Module 15 Alterations of Digestive Function Exam

1. Common causes of constipation include all of the following except:

A) inadequate fluid intake.Feedback: INCORRECT Inadequate fluid intake is a common cause of constipation.

B) laxative use.Feedback: CORRECT Laxatives are used to treat constipation.

C) a low-fiber diet. Feedback: INCORRECT A diet low in fiber is a common cause of constipation.

D) medications.Feedback: INCORRECT Certain medications such as opiods and calcium channel blockers can inhibit intestinal smooth muscle activity, resulting in constipation.2. Which of the following types of diarrhea can be caused by an inability to digest lactose in dairy products?

A) SecretoryFeedback: INCORRECT Secretory diarrhea is caused by gastrointestinal infections or inflammatory bowel diseases.

B) NeurogenicFeedback: INCORRECT Neurogenic dysfunction in the bowel generally results in constipation, not diarrhea.

C) Osmotic Feedback: CORRECT When an individual is unable to digest lactose, the unabsorbed molecules draw water into the lumen, resulting in osmotic diarrhea.

D) MotilityFeedback: INCORRECT Motility diarrhea is caused by increased peristalsis resulting from a bowel resection, fistulae, or neuropathy.

3. Which of the following disorders can result in lower gastrointestinal bleeding?

A) Mallory-Weiss tearFeedback: INCORRECT A Mallory-Weiss tear occurs at the gastroesophageal junction and is a rare cause of upper gastrointestinal bleeding.

B) Peptic ulcers Feedback: INCORRECT

Peptic ulcer disease is a common cause of upper gastrointestinal bleeding.

C) CancerFeedback: CORRECT Colorectal cancer is a common cause of lower gastrointestinal bleeding.

D) HerniaFeedback: INCORRECT A hernia is a protrusion of the intestines through the body wall and does not usually result in gastrointestinal bleeding.4. Which of the following conditions is a complication of gastrointestinal bleeding?

A) Iron deficiency anemiaFeedback: CORRECT Blood loss in gastrointestinal bleeding can result in an iron deficiency due to the loss of iron in the hemoglobin.

B) PolypsFeedback: INCORRECT Polyps can be a cause, not a result, of gastrointestinal bleeding. Blood loss in gastrointestinal bleeding can result in an iron deficiency due to the loss of iron in the hemoglobin.

C) HypertensionFeedback: INCORRECT Blood loss can lead to hypotension and hypovolemic shock. Blood loss in gastrointestinal bleeding can result in an iron deficiency due to the loss of iron in the hemoglobin.

D) AscitesFeedback: INCORRECT Ascites is not a complication of gastrointestinal bleeding. Blood loss in gastrointestinal bleeding can result in an iron deficiency due to the loss of iron in the hemoglobin.

5. The presence of digested dark blood in the stool is called:

A) melena.Feedback: CORRECT Melena is black, tarry stool that occurs when blood components are digested in the upper gastrointestinal tract.

B) hematochezia.Feedback: INCORRECT Hematochezia is the presence of bright red blood in the stool. Melena is black, tarry stool that occurs when blood components are digested in the upper gastrointestinal tract

C) hematemesis.Feedback: INCORRECT Hematemesis is the presence of fresh blood or digested blood in vomited fluids. Melena is black, tarry stool that occurs when blood components are digested in the upper gastrointestinal tract

D) occult bleeding.Feedback: INCORRECT Occult bleeding is manifested by trace amounts of blood in the stool or gastric fluids. Melena is black, tarry stool that occurs when blood components are digested in the upper gastrointestinal tract

6. Which of the following conditions can cause dysphagia?

A) Hiatal herniaFeedback: INCORRECT Dysphagia, or difficulty swallowing, can be caused by hiatal hernia, achalasia, or gastroesophageal reflux.

B) AchalasiaFeedback: INCORRECT Dysphagia, or difficulty swallowing, can be caused by hiatal hernia, achalasia, or gastroesophageal reflux.

C) Gastroesophageal refluxFeedback: INCORRECT Dysphagia, or difficulty swallowing, can be caused by hiatal hernia, achalasia, or gastroesophageal reflux.

D) All of the aboveFeedback: CORRECT Dysphagia, or difficulty swallowing, can be caused by hiatal hernia, achalasia, or gastroesophageal reflux.

7. Reflux esophagitis is defined as:

A) the autoimmune destruction of the esophageal lining.Feedback: INCORRECT Reflux esophagitis is an inflammatory response to the mucosal injury from acid and enzymes that occur with gastroesophageal reflux.

