P20(B)

Children with celiac disease have an autoimmune reaction to gluten, a protein found in wheat, barley, and rye. Consuming gluten can damage their small intestine and lead to various symptoms and complications. Therefore, the dietary requirement for a child with celiac disease is to follow a gluten-free diet, which means avoiding all foods and products that contain gluten. This includes foods made with wheat, barley, and rye, as well as many processed foods that may contain hidden sources of gluten. By adhering to a gluten-free diet, children with celiac disease can manage their condition and prevent further damage to their intestines.

Celiac disease is an autoimmune disorder where the ingestion of gluten causes damage to the small intestine. Gluten is a protein found in certain grains such as wheat, barley, and rye. Therefore, a gluten-free diet for a client with celiac disease means avoiding certain grains that contain gluten. This includes products made from wheat, barley, and rye such as bread, pasta, and cereal.

Steatorrhea is a condition characterized by bulky, fatty, foul-smelling stools. This occurs when there is an excessive amount of fat in the stool, indicating malabsorption or poor digestion of fats. The stool may appear greasy or oily and can be difficult to flush. This condition is often associated with disorders affecting the pancreas, such as pancreatitis or cystic fibrosis, or conditions that affect the absorption of fats in the intestines, such as celiac disease or Crohn's disease.

The initial pathological change in alcoholic liver disease is the accumulation of fat in hepatocytes with hepatomegaly. This refers to the build-up of fat within liver cells, which can lead to enlargement of the liver. This is a common early sign of alcoholic liver disease and can progress to more severe forms of liver damage if not addressed.

Fistulas can form with Crohn's disease due to the recurrent inflammation, necrosis, and fibrosis that occurs in the intestinal wall. This can lead to the formation of abnormal connections between different loops of the intestine, resulting in the development of a fistula. Fistulas are abnormal passageways that can connect different organs or loops of the intestine, allowing the passage of fluid or stool between them.

Intussusception refers to the telescoping or folding of one section of the bowel into another section, causing a blockage. This condition commonly occurs in children and can lead to severe abdominal pain, vomiting, and bloody stools. It requires immediate medical attention as it can lead to bowel obstruction and tissue death if left untreated.

Stools that are more liquid and contain mucus, frank blood, and pus are typical of ulcerative colitis. Ulcerative colitis is a chronic inflammatory bowel disease that affects the lining of the colon and rectum. The inflammation causes ulcers in the lining of the colon, leading to symptoms such as diarrhea, abdominal pain, and bloody stools. The presence of mucus, frank blood, and pus in the stools is characteristic of the inflammation and ulceration in ulcerative colitis.

A typical early sign of cancer in the ascending colon is the presence of occult blood in the stool. Occult blood refers to blood that is not visible to the naked eye and can only be detected through a laboratory test. This can indicate the presence of a tumor or other abnormality in the colon. It is important to note that occult blood in the stool can also be caused by other conditions, so further diagnostic tests would be needed to confirm the presence of cancer.

Dehydration reduces the compensation for acidosis resulting from prolonged diarrhea. In this scenario, the significant change in arterial blood gases that indicates this is a decrease in serum bicarbonate levels. As dehydration limits the body's ability to buffer acid, bicarbonate levels decrease, leading to a drop in serum pH below the normal range of 7.35. This indicates that the body is unable to effectively compensate for the acidosis caused by prolonged diarrhea.

Celiac disease is an autoimmune disorder where the consumption of gluten leads to damage to the intestinal villi. These villi play a crucial role in absorbing nutrients from food. When they are damaged, the absorption of nutrients, including essential vitamins and minerals, is impaired. This can result in malnutrition, as the body is unable to properly absorb and utilize the necessary nutrients for growth and development.

Infection with hepatitis B often does not show any symptoms, which makes it difficult to identify and prevent its spread. Asymptomatic individuals may not be aware that they are infected and can unknowingly transmit the virus to others. This lack of symptoms also makes it challenging to diagnose and treat hepatitis B at an early stage, leading to a higher risk of complications and further spread of the disease.

HDV, also known as hepatitis D virus, requires the presence of hepatitis B virus (HBV) in order to replicate. HDV is a defective virus that cannot replicate on its own, but it can co-infect individuals already infected with HBV. HDV is considered the most severe form of viral hepatitis, as it can lead to more severe liver disease and a higher risk of liver failure.

