Exam

Name___________________________________

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 23.1

Using Figure 23.1, match the following:

1) Mucosa. 1)

2) Duodenal glands found here. 2)

3) Smooth muscle layer. 3)

4) MALT found here. 4)

5) Serosa. 5)

6) Area of the lamina propria. 6)

7) Continuation of the mesentery. 7)

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Figure 23.2

Using Figure 23.2, match the following:

8) Absorptive cells that line the intestinal tract. 8)

9) Cell type specialized to secrete mucus into the lumen of the intestinal tract. 9)

10) Structures that increase the absorptive area of the small intestine. 10)

11) Wide lymph capillary located in the villus. 11)

12) Paneth cells are found here. 12)

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MATCHING. Choose the item in column 2 that best matches each item in column 1.

Match the following:

13) Wavelike smooth muscle contractions A) Hydrolysis

13)
that move foodstuffs through the
alimentary tube. B) Absorption

14) Chemical or mechanical process of C) Digestion 14)

breaking down foodstuffs into simpler
units.
D) Peristalsis

15) Enzymatic breakdown of any type of

15)
food molecule.

16) Process by which simpler chemical

16)
units pass through the lumen of the
gastrointestinal tract into the blood or
lymph.

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SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 23.3

Using Figure 23.3, match the following:

17) Produces enzymes that break down all categories of foodstuffs. 17)

18) Increases surface area for absorption via villi and microvilli. 18)

19) Bacteria process undigested chyme from the small intestine. 19)

20) Only digestive structure with three muscle layers. 20)

21) Receives blood via the hepatic portal system. 21)

22) Contains the brush border enzymes that complete digestion of carbohydrates and 22)
proteins.

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 23) Main function is to filter and process the nutrient-rich blood delivered to it. 23)

24) Produces intrinsic factor. 24)

25) Produces a mucoid barrier to prevent self-digestion. 25)

MATCHING. Choose the item in column 2 that best matches each item in column 1.

Match the following:

26) Increases output of enzymatic-rich A) Secretin

26)
pancreatic juice.
B) Gastric inhibitory peptide
27) Increases output of pancreatic juice
27)
rich in bicarbonate ions. C) Cholecystokinin

28) Increases HCl secretion and stimulates D) Gastrin 28)

contraction of intestinal muscle.

29) Stimulates insulin release and mildly

29)
inhibits HCl production.

TRUE/FALSE. Write 'T' if the statement is true and 'F' if the statement is false.

30) The relatively unchanging pressure in a filling stomach is due to the contraction of the stomach 30)
oblique muscle layer.

31) The circular folds of the small intestine enhance absorption by causing the chyme to spiral, rather 31)
than to move in a straight line, as it passes through the small intestine.

32) Gastric accommodation is an example of smooth muscle plasticity. 32)

33) Food often contains bacteria, but the HCl of the stomach is effective in killing most ingested 33)
microbes.

34) Stellate macrophages are found in the liver and are responsible for removing bacteria and 34)
worn-out cells.

35) The pharyngeal-esophageal phase of swallowing is involuntary and is controlled by the 35)
swallowing center in the thalamus and lower pons.

36) All the chemical and mechanical phases of digestion from the mouth through the small intestine 36)
are directed toward changing food into forms that can pass through the epithelial cells lining the
mucosa into the underlying blood and lymphatic vessels.

37) Pepsinogen is the precursor to the gastric enzyme for protein digestion and is secreted by the 37)
parietal cells.

38) The only essential function of the stomach is to begin the digestion of proteins. 38)

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39) The major role of absorption in the ileum is to reclaim bile salts to be recycled back to the liver. 39)

40) The peritoneum is the most extensive serous membrane in the body. 40)

41) Peyer's patches are primarily found in the submucosa of the duodenum. 41)

42) The submucosal nerve plexus provides the major nerve supply to the GI tract wall and controls GI 42)
motility.

43) The major means of propulsion through the alimentary canal is peristalsis. 43)

44) Dentin anchors the tooth in place. 44)

45) The digestive function of the liver is to produce digestive enzymes. 45)

46) The pancreas has both an endocrine and an exocrine function. 46)

47) Another term for swallowing is deglutition. 47)

48) The splanchnic circulation refers to the arteries that serve the digestive organs and the veins that 48)
carry blood from the digestive organs to the liver.

49) The stomach's contractile rhythm is set by pacemaker cells found in the spinal cord. 49)

50) The major stimulus for production of intestinal fluid is distention or irritation of the intestinal 50)
mucosa by hypertonic or acidic chyme.

51) Most nutrients are absorbed through the mucosa of the intestinal villi by active transport. 51)

52) Severe diarrhea can diminish potassium ion absorption. 52)

53) Mumps is an inflammation of the parotid glands caused by myxovirus. 53)

54) Fats significantly delay the emptying of the stomach through hormonal and neuronal signals. 54)

55) The soft palate reflexively opens the nasopharynx to allow the passage of food, which is now 55)
called a bolus.