B) dysplasia of the epithelial lining of the esophagus.Feedback: INCORRECT Dysplasia of the epithelial lining of the esophagus is called Barrett esophagus.

C) a congenital anomaly of the esophagus.Feedback: INCORRECT An example of a congenital anomaly of the esophagus is esophageal atresia.

D) an inflammatory response to gastroesophageal reflux.Feedback: CORRECT Reflux esophagitis is an inflammatory response to the mucosal injury from acid and enzymes that occur with gastroesophageal reflux.

8. Common manifestations of gastroesophageal reflux disease (GERD) include:

A) nausea, vomiting, and weight loss.Feedback: INCORRECT Nausea, vomiting, and weight loss are manifestations of pyloric stenosis.

B) diarrhea, abdominal cramping, and fever.Feedback: INCORRECT Diarrhea, abdominal cramping, and fever are manifestations of gastroenteritis.

C) heartburn, dysphagia, and pain within one hour of eating.Feedback: CORRECT Heartburn, dysphagia, and pain within one hour of eating, along with acid regurgitation and chronic cough, are all manifestations of gastroesophageal reflux disease (GERD).

D) back pain, ascites, and anorexia.Feedback: INCORRECT Back pain, ascites, and anorexia are manifestations of pancreatitis.

9. Complications associated with gastroesophageal reflux disease (GERD) include which of the following?

A) Esophageal ulcerationsFeedback: INCORRECT GERD can result in ulcerations of the lower esophagus, but it also can lead to esophageal cancer and strictures.

B) Esophageal cancerFeedback: INCORRECT Chronic injury from GERD can cause cellular mutations that develop into cancer, but the disease also can lead to esophageal erosions and strictures.

C) Esophageal stricturesFeedback: INCORRECT Scarring of the esophagus from GERD can cause strictures, but the disease also can lead to esophageal erosions and cancer.

D) All of the aboveFeedback: CORRECT Esophageal ulcerations, strictures, and cancer are all complications associated with gastroesophageal reflux disease.

10. A hiatal hernia is a protrusion of the _____ through the ______.

A) stomach; diaphragmFeedback: CORRECT A hiatal hernia is a protrusion of the stomach through the esophageal hiatus of the diaphragm.

B) duodenum; pyloric sphincterFeedback: INCORRECT A hiatal hernia is a protrusion of the stomach through the esophageal hiatus of the diaphragm.

C) small intestine; inguinal canalFeedback: INCORRECT A hiatal hernia is a protrusion of the stomach through the esophageal hiatus of the diaphragm.

D) rectum; anusFeedback: INCORRECT A hiatal hernia is a protrusion of the stomach through the esophageal hiatus of the diaphragm.11. Paralytic ileus often occurs after:

A) gastroesophageal reflux resolves.Feedback: INCORRECT Paralytic ileus is a functional bowel obstruction caused by failure of motility and often occurs after abdominal surgery.

B) abdominal surgery.Feedback: CORRECT Paralytic ileus is a functional bowel obstruction caused by failure of motility and often occurs after abdominal surgery.

C) pregnancy.Feedback: INCORRECT Paralytic ileus is a functional bowel obstruction caused by failure of motility and often occurs after abdominal surgery.

D) vomiting.Feedback: INCORRECT Paralytic ileus is a functional bowel obstruction caused by failure of motility and often occurs after abdominal surgery.

12. Intestinal obstruction can lead to all of the following complications except:

A) hepatic failure.Feedback: CORRECT Hepatic failure is not a complication of intestinal obstruction.

B) dehydration.Feedback: INCORRECT Dehydration and hypovolemia from decreased intestinal absorption of fluids is a potential complication of bowel obstruction.

C) peritonitis. Feedback: INCORRECT Perotinitis from loss of bowel wall integrity and perforation is a potential complication of bowel obstruction.

D) perforation.Feedback: INCORRECT Perforation from tissue hypoxia and loss of bowel wall integrity is a potential complication of bowel obstruction.

13. The classic symptoms of a small bowel obstruction are:

A) nausea, dyspnea, and mid-back pain.Feedback: INCORRECT Symptoms of a small bowel obstruction include vomiting from vagal nerve stimulation, pain from bowel wall distention, and abdominal distension from accumulation of chyme or ascites.

B) vomiting, severe abdominal pain, and abdominal distension.Feedback: CORRECT Symptoms of a small bowel obstruction include vomiting from vagal nerve stimulation, pain from bowel wall distention, and abdominal distension from accumulation of chyme or ascites.