When the tumor is located at the head of the pancreas, it can cause obstruction of bile or pancreatic secretions. This obstruction can lead to symptoms such as jaundice, abdominal pain, and weight loss, which may prompt further investigation and ultimately lead to an early diagnosis of pancreatic cancer.

Melena refers to the presence of blood in a dark-colored stool. This can indicate bleeding in the upper gastrointestinal tract, such as the stomach or small intestine. The dark color of the stool occurs because the blood has been partially digested by stomach acid. Melena is an important symptom to recognize as it can be a sign of a serious underlying condition, such as a bleeding ulcer or gastrointestinal bleeding. Prompt medical attention should be sought if melena is present.

Iron-deficiency anemia frequently develops with ulcerative colitis due to chronic blood loss in stools. Ulcerative colitis is a condition characterized by inflammation and ulcers in the colon and rectum. The inflammation can cause bleeding, leading to the loss of blood in the stools. Over time, this chronic blood loss can result in a decrease in the body's iron stores, leading to iron-deficiency anemia. Iron is an essential component of hemoglobin, the protein in red blood cells that carries oxygen to the body's tissues. Therefore, the chronic blood loss in ulcerative colitis can lead to a deficiency of iron, resulting in anemia.

Hypovolemic shock is caused by a significant loss of blood or fluid volume in the body. In the case of intestinal obstruction, continued vomiting can lead to a loss of fluids from the body. Additionally, when there is an obstruction in the intestines, fluid can shift into the intestine causing further depletion of fluid volume in the body. Therefore, continued vomiting and fluid shift into the intestine can cause hypovolemic shock to develop in cases of intestinal obstruction.

Colon cancer usually first metastasizes to the liver. This is because the liver receives blood directly from the colon through the portal vein, which allows cancer cells to easily travel and form secondary tumors in the liver. Additionally, the liver provides a favorable environment for the growth and proliferation of colon cancer cells, making it a common site for metastasis in colon cancer patients.

When a volvulus occurs, a section of the intestine twists abnormally, causing compression of the mesenteric arteries. The mesenteric arteries are responsible for supplying blood to the intestine. When they are compressed, blood flow to the affected section of the intestine is restricted, leading to ischemia (lack of oxygen and nutrients). This lack of blood flow can eventually result in gangrene, which is the death of tissue due to a lack of blood supply. Therefore, option b is the correct answer as it explains how a volvulus can cause localized gangrene in the intestine.

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Dehydration limits compensation available for an acid-base imbalance resulting from prolonged vomiting and diarrhea because hypovolemia limits renal function. When the body is dehydrated, there is a decrease in blood volume, which leads to decreased blood flow to the kidneys. This reduction in renal function impairs the kidneys' ability to regulate acid-base balance by excreting excess acid or retaining bicarbonate ions. As a result, the acid-base imbalance caused by vomiting and diarrhea cannot be effectively corrected due to the limited renal function caused by hypovolemia.

The presence of hematemesis, or vomiting of blood, in an individual with peptic ulcer disease suggests that there has been erosion of a large blood vessel. This is because the ulcer has caused damage to the blood vessel, leading to bleeding and subsequent vomiting of blood. Perforation, obstruction, and development of malignancy may also be complications of peptic ulcer disease, but they would not directly cause hematemesis.

Acute appendicitis is usually initiated by the obstruction of the lumen of the appendix. When the lumen becomes blocked, it can lead to the accumulation of mucus, bacteria, and stool, causing inflammation and infection in the appendix. This obstruction can occur due to various reasons such as the presence of fecal matter, enlarged lymphoid tissue, or even a tumor. If left untreated, the blocked appendix can lead to increased pressure, compromised blood flow, and eventually, tissue death. Therefore, the obstruction of the lumen is a common trigger for acute appendicitis.

