Deck 14: Diseases of the Upper Gastrointestinal Tract

Question 1

The control of gastric secretions is accomplished through complementary actions of the nervous and endocrine systems and involves four major chemical messengers: acetylcholine, histamine, gastrin, and:

A) serotonin
B) nitric oxide
C) somatostatin
D) neurotensin
E) norepinephrine

Answer 1

C

Question 2

What is an example of a nutrition intervention recommended for stomatitis?

A) increase intake of carbonated beverages
B) consume no more than 2 alcoholic drinks per day
C) avoid extremes of hot or cold food temperatures
D) use alcohol-based mouth rinses to keep the mouth clean
E) avoid oral glutamine supplements

Answer 2

C

Question 3

Which is considered a true statement regarding hiatal hernia?

A) Most cases of hiatal hernia are considered type 2 (rolling).
B) Symptoms of hiatal hernia are similar to those of Crohn's disease.
C) Incidence of hiatal hernia decreases with age.
D) Pregnancy may increase the risk of hiatal hernia.
E) Surgery for hiatal hernia involves Roux-en-Y gastric bypass.

Answer 3

D

Question 4

Which activity may increase the risk of development of dental caries?

A) drinking liquid while eating
B) eating whole grain bread
C) chewing sugarless gum
D) sipping sugared beverages for prolonged periods
E) consuming fresh fruit

Question 5

Which of the following statements best describes the pharyngeal phase of swallowing?

A) It is the phase in which the involuntary swallowing reflux begins and the bolus is carried through the pharynx to the top of the esophagus.
B) It is the phase in which there is a rapid passage of large amounts of food into the small intestine.
C) It is the phase in which esophageal peristalsis carries the bolus through the esophagus and LES and into the stomach.
D) It is the phase in which the tongue moves the bolus to the back of the throat.
E) It is the phase in which the food is chewed and made into a bolus by the tongue, teeth, and mandible.

Question 6

Which of the following electrolytes are present in saliva?

A) potassium, sodium chloride, bicarbonate
B) sodium, calcium chloride, calcium
C) magnesium, iron, phosphate
D) phosphate, bicarbonate, potassium
E) iron, hydrogen chloride, magnesium

Question 7

What is an example of a change in gastrointestinal physiology that occurs with aging?

A) increased upper esophageal pressure
B) atrophy of the small intestine mucosa
C) enhanced excretion of hydrochloric acid in the stomach
D) increased incidences of diarrhea
E) overproduction of saliva in the mouth

Question 8

Which intervention is most appropriate for preventing "baby bottle tooth decay?"

A) taking a child to the dentist by the time he is 6 months old
B) weaning a child from the bottle by 24 months of age
C) removing a bottle from the child's mouth during sleep
D) brushing the baby's teeth at least once per week
E) offering juice instead of formula

Question 9

The innermost layer of the esophagus is called the:

A) muscle layer
B) mucosa
C) adventitia
D) secretory layer
E) submucosa

Question 10

A jaw fracture that results in multiple pieces of bone is called a:

A) comminuted fracture
B) open fracture
C) closed fracture
D) incomplete fracture
E) complete fracture

Question 11

Which medication is classified as a proton pump inhibitor?

A) Mylanta
B) Gaviscon
C) Pepcid AC
D) Nexium
E) Reglan

Question 12

Inflammation of the oral mucosa that is often associated with fungal infections or with herpes-like viruses is called:

A) stomatitis
B) gingivitis
C) cheilosis
D) glossitis
E) xerostomia

Question 13

Food storage occurs primarily in which part of the stomach?

A) corpus
B) antrum
C) fundus
D) pyloric canal
E) cardia

Question 14

Identify the chemical messenger that stimulates the production of hydrochloric acid.

A) gastrin
B) histamine
C) somatostatin
D) acetylcholine
E) dopamine

Question 15

A dietitian is providing nutrition information to a patient with a jaw fracture who has had a maxillomandibular fixation. Which type of food would the dietitian most likely tell the client to avoid?

A) rye bread
B) 2% milk
C) bananas
D) pasta
E) soft-cooked eggs

Question 16

Saliva is produced in the mouth by three pairs of salivary glands: the parotid, submandibular, and:

A) occipital
B) sublingual
C) supramandibular
D) lingual
E) maxillary

Question 17

Which of the following best describes a nutrition intervention for xerostomia?

A) using a dehumidifier at bedtime
B) avoiding sour and tart foods
C) adding extra sauces and gravies to foods
D) increasing intake of hot foods and fluids
E) limiting caffeine to three servings per day

Question 18

Which is an example of a factor that contributes to lower esophageal sphincter incompetence?

A) renal artery stenosis
B) increased secretion of aldosterone
C) cardiomyopathy
D) cigarette smoking
E) increased secretion of cortisol

Question 19

A patient with dysphagia aspirates food approximately 10% of the time while eating and has no cough reflex. According to the Dysphagia Severity Scale, which level of severity would this patient be classified as having?