C) constipation, pelvic pain, and dysuria.Feedback: INCORRECT Symptoms of a small bowel obstruction include vomiting from vagal nerve stimulation, pain from bowel wall distention, and abdominal distension from accumulation of chyme or ascites.

D) fever, heartburn, and diaphoresis.Feedback: INCORRECT Symptoms of a small bowel obstruction include vomiting from vagal nerve stimulation, pain from bowel wall distention, and abdominal distension from accumulation of chyme or ascites.

14. The most common cause of chronic gastritis is:

A) viral infection.Feedback: INCORRECT The most common cause of chronic gastritis is chronic bacterial infection by Helicobacter pylori.

B) bacterial infection.Feedback: CORRECT The most common cause of chronic gastritis is chronic bacterial infection by Helicobacter pylori.

C) parasitic infection.Feedback: INCORRECT The most common cause of chronic gastritis is chronic bacterial infection by Helicobacter pylori.

D) fungal infection.Feedback: INCORRECT The most common cause of chronic gastritis is chronic bacterial infection by Helicobacter pylori.

15. Individuals with chronic gastritis are at risk for developing which of the following problems?

A) Gastric cancerFeedback: INCORRECT Chronic damage to the stomach mucosa can cause cellular changes that lead to gastric cancer, achlorhydria, and mucosal erosions that can result in gastrointestinal bleeding.

B) AchlorhydriaFeedback: INCORRECT Chronic damage to the stomach mucosa can cause cellular changes that lead to gastric cancer, achlorhydria, and mucosal erosions that can result in gastrointestinal bleeding.

C) Gastrointestinal bleedingFeedback: INCORRECT Chronic damage to the stomach mucosa can cause cellular changes that lead to gastric cancer, achlorhydria, and mucosal erosions that can result in gastrointestinal bleeding.

D) All of the above Feedback: CORRECT Chronic damage to the stomach mucosa can cause cellular changes that lead to gastric cancer, achlorhydria, and mucosal erosions that can result in gastrointestinal bleeding.

16. How does a chronic infection with Helicobacter pylori (H. pylori) lead to duodenal ulcers?

A) Chronic inflammation inhibits the proton pumps in the gastric lining.Feedback: INCORRECT H. pylori infection can stimulate the release of gastrin, which results in increased proton pump activity and acid secretion.

B) Presence of bacteria in the stomach causes the pyloric sphincter to open prematurely, releasing acid into the duodenum.Feedback: INCORRECT Presence of infection does not directly affect gastric emptying.

C) H. pylori inhibits prostaglandins, leading to decreased mucus production.Feedback: INCORRECT Anti-inflammatory medications (NSAIDs) inhibit prostaglandin secretion, which results in decreased mucus production in the duodenum.

D) H. pylori produces substances that are toxic to the duodenal mucosa.Feedback: CORRECT H. pylori bacteria produce ammonia and enzymes that can damage the duodenal mucosa.

17. Non-steroidal anti-inflammatory agents (NSAIDS) cause peptic ulcer by:

A) decreasing gastric bicarbonate production.Feedback: INCORRECT NSAIDS are used to treat inflammatory pain and can increase the risk of peptic ulcer disease by inhibiting prostaglandin synthesis, which normally stimulates the production of gastric mucous.

B) accelerating the proton pump in parietal cells. Feedback: INCORRECT NSAIDS are used to treat inflammatory pain and can increase the risk of peptic ulcer disease by inhibiting prostaglandin synthesis, which normally stimulates the production of gastric mucous.

C) inhibiting mucosal prostaglandin synthesis.Feedback: CORRECT NSAIDS are used to treat inflammatory pain and can increase the risk of peptic ulcer disease by inhibiting prostaglandin synthesis, which normally stimulates the production of gastric mucous.

D) reducing mucosal blood flow.Feedback: INCORRECT NSAIDS are used to treat inflammatory pain and can increase the risk of peptic ulcer disease by inhibiting prostaglandin synthesis, which normally stimulates the production of gastric mucous.

18. In addition to NSAID use, possible risk factors for peptic ulcer disease include all of the following except:

A) smoking.Feedback: INCORRECT Smoking is a known risk factor for peptic ulcer disease.

B) alcoholism.Feedback: INCORRECT Alcoholism is a known risk factor for peptic ulcer disease.

C) psychological stress.Feedback: INCORRECT Psychological stress may be a risk factor for peptic ulcer disease, although the results of studies are inconclusive at this point.

D) female gender.Feedback: CORRECT Men have a higher incidence of duodenal ulcers than women, and gastric ulcers affect men and women equally.