Crohn's disease is a chronic inflammatory condition that primarily affects the gastrointestinal tract. The characteristic changes seen in Crohn's disease involve inflamed areas of the wall of the ileum, which is the last part of the small intestine. These inflamed areas can alternate with thick fibrotic or normal areas, leading to a patchy appearance. This pattern of inflammation and fibrosis can cause various symptoms such as abdominal pain, diarrhea, and weight loss. The other options mentioned in the question, such as degeneration and flattening of the villi, herniations of the mucosa, or continuous mucosal inflammation and ulceration in the rectum and colon, are not specific to Crohn's disease.

Inflammatory bowel disease refers to a group of disorders characterized by chronic inflammation of the digestive tract. The term "idiopathic" means that the cause of the disease is unknown. In the case of inflammatory bowel disease, the exact cause is still not fully understood. While physical and emotional stress, autoimmune reactions, and genetic factors may play a role in the development of the disease, none of these factors can be definitively identified as the sole cause. Therefore, the correct answer is idiopathic, indicating that the cause of inflammatory bowel disease is unknown.

Genetic and immunologic factors appear to have a role in the etiology of inflammatory bowel diseases. This suggests that certain genes and immune system abnormalities may contribute to the development of these diseases. It is important to note that while dietary factors and environmental toxins may also play a role, the question specifically asks for the factors that "appear" to have a role, indicating that genetic and immunologic factors are the most significant in this context. Chronic alcoholism, on the other hand, is not mentioned as a factor in the etiology of inflammatory bowel diseases.

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. It is commonly caused by sexually transmitted infections such as chlamydia and gonorrhea. If left untreated, the infection can spread from the fallopian tubes directly into the peritoneal cavity, which is the space surrounding the abdominal organs. This can lead to bacterial peritonitis, which is inflammation and infection of the peritoneum. Therefore, option c is the correct answer as it explains how PID frequently leads to bacterial peritonitis.

Choledocholithiasis refers to the obstruction of the biliary tract by gallstones. The term specifically refers to the presence of gallstones in the common bile duct, which is the tube that carries bile from the liver to the small intestine. This condition can lead to symptoms such as abdominal pain, jaundice, and digestive issues. Treatment usually involves the removal of the gallstones, either through medication or surgery, to relieve the obstruction and prevent further complications.

Ascites in patients with cirrhosis is primarily caused by portal hypertension, which leads to increased pressure in the portal vein and subsequent fluid accumulation in the peritoneal cavity. Increased aldosterone levels contribute to ascites by causing sodium and water retention, further exacerbating fluid accumulation. Additionally, cirrhosis often leads to a deficit of albumin, a protein responsible for maintaining oncotic pressure in the blood vessels. This deficit reduces the ability of the blood vessels to retain fluid, leading to its leakage into the peritoneal cavity and the development of ascites.

Long-term exposure to certain chemicals is a major cause of primary hepatocellular cancer. This type of cancer originates in the liver cells and is often associated with exposure to carcinogens such as aflatoxins, vinyl chloride, and arsenic. These chemicals can damage the DNA within the liver cells, leading to the development of cancerous cells. Other risk factors for hepatocellular cancer include chronic viral hepatitis B or C infection and alcohol abuse. Metastatic tumors, acute hepatitis, and chronic cholelithiasis are not primary causes of hepatocellular cancer.

Hepatitis B is a viral infection that primarily affects the liver. One of the main symptoms of hepatitis B is inflammation and enlargement of the liver. This occurs due to the immune response triggered by the virus, which causes damage to the liver cells. The inflammation and enlargement of the liver can lead to symptoms such as abdominal pain, jaundice, and fatigue. It is important to note that while the liver can regenerate, in some cases, chronic hepatitis B infection can lead to liver damage and scarring, which may impair the liver's ability to regenerate.

When a portion of the proximal stomach and the paraesophageal junction move above the diaphragm, it is called a sliding hernia. This occurs when the upper part of the stomach and the junction between the esophagus and stomach slide up into the chest through the diaphragm opening. This can cause symptoms such as heartburn, regurgitation, and difficulty swallowing. It is different from a rolling hernia, which involves a part of the stomach rolling up next to the esophagus. Dysphagia refers to difficulty swallowing, and pyloric stenosis is a condition where the opening between the stomach and small intestine becomes narrow.

