Gastrointestinal Disorders (Practice Mode) Quiz

Helicobacter pylori (H. pylori) is a bacteria responsible for most ulcers and many cases of chronic gastritis (inflammation of the stomach). This organism can weaken the protective coating of the stomach and duodenum (first part of the small intestines), allowing the damaging digestive juices to irritate the sensitive lining of these body parts.

passage of stool is more than 3 bowel movements per day

Occult blood test or stool guiac test is a test that detects the presence of hidden (occult) blood in the stool (bowel movement). The stool guaiac is the most common form of fecal occult blood test (FOBT) in use today. So stool specimen will be collected.

Rationale: Increase in WBC counts is suggestive of appendicitis because of bacterial invasion and inflammation. Normal WBC count is 5, 000 – 10, 000/mm3. Other options are normal values.

Rebound tenderness is pain felt upon sudden release of the examiners hand which in most cases suggest peritonitis. Referred pain is pain felt in an area remote from the site of origin. Direct tenderness is localized pain upon palpation. Indirect tenderness is pain outside the area of palpation.

Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.

Stress is an environmental factor that is thought to cause ulcerative colitis. Test taking skill: options b, c, and d are all healthy lifestyles.

Rationale: Hemorrhoids are associated with prolonged sitting, or standing, portal hypertension, chronic constipation and prolonged intra abdominal pressure as associated with pregnancy and the strain of vaginal delivery. Her job as a schoolteacher does not require prolong sitting or standing. Age and leg varicosities are not related to the development of hemorrhoids.

Rationale: Positioning in the early postoperative phase should avoid stress and pressure on the operative site. The prone and side – lying are ideal from a comfort perspective. A high Fowler’s or supine position will place pressure on the operative site and is not recommended. There is no need for trendelenburg’s position.

Mr. Trinidad’s BMI is 23 which is normal. Refer to rationale number 15.

Assessment precedes intervention. Symptoms presented are signs of peritonitis. Assessment will provide you the data for prompt intervention.

Amylase aids in the digestion of carbohydrates. Trypsin/Chymotrypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.

Appendix and cecum is located in the right iliac region. Liver and gall bladder is at the right hypochondriac. Sigmoid colon is at the left iliac. Duodenum, stomach and pancreas is in the epigastric region.

Rationale: If a confirmed diagnosis is made and the pain suddenly without any intervention, the appendix may have ruptured; the pain is lessened because the appendix is no longer distended thus surgery is still needed.

Rationale: Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.

Post – operatively, no bowel sounds are present so this is a normal finding. Bleeding and hemorrhage must be prevented to avoid complications. Bowel movement occurs only after flatus and bowel sounds are noted.

The cause is unknown but is thought to be multifactorial. Heredity, infectious agents, altered immunity or autoimmune and environmental are factors to be considered. Test taking skill: which does not belong? Options a, b, and d are all modifiable factors.

All are correct but option b is the best answer. In patients with GERD, this type of diet must be avoided to avoid backflow of gastric contents. Excessive caffeine reduces the tone of lower esophageal sphincter. Test Taking Skills: look for the umbrella effect

Eating meat can cause false positive test result. Using proper stool collection technique, avoiding certain drugs, and observing dietary restrictions can minimize these measurement errors.

In diarrhea, metabolic acidosis is the acid – base imbalance that occurs while in vomiting, metabolic alkalosis occur. This is a metabolic disorder that’s why eliminate options c and d.

Endoscopy determines bleeding, pain, difficulty swallowing, and a change in bowel habits. This would yield good visualization of the ulcer crater. Other options are also diagnostic tests in PUD.

Rationale: Straining can increase intra abdominal pressure. Health teachings also include: suggest to eat high roughage diet, wearing of cotton undergarments and use of sitz bath for 15 minutes.

In gastric ulcer food intake aggravates pain which usually occur ½ - 1 hour before meal or immediately during or after food intake. Options a, b, c suggests duodenal ulcer.

During abdominal examination, positioning the client in supine with knees flexed will promote relaxation of abdominal muscles. Options b and d are inaccurate in this type of procedure. Lying on back or supine may be correct but option a is the best answer.

There is no known cause of IBS, and diagnosis is made by excluding all the other diseases that cause the symptoms. There is no inflammation if the bowel. Some factors exacerbate the symptoms including anxiety, fear, stress, depression, some foods and drugs but there do not cause the disease.