19. Which type of ulcer is a stress ulcer that is associated with burn injuries?

A) AddisonFeedback: INCORRECT Curling ulcers are ischemic ulcers that occur following severe burn injuries.

B) CushingFeedback: INCORRECT Curling ulcers are ischemic ulcers that occur following severe burn injuries. Cushing ulcers occur following head trauma or brain surgery.

C) CurlingFeedback: CORRECT Curling ulcers are ischemic ulcers that occur following severe burn injuries.

D) RetroperitonealFeedback: INCORRECT Curling ulcers are ischemic ulcers that occur following severe burn injuries.

20. Gastric ulcers are characterized by:

A) increased acid secretion.Feedback: INCORRECT

Duodenal ulcers can be associated with increased acid secretion; however, gastric ulcers are generally associated with normal or low acid production.

B) regurgitation of bile.Feedback: INCORRECT Regurgitation of bile can occur with vomiting if the pyloric sphincter is relaxed, but is not generally associated with peptic ulcer disease.

C) pain with eating.Feedback: CORRECT Gastric ulcers are often associated with pain upon eating because the presence of food stimulates acid and enzyme secretion, which causes further damage to the gastric mucosa and underlying tissue.

D) bloody diarrhea.Feedback: INCORRECT If a gastric ulcer bleeds, the manifestations would include melena or hematemesis. Lower gastrointestinal bleeding manifests with bloody stools.

21. Severe trauma can result in stress ulcers that often first manifest with:

A) abdominal pain.Feedback: INCORRECT Stress ulcers of the stomach and duodenum are often painless; thus, the first sign is often acute gastrointestinal bleeding.

B) peritonitis.Feedback: INCORRECT Although a severe ulcer can penetrate the stomach or duodenal wall and lead to peritonitis, an earlier sign is bleeding from the ulceration.

C) severe bleeding.Feedback: CORRECT The first sign of stress ulcers is often acute gastrointestinal bleeding.

D) dumping syndrome.Feedback: INCORRECT The first sign of stress ulcers is often acute gastrointestinal bleeding.22. Gastrectomy surgery commonly leads to a vitamin B12 deficiency anemia because:

A) vitamin B12 is absorbed in the stomach.Feedback: INCORRECT Vitamin B12 is absorbed in the ileum but requires intrinsic secretion by the stomach.

B) decreased HCl production affects vitamin B12 absorption.Feedback: INCORRECT HCl production by the stomach does not affect vitamin B12 absorption. The stomach secretes intrinsic factor, which is required for vitamin B12 absorption in the ileum.

C) pepsin is required for the conversion of vitamin B12 into its active form. Feedback: INCORRECT Vitamin B12 is active when ingested; however, the stomach secretes intrinsic factor, which is required for vitamin B12 absorption in the ileum.

D) decreased intrinsic factor production results in decreased vitamin B12 absorption in the ileum. Feedback: CORRECT The stomach secretes intrinsic factor, which is required for vitamin B12 absorption in the ileum.

23. Which of the following disorders is characterized by night blindness, osteopathy, and clotting disorders?

A) Post-gastrectomy syndromeFeedback: INCORRECT Night blindness, osteopathy, and clotting disorders are caused by bile salt deficiency and the resulting malabsorption of fat soluble vitamins A, D, and K. Fats are not digested or absorbed in the stomach.

B) Gluten-sensitive enteropathyFeedback: INCORRECT Night blindness, osteopathy, and clotting disorders are caused by bile salt deficiency and the resulting malabsorption of fat soluble vitamins A, D, and K.

C) Bile salt deficiencyFeedback: CORRECT Night blindness, osteopathy, and clotting disorders are caused by bile salt deficiency and the resulting malabsorption of fat soluble vitamins A, D, and K.

D) Lactase deficiencyFeedback: INCORRECT Night blindness, osteopathy, and clotting disorders are caused by bile salt deficiency and the resulting malabsorption of fat soluble vitamins A, D, and K.

24. Which of the following disorders is characterized by the inability to digest all nutrients?

A) Pancreatic insufficiencyFeedback: CORRECT Because the pancreas secretes lipase, proteases, and amylase, a decrease in pancreatic enzymes results in an inability to digest fats, proteins, and carbohydrates.

B) Gluten-sensitive enteropathyFeedback: INCORRECT Gluten-sensitive enteropathy can result in lactase deficiency, the inability to digest lactose in milk products.

C) Bile salt deficiencyFeedback: INCORRECT Bile salt deficiency results in the inability to emulsify and absorb fats.

D) Lactase deficiencyFeedback: INCORRECT Lactase deficiency results in the inability to digest lactose in milk products.