Hirschsprung's disease refers to a congenital condition where there is a lack of innervation from the peripheral nervous system (PNS) in a segment of the colon. This lack of innervation leads to a loss of muscle movement in that segment of the colon, causing a functional obstruction. This can result in symptoms such as constipation, abdominal distension, and failure to pass stool in newborns and infants. Surgical intervention is often required to remove the affected segment of the colon and restore normal bowel function.

Post-gastrectomy patients frequently experience hypoglycemia 2-3 hours after meals. This is because the removal of the stomach reduces the production of the hormone gastrin, which is responsible for stimulating the release of insulin. Without sufficient insulin, blood sugar levels drop, leading to hypoglycemia. Symptoms of hypoglycemia include weakness, dizziness, sweating, and confusion. Prompt treatment with glucose or a sugary snack is necessary to raise blood sugar levels and prevent further complications.

Severe steady abdominal pain is a typical indicator of an intestinal obstruction caused by paralytic ileus. Paralytic ileus is a condition where there is a loss of normal bowel function, leading to a buildup of gas and fluids in the intestines. This can cause severe pain in the abdomen as the intestines become distended. The pain is usually constant and does not come and go like colicky pain. Excessive audible bowel sounds and visible peristalsis are more commonly associated with mechanical bowel obstructions, while intermittent colicky pain is seen in conditions like kidney stones or gallbladder issues.

Both HBV (Hepatitis B Virus) and HCV (Hepatitis C Virus) increase the risk of hepatocellular carcinoma. This is because chronic infection with these viruses can lead to inflammation and damage to the liver, which can eventually progress to liver cancer. Hepatocellular carcinoma is one of the most common types of liver cancer, and individuals with chronic HBV or HCV infection are at a higher risk of developing this cancer compared to those without these infections.

Jaundice usually develops with hepatocellular carcinoma. This statement suggests that jaundice is often associated with liver cancer. It does not indicate permanent liver damage or that all individuals with hepatitis are jaundiced. It is not stated that jaundice is the first manifestation of hepatitis, so statement 1 is not necessarily true. Therefore, the correct answer is b. 4 only.

The characteristic rigid abdomen found in a patient with peritonitis is caused by inflamed peritoneum resulting in reflex abdominal muscle spasm. When the peritoneum becomes inflamed, it irritates the abdominal muscles, causing them to contract involuntarily in an attempt to protect the area. This reflex spasm leads to the rigidity and firmness of the abdomen. Increased fluid and gas can cause abdominal distention, but they do not specifically cause the characteristic rigidity seen in peritonitis. Inflammation of the peritoneum and organs may cause a firm mass, but it does not explain the rigid abdomen. Voluntary contraction of the abdominal muscles is not a mechanism involved in peritonitis.

Peptic ulcers are most commonly found in the proximal duodenum, which is the beginning of the small intestine. The acidic digestive juices in the stomach can damage the lining of the duodenum, leading to the formation of ulcers. The proximity of the duodenum to the stomach makes it more susceptible to the effects of these digestive juices. Additionally, the presence of certain bacteria, such as Helicobacter pylori, can also contribute to the development of peptic ulcers in the duodenum.

Decreased vagal stimulation does not decrease the resistance of the mucosal barrier in peptic ulcer disease. Vagal stimulation actually increases the production of gastric acid and can contribute to the development of peptic ulcers. Prolonged vasoconstriction, excessive glucocorticoid intake, and proteases and cytotoxins from H. pylori are all factors that can decrease the resistance of the mucosal barrier and contribute to the development of peptic ulcers.

Anti-inflammatory medications such as ASA are not a common predisposing factor to gastric carcinoma. Gastric carcinoma is often associated with factors such as ingestion of smoked foods, genetic factors, and ingestion of foods preserved with nitrates. However, the use of anti-inflammatory medications like ASA is not typically considered a risk factor for developing gastric carcinoma.

During acute appendicitis, the appendix becomes inflamed. If left untreated, the inflammation can lead to necrosis, causing the appendiceal wall to become necrotic and weak. As a result, intestinal bacteria can escape through this weakened wall and enter the surrounding tissues, leading to localized peritonitis. This occurs before rupture because once the appendix ruptures, the bacteria can spread more widely throughout the abdomen, causing generalized peritonitis.