56) When swallowing, the glottis covers the epiglottis. 56)

57) Most gastric ulcers are due to excessive production of hydrochloric acid. 57)

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MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

58) The enterohepatic circulation reabsorbs bile salts in the distal portion of the small intestine (ileum). 58)
All of the following statements about the enterohepatic circulation are true except one. Select the
statement below that is NOT true of the enterohepatic circulation?
A) Reabsorption of bile salts reduces the need to synthesize new bile salts.
B) The reabsorption of bile salts allows them to be reused within new bile.
C) All of the components of bile are recycled by this circulation.
D) Reabsorbing bile salts in the ileum gives more time to emulsify lipid and aid in their
absorption within a greater length of the small intestine.

59) Which of the following is the best illustration of the difference between metabolism and digestion? 59)
A) Digestions must happen first for metabolism to follow it.
B) Digestion has a wide variety of chemical reactions while metabolism is restricted to only a
few reaction types.
C) Metabolism comprises all of the chemical reactions preformed within the body while
digestion is only the breakdown of food within the GI tract.
D) Digestion requires enzymes for it to take place while metabolism does not necessarily need or
use them.

60) Which of the following is least involved in the mechanical breakdown of food, digestion, or 60)
absorption?
A) the oral cavity B) the small ingestion
C) the esophagus D) large intestine

61) Which of the following would likely be absorbed in the stomach? 61)
A) a serving of alcohol B) a piece of candy
C) a serving of lean chicken breast D) a serving of pasta

62) Which of the following is the best explanation of the benefit in the digestive system having the 62)
largest collection of lymphoid tissue (MALT) at the distal end of the small intestine?
A) The alkaline secretions of the small intestine aid in the growth of bacteria and these bacteria
must be controlled.
B) The huge numbers of bacteria living in the large intestine must be prevented from entering
the lumen of the small intestine and being absorbed with food's nutrients into the blood
stream.
C) The body will actively excrete pathogens out of the body, into the digestive system, to be
removed from the body in feces.
D) The digestive systems first and foremost job is to digest and absorb nutrients so it puts off
immunity for last.

63) Bile salts break up the fat globule into smaller fat droplets. This role of bile salts is best described as 63)
________.
A) lipid digestion B) lipid emulsification
C) lipid ingestion D) lipid absorption

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64) A doctor consulting a patient that recently has had their gall bladder removed would likely advise 64)
________.
A) eating a low to no carb diet
B) eating foods that are low in fat
C) eating fewer, but larger meals
D) increasing unsaturated fats while eliminating trans fats in their diets

65) A ruptured appendix is life threatening because ________. 65)

A) it is likely to cause severe internal bleeding
B) the large intestine will no longer be able to receive digested material from the small intestine
C) it is likely to cause massive infection of the abdominopelvic cavity
D) loss of the appendix's function will cause an immune deficiency in the digestive system

66) All but one of the following is a function of the low pH found in the stomach. Select the 66)
description below that does NOT reflect a role of stomach acid.
A) The stomach's acid catabolically breaks down food stuffs in preparation for absorption.
B) Many potentially harmful bacteria will be prevented entry to the small intestine by stomach
acid.
C) Low pH converts pepsinogen to its active form of pepsin, preventing the protease enzyme
from digesting the cells that produce it.
D) Stomach acid denatures proteins making the poly peptide chain more accessible to pepsin
digestive enzymes.

67) Fat absorption through the plasma membrane of epithelial cells ________. 67)
A) requires vesicular, active transport of the relatively large fatty acids and monoglyceride
B) requires enzymes attached to the brush border to further breakdown the fats
C) occurs by simple diffusion because lipids are able to penetrate the hydrophobic fatty acid
tails within the plasma membrane
D) is accomplished by cotransporters that use the concentration gradient of Na + outside of the
cells

68) Select the best explanation for why protease enzymes are secreted in inactive forms. 68)
A) The immunoglobulins protecting the digestive tract would be digested without proper
regulation of protein digesting enzymes.
B) The enzymes would digest each other if they were not properly regulated.
C) The cells producing inactive enzymes are themselves protected from the enzymes until they
are safely within the lumen of the GI tract.
D) Inactive enzymes will simply be expelled with the feces if no protein is present in the
digesting food; this will help to conserve energy.

69) Select the description below that illustrates a difference between a sphincter and circular muscle. 69)
A) Sphincters are found throughout the GI tract while circular muscle is found only in the
proximal portion of the GI tract.
B) A sphincter is composed of smooth muscle while circular muscle is composed of skeletal
muscle tissue.
C) Sphincters are found in the proximal portion of the GI tract while circular muscle is found in
the distal portions.
D) A sphincter is a thickening of circular muscle that can prevent the movement of digesting
materials while circular muscle is involved in propulsion digesting material.

