the trachea.

Tracheoesophageal Fistulae

Gastrin-secreting tumor.

Zollinger-Ellison Syndrome