Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 42: Alterations of Digestive FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Where in the brain is the vomiting center located?a. Hypothalamusb. Medulla oblongatac. Ponsd. MidbrainANS: BThe vomiting center of the brain lies in the medulla oblongata and includes the reticular formation, tractus solitarius nucleus, and the parabrachial nucleus. The other locations listed are not related to vomiting.PTS: 1 DIF: Cognitive Level: Remembering 2. Antiemetic agents, such as domperidone and metoclopramide, are antagonists for which receptors?a. 5-Hydroxytryptamine (5-HT) serotoninb. Histamine-2c. Acetylcholined. DopamineANS: DMetoclopramide and domperidone are dopamine antagonists, making them effective antiemetic agents.PTS: 1 DIF: Cognitive Level: Remembering 3. A patient in the clinic reports projectile vomiting without nausea or other gastrointestinal symptoms. What action by the healthcare professional is most appropriate?a. Provide antiemetic medications.b. Arrange a brain scan.c. Administer intravenous hydration.d. Schedule a GI consultation.ANS: BProjectile vomiting is caused by the direct stimulation of the vomiting center by neurologic lesions such as increased intracranial pressure, tumors, or aneurysms of the brainstem. The professional should arrange a CT scan or MRI of the brain. It can also be caused by gastric outlet obstruction, but the patient does not report pain which is a common finding in that condition, so a GI consultation is not warranted at this time. Antiemetics might be helpful but are not the priority. There is no indication that the patient is dehydrated, but if that were the case, hydration would be important.PTS: 1 DIF: Cognitive Level: Applying 4. A patient reports feeling constipated. When assessing this patient, how often should the patient report bowel movements to be considered within the normal range?a. Once a dayb. Once every 2 daysc. Once a weekd. Once every 2 weeksANS: CNormal bowel habits range from two or three evacuations per day to one per week.PTS: 1 DIF: Cognitive Level: Remembering 5. How many stools per day are considered the upper limits of normal?a. Twob. Threec. Fived. SevenANS: BMore than three stools per day are considered abnormal.PTS: 1 DIF: Cognitive Level: Remembering 6. The adult intestine processes approximately how many liters of luminal content per day?a. 3b. 6c. 9d. 12ANS: CThe adult intestine processes approximately 9 L of luminal content per day. Of this amount, 2 L is ingested and the remaining 7 L consists of intestinal secretions.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. A person who has cholera (Vibrio cholerae) would be expected to have which type of diarrhea?a. Osmoticb. Secretoryc. Small volumed. MotilityANS: BPrimary causes of secretory diarrhea are bacterial enterotoxins, particularly those released by cholera or strains of Escherichia coli, and neoplasms, such as gastrinoma or thyroid carcinoma. In osmotic diarrhea, a nonabsorbable substance in the intestine draws water into the lumen by osmosis and increases stool weight and volume, producing large-volume diarrhea. Small-volume diarrhea usually is caused by an inflammatory disorder of the intestine, such as ulcerative colitis, Crohn disease, or microscopic colitis. Excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption, resulting in diarrhea.PTS: 1 DIF: Cognitive Level: Remembering 8. What type of diarrhea is a result of lactase deficiency?a. Motilityb. Osmoticc. Secretoryd. Small-volumeANS: BMalabsorption related to lactase deficiency, pancreatic enzyme or bile salt deficiency, small intestine bacterial overgrowth, and celiac disease cause osmotic diarrhea. Excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption, resulting in diarrhea. Primary causes of secretory diarrhea are bacterial enterotoxins, particularly those released by cholera or strains of Escherichia coli, and neoplasms, such as gastrinoma or thyroid carcinoma. Small-volume diarrhea usually is caused by an inflammatory disorder of the intestine, such as ulcerative colitis, Crohn disease, or microscopic colitis.PTS: 1 DIF: Cognitive Level: Remembering 9. A professor has taught the students about the pathogenesis of abdominal pain. Which statement by a student indicates the professor needs to review the material?a. Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain.b. Edema and vascular congestion produce abdominal pain by stretching.c. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.d. Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.ANS: DLow concentrations of anaerobes are not typically a cause of abdominal pain. The professor would need to review this content if a student made that statement. The other statements are correct.PTS: 1 DIF: Cognitive Level: Evaluating 10. How can abdominal pain that is visceral in nature best be described?a. Diffuse, vague, poorly localized, and dullb. It travels from a specific organ to the spinal cord.c. The pain lateralizes from only one side of the nervous system.d. Associated with the peristalsis of the gastrointestinal tractANS: AVisceral pain arises from a stimulus (distention, inflammation, ischemia) acting on mechanical and chemical nociceptors of abdominal organs. Pain is usually felt near the midline in the epigastrium (upper midabdomen), midabdomen, or lower abdomen. The pain is poorly localized, is dull rather than sharp, and is difficult to describe.PTS: 1 DIF: Cognitive Level: Remembering 11. A patient asks the healthcare professional to describe the cause of gastroesophageal reflux disease (GERD). What response by the professional is best?a. Excessive production of hydrochloric acidb. Zone of low pressure of the lower esophageal sphincterc. Presence of Helicobacter pylori in the esophagusd. Reverse muscular peristalsis of the esophagusANS: BNormally, the resting tone of the lower esophageal sphincter maintains a zone of high pressure that prevents gastroesophageal reflux. In individuals who develop reflux esophagitis, this pressure tends
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