25. All of the following are characteristics of ulcerative colitis except:

A) iron deficiency anemia.Feedback: INCORRECT Ulcerations from chronic autoimmune and inflammatory injury can bleed, leading to iron deficiency anemia.

B) the presence of ”skip” lesions. Feedback: CORRECT Ulcerative colitis begins in the rectum and advances back through the colon in a continuous manner and does not “skip” parts of the mucosa.

C) diarrhea.Feedback: INCORRECT Chronic injury and inflammation leads to watery diarrhea.

D) an increased risk of colon cancer.Feedback: INCORRECT Chronic inflammation in ulcerative colitis increases the risk of developing colon cancer.

26. Which of the following factors are known causes of ulcerative colitis?

A) Genetic predispositionFeedback: INCORRECT Ulcerative colitis often runs in families. Symptoms are related to autoimmune injury to the mucosal lining and the resulting inflammation.

B) Autoimmune injuryFeedback: INCORRECT Symptoms are related to autoimmune injury to the mucosal lining and the resulting inflammation. Ulcerative colitis often runs in families.

C) InflammationFeedback: INCORRECT Symptoms are related to autoimmune injury to the mucosal lining and the resulting inflammation. Ulcerative colitis often runs in families.

D) All of the aboveFeedback: CORRECT Ulcerative colitis often runs in families. Symptoms are related to autoimmune injury to the mucosal lining and the resulting inflammation.

27. Common characteristics of Chron disease include which of the following?

A) Significant blood loss in diarrheaFeedback: INCORRECT Gastrointestinal bleeding is more common in ulcerative colitis than in Chron disease.

B) Gastroesophageal refluxFeedback: INCORRECT Chron disease involves mucosal erosions of the distal ileum, ascending colon, and descending colon; therefore, it does not affect the gastroesophageal junction.

C) Vitamin B12 deficiencyFeedback: CORRECT Vitamin B12 malabsorption due to injury to the mucosa of the ileum is a common characteristic of Chron disease.

D) Mucosal erosions of the rectumFeedback: INCORRECT Chron disease involves mucosal erosions of the distal ileum, ascending colon, and descending colon.

28. Diverticula are:

A) ulcers that form in the colon.Feedback: INCORRECT Diverticula are sac-like outpouchings of the mucosa through the muscle layers of the digestive tract.

B) outpouchings of the colon's mucosa.Feedback: CORRECT Diverticula are sac-like outpouchings of the mucosa through the muscle layers of the digestive tract.

C) perforations of the colon wall.Feedback: INCORRECT Although they can perforate, diverticula are sac-like outpouchings of the mucosa through the muscle layers of the digestive tract.

D) areas where the colon wall is hypertrophied.Feedback: INCORRECT Diverticula are sac-like outpouchings of the mucosa through the muscle layers of the digestive tract.

29. Diverticulosis can be related to which of the following dietary problems?

A) Lactose deficiencyFeedback: INCORRECT Lactose deficiency is not related to diverticulosis. Diverticula form when there is not enough stool bulk, which is related to a diet high in refined foods.

B) Diet high in refined foodsFeedback: CORRECT Diverticula form when there is not enough stool bulk, which is related to a diet high in refined foods, and when there is weakening of the wall of the colon.

C) Iron deficiencyFeedback: INCORRECT Iron deficiency is not related to diverticulosis. Diverticula form when there is not enough stool bulk, which is related to a diet high in refined foods.

D) High fiber intakeFeedback: INCORRECT A diet high in fiber can reduce the risk of diverticulosis. Diverticula form when there is not enough stool bulk, which is related to a diet high in refined foods.

30. Appendicitis usually presents with pain that manifests in which abdominal quadrant?

A) Right upperFeedback: INCORRECT Most individuals with appendicitis present with periumbilical pain that increases in intensity over several hours and then “moves” to the right lower quadrant.

B) Right lowerFeedback: CORRECT Most individuals with appendicitis present with periumbilical pain that increases in intensity over several hours and then “moves” to the right lower quadrant.

C) Left upperFeedback: INCORRECT Most individuals with appendicitis present with periumbilical pain that increases in intensity over several hours and then “moves” to the right lower quadrant.

D) Left lowerFeedback: INCORRECT Most individuals with appendicitis present with periumbilical pain that increases in intensity over several hours and then “moves” to the right lower quadrant.

31. Which of the following nutritional disorders is characterized by consumption of large amounts of food (binging) followed by self-induced vomiting and/or the use of laxatives (purging)?