A) 2
B) 3
C) 4
D) 5
E) 6

Question 20

Hydrochloric acid and intrinsic factor are secreted in the stomach by:

A) the pylorus
B) histamine
C) somatostatin
D) parietal cells
E) mucous cells

Question 21

A patient is has to undergo a procedure that involves passing a tube through the oral pharynx into the stomach. The barometric pressure is measured using a transducer. This procedure most accurately describes:

A) endoscopy
B) barium radiology study
C) esophageal manometry study
D) 24-hour pH monitoring
E) urea breath test

Question 22

LK is a 40-year-old female s/p gastric resection 2 weeks ago due to a perforated ulcer from complicated PUD. Prior to her surgery, she was experiencing severe pain and had an upset stomach. She is now complaining of persistent diarrhea after she eats.
Which foods would the dietitian most likely recommend?

A) scrambled eggs
B) chocolate milk
C) sausage
D) red wine
E) peanut butter

Question 23

Which of the following is a possible cause of xerostomia?

A) lying on bed immediately after meals
B) eating frequent and large meals
C) rinsing the mouth with a saline solution
D) taking drugs for cancer treatment
E) adding extra sauces and gravies to foods

Question 24

Which type of food would most likely be recommended during gastroparesis?

A) whole oats
B) prune juice
C) cheese
D) sushi
E) buttermilk

Question 25

The most common symptoms of gastroparesis are:

A) abdominal pain and hematemesis
B) nausea, vomiting, and postprandial fullness
C) abdominal distention, nausea, and flatulence
D) epigastric pain and blood in the stool
E) heartburn and food impaction

Question 26

Major innervation for the enteric nervous system is supplied by parasympathetic and sympathetic fibers of the autonomic nervous system.

Question 27

LK is a 40-year-old female s/p gastric resection 2 weeks ago due to a perforated ulcer from complicated PUD. Prior to her surgery, she was experiencing severe pain and had an upset stomach. She is now complaining of persistent diarrhea after she eats.
Which medication would most likely be prescribed for LK's condition?

A) clarithromycin
B) atorvastatin calcium
C) niacin
D) bevacizumab
E) amlodipine

Question 28

LK is a 40-year-old female s/p gastric resection 2 weeks ago due to a perforated ulcer from complicated PUD. Prior to her surgery, she was experiencing severe pain and had an upset stomach. She is now complaining of persistent diarrhea after she eats.
LK would most likely be at risk of which nutrient deficiency?

A) vitamin B₆
B) niacin
C) iron
D) potassium
E) phosphorus

Question 29

The most common symptom related to peptic ulcer disease is:

A) nausea
B) belching
C) epigastric pain
D) anorexia
E) vomiting

Question 30

What describes an appropriate nutrition intervention for a patient following gastric surgery?

A) instruct the patient to lie down after eating
B) increase progression to solid food to avoid dumping syndrome
C) reduce intake from six meals per day to three
D) supplement with folate and vitamin B₆
E) advise the patient to consume liquids with meals

Question 31

Which gastrointestinal condition is not associated with dysphagia?

A) dumping syndrome
B) achalasia
C) hiatal hernia
D) gastroparesis
E) GERD

Question 32

Which of the following describes the purpose of vagotomy?

A) enlargement of the pyloric sphincter
B) elimination of the cholinergic stimulation of the stomach
C) treatment of the jejunum in the small intestine
D) lowering the pressure on the lower esophageal sphincter
E) measurement of the pressure in the small intestine before and after a meal

Question 33

LK is a 40-year-old female s/p gastric resection 2 weeks ago due to a perforated ulcer from complicated PUD. Prior to her surgery, she was experiencing severe pain and had an upset stomach. She is now complaining of persistent diarrhea after she eats. Which nutritional recommendation would be most appropriate for LK?
Avoiding all desserts and sweets

A) restricting foods that irritate the gastric mucosa
B) allowing plenty of fluids with meals
C) eating 1-3 large meals each day
D) supplementing with folate and magnesium
E) "How . . .?"

Question 34

Which of the following describes the mechanism of action of metoclopramide in managing nausea?

A) blocking dopamine, which affects the vomiting center in the brain
B) increasing the effectiveness of other antiemetics
C) strengthening the pyloric sphincter to increase gastric emptying
D) reducing the effect of prostaglandins
E) blocking substance P in the brain, which has a direct effect on the vomiting center

Question 35

The most common surgical procedure used for refractory GERD is:

A) a videofluoroscopy swallowing procedure
B) the Roux-en-Y procedure
C) a gastroduodenostomy
D) the Nissen fundoplication
E) a partial gastrectomy with a reconstruction

Question 36

Which is considered a symptom of gastroesophageal reflux in infants?

A) constipation
B) increased food intake
C) dry mucous membranes
D) irritability
E) diarrhea

Question 37

LK is a 40-year-old female s/p gastric resection 2 weeks ago due to a perforated ulcer from complicated PUD. Prior to her surgery, she was experiencing severe pain and had an upset stomach. She is now complaining of persistent diarrhea after she eats.
What is the most likely cause of LK's persistent diarrhea?

