Chapter 23 The Digestive System Exam
1) Richard is told by his family doctor that he is bleeding from either the colon or the rectum, and he should see a specialist as soon as possible. Which specialist should he go see?
Answer: Richard should see a proctologist.
2) Mrs. Wong goes to the emergency room with the following symptoms: severe pain in the umbilical region, loss of appetite, nausea, and vomiting. While she was waiting to see a doctor, the pain moved to the lower right abdominal quadrant. What is the diagnosis and treatment?
Answer: The diagnosis is appendicitis. The accepted treatment is immediate surgical removal of the appendix.
3) Jose is brought to the emergency room complaining of a burning sensation in his chest, increased salivation, and difficulty in swallowing. He is having difficulty breathing and feels the presence of a "lump in his throat." The diagnosis is gastroesophageal reflux disease. Explain.
Answer: Gastroesophageal reflux disease is a disorder in which the rate of reflux is greater than in normal individuals and causes clinical symptoms and/or histological changes. Reflux and regurgitation may result in aspiration of gastric contents into the air passages, causing respiratory distress such as hoarseness, asthma, and pneumonia. The sensation of a lump in his throat may be due to esophageal sphincter pressure.
4) Sami has been hospitalized with acute gastritis. Her symptoms were epigastric pressure (just above the stomach), headache, nausea, and vomiting. She revealed that she had been suffering back pain and drank four shots of gin and took three aspirin to "kill the pain." What led the physician to make this diagnosis, and what may have caused the sudden attack?
Answer: Gastritis is an inflammation of the mucosal lining of the stomach. The probable reason for the abrupt onset of symptoms is due to rapid and heavy ingestion of alcohol and aspirin. Acute gastritis is often due to chemical irritants, particularly alcohol or salicylate.
5) A woman is brought to an emergency room complaining of severe pain in her left iliac region. She claims previous episodes and says that the condition is worse when she is constipated, and is relieved by defecation. A large, tender mass is palpated in the left iliac fossa and a barium study reveals a large number of diverticula in her descending and sigmoid colon. What are diverticula, and what is believed to promote their formation? Does this woman have diverticulitis or diverticulosis? Explain.
Answer: Diverticula are small herniations of the mucosa through the colon walls, a condition called diverticulosis. They are believed to form when the diet lacks bulk and the volume of residue in the colon is small. The colon narrows contractions of its circular muscles and they become more powerful, increasing the pressure on its walls. Diverticulitis is a condition in which the diverticula become inflamed. This woman has diverticulitis due to the inflammation of her diverticula.
6) A patient is 67 years old and has had a hiatal hernia for three years. In the last year, she has complained of worsening heartburn, especially at night. What are the characteristic symptoms of a hiatal hernia and which of these symptoms did the patient have?
Answer: Heartburn and regurgitation from gastroesophageal reflux are the most common clinical manifestations of hiatal hernia. This patient complained of heartburn.
7) A patient was admitted to the hospital because of severe epigastric pain. He has noted that his stools were darker than the usual brown color. He appears pale and very anxious. The history reports that he drinks 2-3 beers per day and smokes 2 packs of cigarettes a day. Based on the assessment data, what condition might the nurse determine this patient has? Explain why.
Answer: The patient most likely has a gastric ulcer. The most distressing symptom of a gastric ulcer is gnawing epigastric pain that seems to bore through to the back. The danger posed by ulcers is perforation of the stomach wall followed by peritonitis and massive hemorrhage. Because the patient's stools are darker than usual and he is pale and anxious, the nurse suspects a bleeding ulcer. Factors such as smoking and alcohol increase hypersecretion of hydrochloric acid and low secretion of mucus.
8) A patient has esophageal cancer and must have a feeding tube inserted. The nurse tells the patient that the tube will be inserted surgically into the duodenum. The patient's wife asks why the tube will not be inserted into the stomach. What should the nurse say?
Answer: The duodenum is part of the small intestine, which is the body's major digestive organ. Digestion is completed and absorption is best in the small intestine. There is also less risk for vomiting, which may cause complications.
9) A 45-year-old patient was admitted to the hospital with a diagnosis of cirrhosis of the liver. He is thin and malnourished. His abdomen is very large due to an accumulation of fluid in the abdominal cavity. His lower extremities are very swollen. Explain why these changes have occurred.
Answer: Cirrhosis is a diffuse and progressive chronic inflammation of the liver that typically results from chronic alcoholism or severe chronic hepatitis. Cirrhosis is characterized by extensive degeneration and destruction of the liver parenchymal cells. Edema and ascites (accumulation of fluid in the peritoneal cavity) are the clinical manifestations of the portal hypertension.
10) A 45-year-old patient was admitted to the hospital with a diagnosis of cirrhosis of the liver. The nurse is observing him closely for the possibility of gastrointestinal bleeding. Why is this considered a possible complication?
Answer: As scar tissue eventually shrinks, it obstructs blood flow throughout the hepatic portal system, causing portal hypertension. Some veins of the portal system anastomose with veins that drain into the venae cavae. However, these connecting veins are small and tend to burst when forced to carry large volumes of blood. Signs of their failure include vomiting blood.
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