A) ObesityFeedback: INCORRECT Binging and purging behaviors are typical of bulimia nervosa. Obesity is a body weight of over 120% of ideal body weight.

B) Anorexia nervosaFeedback: INCORRECT Binging and purging behaviors are typical of bulimia nervosa. Anorexia nervosa is characterized by the fear of becoming obese despite severe weight loss.

C) Bulimia nervosaFeedback: CORRECT Binging and purging behaviors are typical of bulimia nervosa.

D) KwashiorkorFeedback: INCORRECT Binging and purging behaviors are typical of bulimia nervosa. Kwashiorkor is caused by severe protein deficiency.

32. What is the most common cause of acute mesenteric (vascular) insufficiency?

A) Emboli Feedback: CORRECT The most common cause of acute mesenteric insufficiency is obstruction of one of the mesenteric arteries by an embolus.

B) Heart failureFeedback: INCORRECT The most common cause of acute mesenteric insufficiency is obstruction of one of the mesenteric arteries by an embolus. Heart failure is a cause of chronic mesenteric insufficiency.

C) IleusFeedback: INCORRECT The most common cause of acute mesenteric insufficiency is obstruction of one of the mesenteric arteries by an embolus. An ileus can develop as a result of mesenteric insufficiency.

D) AnemiaFeedback: INCORRECT The most common cause of acute mesenteric insufficiency is obstruction of one of the mesenteric arteries by an embolus. Anemia is a cause of chronic mesenteric insufficiency.33. Although the term hepatitis describes any inflammatory process affecting the liver, it is usually used to describe liver inflammation due to:

A) bacterial infection.Feedback: INCORRECT Most causes of hepatitis are viral in origin.

B) viral infection.Feedback: CORRECT Most causes of hepatitis are viral in origin.

C) prescription drug toxicity.Feedback: INCORRECT Most causes of hepatitis are viral in origin.

D) street drug toxicity.Feedback: INCORRECT Most causes of hepatitis are viral in origin.

34. Which of the following types of hepatitis is acquired from ingesting contaminated food and manifests acutely with fever, abdominal pain, and jaundice, but does not usually result in fulminant liver failure?

A) Hepatitis AFeedback: CORRECT Hepatitis A is acquired from ingesting contaminated food and manifests acutely with fever, abdominal pain, and jaundice. Individuals with hepatitis A generally make a full recovery.

B) Hepatitis BFeedback: INCORRECT Hepatitis B is transmitted through contact with contaminated blood or body fluids. These characteristics are typical of hepatitis A infection only.

C) Hepatitis CFeedback: INCORRECT Hepatitis C is transmitted through contact with contaminated blood or body fluids, does not manifest acutely, and can result in liver failure. These characteristics are typical of hepatitis A infection only

D) All of the aboveFeedback: INCORRECT These characteristics are typical of hepatitis A infection only.

35. The most common cause of liver cirrhosis are hepatitis C and:

A) alcoholism.Feedback: CORRECT High alcohol consumption causes liver injury and inflammation resulting in fibrosis and scarring of the liver.

B) cocaine abuse.Feedback: INCORRECT High alcohol consumption causes liver injury and inflammation resulting in fibrosis and scarring of the liver. Cocaine use is not associated with liver cirrhosis.

C) overdose of antibiotic medications.Feedback: INCORRECT High alcohol consumption causes liver injury and inflammation resulting in fibrosis and scarring of the liver. Overuse of antibiotics is not associated with liver cirrhosis.

D) liver cancer.Feedback: INCORRECT High alcohol consumption causes liver injury and inflammation resulting in fibrosis and scarring of the liver. Liver cancer is not a common disease.

36. Cholelithiasis is:

A) an infection of the gallbladder.Feedback: INCORRECT Cholelithiasis is the accumulation of gallstones in the gallbladder.

B) gallbladder atrophy.Feedback: INCORRECT

Cholelithiasis is the accumulation of gallstones in the gallbladder.

C) hypersecretion of bile by the liver.Feedback: INCORRECT Cholelithiasis is the accumulation of gallstones in the gallbladder.

D) the accumulation of gallstones in the gallbladder.Feedback: CORRECT Cholelithiasis is the accumulation of gallstones in the gallbladder.

37. The most common cause of portal hypertension is:

A) renal failure.Feedback: INCORRECT The most common cause of portal hypertension is liver cirrhosis. The obstruction of blood flow in the liver leads to increased venous pressures in the hepatic portal vein. Renal failure does not generally lead to portal hypertension.

B) liver cirrhosis.Feedback: CORRECT The most common cause of portal hypertension is liver cirrhosis. The obstruction of blood flow in the liver leads to increased venous pressures in the hepatic portal vein.