A) hiatal hernia
B) dumping syndrome
C) dehydration
D) gastroesophageal reflux
E) gastroparesis

Question 38

The gold standard for diagnosis of gastroparesis is the:

A) upper GI endoscopy
B) endoscopic retrograde cholangiopancreatography (ERCP)
C) endoscopic ultrasound
D) esophagography test
E) scintigraphic gastric emptying test

Question 39

Which is a correct statement regarding late dumping syndrome?

A) It occurs 30-60 minutes after a meal.
B) It is especially common after eating protein.
C) It increases the risk of hypoglycemia.
D) It causes gas, cramping, and diarrhea.
E) It results in sweating, flushing, and dizziness.

Question 40

Which type of food would most likely be recommended during the recovery period after gastric surgery?

A) whole grains
B) potatoes without the skin
C) luncheon meat
D) chocolate milk
E) fruit juice

Question 41

Medications called _______________, which act to block the effect of acetylcholine, reduce the amount of saliva production as a major side effect.

Question 42

There is a strong association between obesity and gastroesophageal reflux disease.

Question 43

Zollinger-Ellison (ZE) syndrome is similar in symptoms to PUD but is typically unresponsive to standard therapy.

Question 44

Dysgeusia is the complete inability to taste; it is also called "mouth blindness."

Question 45

Major innervation for the enteric nervous system is supplied by parasympathetic and sympathetic fibers of the autonomic nervous system. Parasympathetic impulses are carried by the _______________.

Question 46

The post-gastrectomy diet encourages a well-balanced diet slightly higher in protein and fat.

Question 47

Control of gastric secretions is accomplished through complementary actions of the nervous and _______________ systems.

Question 48

For a patient with maxillomandibular fixation, all foods must be prepared so that each easily moves through a _______________.

Question 49

Several different types of bacteria commonly found in the mouth colonize the surface of the tooth to form plaque.

Question 50

Achalasia is a condition where the upper portion of the stomach protrudes through the esophagus into the thoracic cavity.

Question 51

The symptoms of eosinophilic esophagitis experienced by a patient depend on the phase of swallowing that is impaired.

Question 52

Medicines for high blood pressure and depression often are causes of xerostomia.

Question 53

The term _______________ refers to an individual without any teeth.

Question 54

_______________ is fissuring and scaling at the corners or angles of the mouth that may be a sign or symptom of riboflavin, folate, niacin, pyridoxine, vitamin B₁₂, or iron deficiency.

Question 55

Partially digested food in a semi-fluid state that enters the stomach and small intestine is called _______________.

Question 56

The Nissen fundoplication for treatment of refractory GERD involves taking the fundus of the _______________ and wrapping it around the lower esophagus.

Question 57

_______________ ingested when teeth are developing is incorporated into the structure of the enamel and protects it against the action of acids.

Question 58

The outer layer, or _______________, of tissue for the esophagus is connective tissue and has no additional outer covering.

Question 59

Pharyngeal and esophageal phases of swallowing take only 3-5 minutes under normal conditions.

Question 60

Most medications are absorbed in the _______________.

Question 61

_______________ is the rupture of the esophagus, and a _______________ is a tear of the lower esophageal sphincter caused by forceful vomiting.

Question 62

For those individuals who are unable to safely swallow or consume adequate nutrition orally because of dysphagia, _______________ feedings should be considered.

Question 63

Explain manifestations, clinical diagnosis, and treatment interventions of gastroesophageal reflux among infants.

Question 64

Type A gastritis is a condition most often related to _______________.

Question 65

List the seven functions of saliva in the oral cavity.

Question 66

_______________ is an inflammatory condition characterized by infiltration of eosinophils within the esophageal mucosa.

Question 67

List three examples each of dietary factors that increase the risk of dental caries and those that decrease the risk of dental caries.

Question 68

_______________ is a motility disorder characterized by an absence of or weakened peristalsis within the esophagus.

Question 69

Describe the process of swallowing as food moves from the oral cavity to the stomach; include the processes of the four phases of swallowing.

Question 70

Name four different types of diagnostic procedures that may be used in identifying upper GI pathology.

Question 71

Describe the process of a focused assessment of the upper gastrointestinal tract for a client, including relevant measurements and subjective data.

Question 72

Name the four chemical messengers in the stomach that are used to control gastric secretions.

Question 73

Discuss nutrition therapy used for jaw fracture; include examples of recommended foods.

Question 74

_______________ involves ulcerations of the gastric or duodenal mucosa that penetrate the submucosa.

Question 75

The cephalic (head) phase refers to release of _______________ and _______________ when stimulated by tasting, smelling, or even seeing food.

Question 76

Selective _______________ is a surgical procedure that eliminates innervations from the vagus nerve to parietal cells, resulting in decreased acid production and a decreased response to gastrin.

Question 77

The purposes of mastication are to break food down into smaller pieces, to mix food with saliva, and:

A) to move food from the front of the mouth to the pharynx
B) to regulate speech patterns
C) to facilitate an immune reaction
D) to provide antibacterial protection
E) to stimulate taste buds

Question 78

Describe the purpose of the National Dysphagia Diet, and list examples of foods to include from each level.

Question 79

Describe clinical manifestations of GERD.

Question 80

The dysplastic cellular changes associated with Barrett's esophagus are considered to be a precursor to _______________.