In acute pancreatitis, the activation and spread of proteolytic enzymes is the main cause of massive inflammation and necrosis. These enzymes, such as trypsin, are normally produced in the pancreas but become activated prematurely, leading to the digestion of pancreatic tissue. This activation can be triggered by various factors, such as alcohol abuse, gallstones, or certain medications. The spread of these enzymes can cause widespread inflammation and tissue damage, leading to the characteristic symptoms of acute pancreatitis.

Chemical peritonitis refers to inflammation of the peritoneum, which is the lining of the abdominal cavity. A perforated gall bladder can lead to chemical peritonitis because the bile and bacteria from the gall bladder can leak into the peritoneal cavity. This can result in the leakage of intestinal bacteria into the blood and the peritoneal cavity. This can lead to infection and inflammation in the abdominal cavity, causing symptoms such as abdominal pain, fever, and an elevated white blood cell count.

Post-hepatic jaundice is a condition that occurs when there is a blockage in the bile ducts, preventing the flow of bile from the liver to the intestines. This can result in the accumulation of bilirubin in the bloodstream. Pruritic skin, or itchy skin, is a common symptom of post-hepatic jaundice due to the buildup of bilirubin in the body. Additionally, light-colored stools can occur because the bile, which gives stools their normal brown color, is not able to reach the intestines. Dark-colored stools and urine are more commonly associated with pre-hepatic or hepatic jaundice. Increased serum levels of unconjugated bilirubin are seen in pre-hepatic and hepatic jaundice, not specifically post-hepatic jaundice. Loss of all metabolic functions is not directly related to post-hepatic jaundice.

Diverticulitis is a condition characterized by the inflammation or infection of small pouches called diverticula in the colon. The typical pain associated with diverticulitis is located in the lower left quadrant of the abdomen. This pain is often described as a constant, dull ache or cramping sensation. It may also be accompanied by other symptoms such as fever, nausea, changes in bowel habits, and tenderness in the affected area. The pain in the lower left quadrant is a result of the inflammation and infection in the diverticula, which can cause localized discomfort.

Partial obstruction of the sigmoid colon resulting from diverticular disease would likely result in a small, hard stool. Diverticular disease is characterized by the formation of small pouches or sacs in the colon, known as diverticula. When these diverticula become inflamed or infected, it can lead to partial blockage of the colon. This obstruction can make it difficult for stool to pass through, resulting in a smaller and harder stool. Other symptoms of diverticular disease may include abdominal pain, bloating, and changes in bowel habits, but severe colicky pain and frequent diarrhea are less likely to be associated with a partial obstruction.

During the icteric stage of viral hepatitis, hepatomegaly (enlarged liver), elevated serum liver enzymes, and lighter-colored stools are commonly present. However, esophageal varices are not typically associated with this stage of the disease. Esophageal varices are enlarged veins in the lower part of the esophagus that can occur in advanced liver disease, such as cirrhosis, but are not specific to viral hepatitis.

Prolonged severe vomiting leads to a loss of stomach acid, resulting in metabolic alkalosis. This causes a decrease in bicarbonate ion levels. Additionally, the loss of stomach acid leads to a decrease in the production of carbon dioxide, resulting in a decrease in PCO2 levels. The decrease in bicarbonate ion and PCO2 levels causes a decrease in serum pH, resulting in acidemia. Therefore, the expected changes in arterial blood gases with prolonged severe vomiting are decreased bicarbonate ion, decreased PCO2, and serum pH 7.35.

In acute pancreatitis, inflammation and increased vascular permeability of the peritoneum can lead to chemical peritonitis and shock. This occurs because the inflammation and increased permeability affect fluid balance in the peritoneum, causing fluid to leak into the peritoneal cavity. This fluid accumulation can lead to peritonitis, which is inflammation of the peritoneum. Additionally, the fluid imbalance can result in decreased blood volume and hypovolemic shock.

Deficiencies of vitamins A, D, and K occur in patients with cirrhosis primarily because of decreased production of bile for absorption. The liver plays a crucial role in the production of bile, which is necessary for the absorption of these vitamins. In cirrhosis, the liver becomes damaged and its ability to produce bile is impaired. As a result, the absorption of vitamins A, D, and K is compromised, leading to deficiencies in these vitamins.