C) congestive heart failure.Feedback: INCORRECT The most common cause of portal hypertension is liver cirrhosis. The obstruction of blood flow in the liver leads to increased venous pressures in the hepatic portal vein. In some cases, severe CHF can lead to portal hypertension.

D) esophageal varices.Feedback: INCORRECT The most common cause of portal hypertension is liver cirrhosis. The obstruction of blood flow in the liver leads to increased venous pressures in the hepatic portal vein. Portal hypertension can result in the development of esophageal varices.

38. Which of the following statements explains why portal hypertension leads to ascites?

A) Hepatosplenomegaly developsFeedback: INCORRECT Portal hypertension leads to hepatosplenomegaly when the back-up of blood engorges the liver and spleen. The back- up of blood in the mesenteric veins causes an increase in capillary hydrostatic pressures and the leakage of fluid into the peritoneal cavity, which is called ascites.

B) Back-up of blood in the intra-abdominal veins occursFeedback: CORRECT In portal hypertension, the back-up of blood in the mesenteric veins causes an increase in capillary hydrostatic pressures and the leakage of fluid into the peritoneal cavity, which is called ascites.

C) Esophageal varices form in the lower esophagusFeedback: INCORRECT

Portal hypertension leads to esophageal varices when the backup of blood engorges the veins in the mucosal lining of the esophagus. The back-up of blood in the mesenteric veins causes an increase in capillary hydrostatic pressures and the leakage of fluid into the peritoneal cavity, which is called ascites.

D) Hemorrhoids can bleedFeedback: INCORRECT The back-up of blood in the mesenteric veins causes an increase in capillary hydrostatic pressures and the leakage of fluid into the peritoneal cavity, which is called ascites.

39. Symptoms of hepatic encephalopathy are caused by increased serum levels of:

A) ammonia.Feedback: CORRECT When the liver is severely injured, hepatocytes are unable to convert ammonia to urea. The result is toxic accumulation of ammonia in the blood, a condition known as hepatic encephalopathy.

B) potassium.Feedback: INCORRECT When the liver is severely injured, hepatocytes are unable to convert ammonia to urea. The result is toxic accumulation of ammonia in the blood, a condition known as hepatic encephalopathy.

C) urea.Feedback: INCORRECT When the liver is severely injured, hepatocytes are unable to convert ammonia to urea. The result is toxic accumulation of ammonia in the blood, a condition known as hepatic encephalopathy.

D) creatinine.Feedback: INCORRECT When the liver is severely injured, hepatocytes are unable to convert ammonia to urea. The result is toxic accumulation of ammonia in the blood, a condition known as hepatic encephalopathy.

40. Which of the following symptoms is associated with hepatic encephalopathy?

A) Ascites, bleeding disorders, and immunosuppressionFeedback: INCORRECT Ascites, bleeding disorders, and immunosuppression are all symptoms of severe liver disease. Hepatic encephalopathy, however, manifests with mental status changes.

B) Peripheral edema, dyspnea, and weight gainFeedback: INCORRECT Peripheral edema, dyspnea, and weight gain are all symptoms of severe liver disease due to the inability of the liver to synthesize albumin. Hepatic encephalopathy, however, manifests with mental status changes.

C) Decreased urinary output, increased serum creatinine, and elevated liver enzymesFeedback: INCORRECT Decreased urinary output, increased serum creatinine, and elevated liver enzymes are associated with severe liver disease and hepatorenal syndrome. Hepatic encephalopathy, however, manifests with mental status changes.

D) Memory loss and confusion, progressing to comaFeedback: CORRECT Hepatic encephalopathy results in abnormal neurotransmitter function and neuronal injury. Manifestations include mental status changes such as memory loss and confusion. As the condition develops, the patient will become comatose.41. Jaundice related to biliary duct obstruction is manifested by which of the following laboratory alterations?

A) Decreased unconjugated bilirubinFeedback: INCORRECT In cases of bile duct obstruction, the liver conjugates bilirubin but is unable to secrete it into the bile that is backed up. The conjugated bile seeps back into the plasma and deposits in the skin and other surface tissues, causing jaundice.

B) Increased unconjugated bilirubinFeedback: INCORRECT In cases of bile duct obstruction, the liver conjugates bilirubin but is unable to secrete it into the bile that is backed up. The conjugated bile seeps back into the plasma and deposits in the skin and other surface tissues, causing jaundice. Elevated unconjugated bilirubin is caused by hemolysis.