Light palpation is done to identify areas of tenderness and swelling. Deep palpation is done to identify masses in all four quadrants. Test taking skills: one of the opposite is the correct answer

Rationale: Applying heat during the immediate postoperative period may cause hemorrhage at the surgical site. Moist heat may relieve rectal spasms after bowel movements. Urinary retention caused by reflex spasm may also be relieved by moist heat. Increasing fiber and fluid in the diet can help constipation.

Rationale: A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause obstruction.

An increase intraluminal pressure causes the outpouching of the colon wall resulting to diverticulosis. Option a suggests diverticulitis. Test taking skill: one of the opposite is the correct answer.

A lack of adequate blood supply and nutrients from the diet such as low fiber foods may contribute to the development of the disease. Test taking skill: one of the opposite is the correct answer.

The NGT’s primary purpose is for bowel decompression especially for clients suffering from obstruction.

Stomach is a hollow digestive organ in the GI tract. The liver, gall baldder and pancreas are all solid organs which are part of the hepato-biliary system. Test taking skills: which does not belong to the group?

GERD is the backflow of gastric or duodenal contents into the esophagus caused by incompetent lower esophageal sphincter. Pyrosis or heartburn, dyspepsia and dysphagia are cardinal symptoms.

Early in the bowel obstruction, the bowel attempts to move the contents past the obstruction and this is heard as high pitched tinkling bowel sounds. As the obstruction progresses, bowel sounds will diminish and may finally become absent.

The digestive processes involve six steps. Ingestion is taking in of food in the mouth; mastication is the mechanical process where food is converted into bolus; deglutition is the act of swallowing; digestion is the chemical breakdown of food into chime; absorption occurs in the small intestines (solutes) and large intestines (water) and egestion/defecation where elimination of feces occur.

Diarhhea is an intestinal disorder that is self – limiting. Options a, c and d are etiological factors of diarrhea.

Mr. Cruz’ BMI belongs to the overweight category (24 – 26), malnourished (less than 17), underweight (17 – 19), normal (20 – 23), obese (27 – 30) and morbidly obese (greater than 30). BMI is weight in kilograms divided by height in square meters.

RInspection is the first step in abdominal exam to note the contour and symmetry of abdomen as well as localized bulging, distention and peristaltic waves. Auscultation is done to determine the character, location and frequency of bowel sounds. Percussion is to assess tympany or dullness. Palpation is to asses areas of tenderness and discomfort. Note: In abdominal exam: Inspection, Auscultation, Percussion and Palpation are the correct order.

Barium enema is used to diagnose diverticulosis, however, this is contraindicated when diverticulitis is present because of the risk of rupturing the diverticulum. Test taking skill: options b and c are opposite; one may be the correct answer.

Oresol is the immediate home care management for diarrhea to prevent dehydration. Water may not be enough to prevent diarrhea.

Chronic inflammatory of GI mucosa occurs anywhere from the mouth to anus but most often in terminal ileum. Inflammatory lesions are local and involve all layers of the intestinal wall.

Barium swallow or upper GI series would confirm GERD. Endoscopy is another diagnostic test. Options a and d are the same. Option c is incorrect.

The use of natural laxatives such as foods and fruits high in fiber is still the best way of preventing constipation Increasing fluid intake, taking laxatives judiciously and exercise also can prevent this.

refer to rationale for number 23. Test taking skill: which does not belong? Options a, c and d are all modifiable factors

Rationale: Gastrin stimulates chief cells to produce pepsinogen when foods enter and suppression of pepsinogen when it leaves and enters the small intestines; it is the major hormone that regulates acid secretion in the stomach. Pepsin; a gastric protease secreted in an inactive form, pepsinogen, which is activated by stomach acid that acts to degrade protein. HCl is produced by the parietal cells. Insulin is a pancreatic hormone.

Due to increase frequency and fluid content in the stools, diarrhea may cause fluid and electrolyte imbalance such as hypokalemia. Once potassium is depleted, this will affect the contractility of the heart causing cardiac arrhythmia leading to death.

Rationale: The laryngopharynx serves as passageway for air and food and so as with the oropharynx. Option a is nasopharynx. Answers b and c may be correct but air and food is more accuarte.

When difficulty of swallowing is accompanied with pain this is now referred as odynophagia. Dysphagia is difficulty of swallowing alone.

Rationale: Option a are local anesthetics; c are antiseptics and d are keratolytics.

Mr. Trinidad’s BMI is 23 which is normal. Overweight category (24 – 26), malnourished (less than 17), underweight (17 – 19), normal (20 – 23), obese (27– 30) and morbidly obese (greater than 30). BMI is weight in kilograms divided by height in square meters.