C) Decreased conjugated bilirubinFeedback: INCORRECT In cases of bile duct obstruction, the liver conjugates bilirubin but is unable to secrete it into the bile that is backed up. The conjugated bile seeps back into the plasma and deposits in the skin and other surface tissues, causing jaundice.

D) Increased conjugated bilirubinFeedback: CORRECT In cases of bile duct obstruction, the liver conjugates bilirubin but is unable to secrete it into the bile that is backed up. The conjugated bile seeps back into the plasma and deposits in the skin and other surface tissues, causing jaundice.

42. Tissue damage in acute pancreatitis is caused by:

A) leakage of pancreatic enzymes into pancreatic tissue.Feedback: CORRECT Tissue damage in acute pancreatitis is caused by leakage of pancreatic enzymes into pancreatic tissue and the resulting autodigestion of the gland.

B) hydrochloric acid reflux into the pancreatic duct.Feedback: INCORRECT Tissue damage in acute pancreatitis is caused by leakage of pancreatic enzymes into pancreatic tissue and the resulting autodigestion of the gland.

C) autoimmune destruction of the pancreas.Feedback: INCORRECT Tissue damage in acute pancreatitis is caused by leakage of pancreatic enzymes into pancreatic tissue and the resulting autodigestion of the gland.

D) insulin toxicity.Feedback: INCORRECT Tissue damage in acute pancreatitis is caused by leakage of pancreatic enzymes into pancreatic tissue and the resulting autodigestion of the gland.

43. The most common cause of chronic pancreatitis is:

A) narcotic addiction.Feedback: INCORRECT Chronic pancreatitis is most often associated with chronic alcohol abuse. Individuals with chronic pancreatitis sometimes become addicted to narcotic pain medications taken for chronic pain.

B) gall stones.Feedback: INCORRECT Chronic pancreatitis is most often associated with chronic alcohol abuse. Gall stones are a cause of acute pancreatitis.

C) alcohol abuse. Feedback: CORRECT Chronic pancreatitis is most often associated with chronic alcohol abuse.

D) diabetes mellitus.Feedback: INCORRECT Chronic pancreatitis is most often associated with chronic alcohol abuse.

44. Which of the following risk factors increases a person's chance of developing esophageal cancer?

A) SmokingFeedback: INCORRECT Smoking, alcohol, and gastroesophageal reflux leading to Barett esophagus all increase the risk of developing esophageal cancer, which has very poor survival rates.

B) AlcoholFeedback: INCORRECT Smoking, alcohol, and gastroesophageal reflux leading to Barett esophagus all increase the risk of developing esophageal cancer, which has very poor survival rates.

C) Gastroesophageal refluxFeedback: INCORRECT Smoking, alcohol, and gastroesophageal reflux leading to Barett esophagus all increase the risk of developing esophageal cancer, which has very poor survival rates.

D) All of the above Feedback: CORRECT Smoking, alcohol, and gastroesophageal reflux leading to Barett esophagus all increase the risk of developing esophageal cancer, which has very poor survival rates.45. Risk of developing cancer is increased with which of the following gastrointestinal disorders?

A) Duodenal ulcersFeedback: INCORRECT Risk of developing cancer is increased only with ulcerative colitis and Chron disease.

B) DiverticulosisFeedback: INCORRECT Risk of developing cancer is increased only with ulcerative colitis and Chron disease.

C) Ulcerative colitisFeedback: CORRECT Risk of developing cancer is increased only with ulcerative colitis and Chron disease.

D) Dumping syndromeFeedback: INCORRECT Risk of developing cancer is increased only with ulcerative colitis and Chron disease.

46. Which of the following symptoms is most specific to colon cancer?

A) Nausea and jaundiceFeedback: INCORRECT Nausea and jaundice are symptoms of liver or bile duct cancer. Abdominal pain and hematochezia, along with weight loss, changes in bowel movements, and bowel obstruction, are symptoms of colon cancer.

B) Abdominal pain and hematocheziaFeedback: CORRECT Abdominal pain and hematochezia, along with weight loss, changes in bowel movements, and bowel obstruction, are symptoms of colon cancer.

C) Epigastric pain and vomitingFeedback: INCORRECT Epigastric pain and vomiting are symptoms of stomach cancer. Abdominal pain and hematochezia, along with weight loss, changes in bowel movements, and bowel obstruction, are symptoms of colon cancer.

D) Heartburn and dysphagiaFeedback: INCORRECT Heartburn and dysphagia are symptoms of esophageal cancer. Abdominal pain and hematochezia, along with weight loss, changes in bowel movements, and bowel obstruction, are symptoms of colon cancer.