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70) In the enteric nervous system, a long reflexive pathway has an advantage over a short reflexive 70)
pathway in the fact that ________.
A) long reflexive pathways are quicker to respond than short reflexive pathways
B) long reflexive pathways can be stimulated by things outside of the GI tract
C) long reflexive pathways can respond throughout the entire length of the GI tract while short
reflexive pathways can only respond in the proximal end
D) long reflexive pathways last much longer than short reflexive pathways

71) The sight of food can trigger a series of events that results in the release of gastric juice. All but one 71)
of the following is true in regards to the previous statement. Select the one answer that is NOT
true.
A) This is an example of a long reflexive pathway.
B) The motor nerves of this pathway are part of the sympathetic division of the autonomic
nervous system.
C) The cerebral cortex, hypothalamus and medulla oblongata are all involved in processing the
stimulatory information.
D) This prepares the stomach for food before its arrival in the stomach.

72) All of the following are true of swallowing (deglutition) except one. Select the statement that is 72)
NOT true of swallowing.
A) The epiglottis assists in propelling food into the trachea.
B) The involuntary portion of swallowing takes place in the pharynx.
C) The voluntary phase of swallowing takes place within the mouth.
D) The mouth, pharynx and esophagus all take part in swallowing.

73) Some antacid drugs block histamine receptors, resulting in reduction of the production and 73)
excretion of stomach acid. These drugs have the biggest effect on which of the following?
A) mucous neck cells B) chief cells
C) parietal cells D) surface epithelial cells

74) Which of the following is NOT a function of cholecystokinin (CCK)? 74)

A) stimulate gall bladder to release bile B) open hepatopancreatic sphincter
C) increase production of stomach acid D) increase production of pancreatic juice

75) Generally, the hormones secretin and cholecystokinin which are released by duodenal 75)
enteroendocrine cells will ________.
A) increase the force of stomach contractions
B) increase stomach emptying
C) increase the release of digestive enzymes and bile
D) decrease the activities of the accessory digestive organs

76) Select the one response below that would NOT result from a drug that blocks histamine receptors 76)
in the cells lining the stomach.
A) It would cause the release of secretin and cholecystokinin.
B) It would reduce the symptoms of heartburn.
C) It would raise the pH of the stomach.
D) It would lower the activity of parietal cells.

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77) Specific enteroendocrine cells of the stomach, called G cells, are stimulated by partially digested 77)
proteins, caffeine, and rising pH. When stimulated, G cells secrete ________.
A) hydrochloric acid B) ghrelin
C) pepsin D) gastrin

78) The mechanical and chemical receptors that control digestive activity are located ________. 78)
A) in the glandular tissue that surround the organ lumen
B) in the pons and medulla
C) in the walls of the tract organs
D) in the oral cavity

79) The function of the hepatic portal circulation is to ________. 79)

A) collect absorbed nutrients for metabolic processing in the liver
B) return glucose to the general circulation when blood sugar is low
C) distribute hormones throughout the body
D) carry toxins to the kidney for disposal through the urinary tract

80) The chemical and mechanical processes of food breakdown are called ________. 80)
A) digestion B) absorption C) secretion D) ingestion

81) When we ingest large molecules such as lipids, carbohydrates, and proteins, they must undergo 81)
catabolic reactions whereby enzymes split these molecules. This series of reactions is called
________.
A) mechanical breakdown B) secretion
C) chemical digestion D) absorption

82) The sheets of peritoneal membrane that hold the digestive tract in place are called ________. 82)
A) mesenteries B) serosal lining C) lamina propria D) mucosal lining

83) From the esophagus to the anal canal, the walls of every organ of the alimentary canal are made up 83)
of the same four basic layers. Arrange them in order from the lumen.
A) submucosa, serosa, muscularis externa, and mucosa
B) muscularis externa, serosa, mucosa, and submucosa
C) mucosa, submucosa, muscularis externa, and serosa
D) serosa, mucosa, submucosa, and muscularis externa

84) Which of the following is NOT a factor that helps create the stomach mucosal barrier? 84)
A) secretion of pepsinogen
B) replacing of damaged epithelial mucosa cells
C) tight junctions of epithelial mucosa cells
D) thick coating of bicarbonate-rich mucus

85) What part of the tooth bears the force and resists the friction of chewing? 85)
A) crown B) pulp C) enamel D) cementum

86) The capillaries that nourish the epithelium and absorb digested nutrients lie in the ________. 86)
A) adventitia B) submucosa C) serosa D) lamina propria

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87) Choose the incorrect statement regarding bile. 87)
A) Bile functions to carry bilirubin formed from breakdown of worn-out RBCs.
B) Bile functions to emulsify fats.
C) Bile is both an excretory product and a digestive secretion.
D) Bile contains enzymes for digestion.

88) The absorptive effectiveness of the small intestine is enhanced by increasing the surface area of the 88)
mucosal lining. Which of the following accomplish this task?
A) the rugae and haustra B) the vast array of digestive enzymes
C) villi, and microvilli D) Brunner's glands and Peyer patches

89) Select the statement that is true concerning primary teeth. 89)
A) There are 20 primary teeth, and by 24 months of age, most children have all 20.
B) There are 32 primary teeth, and by 36 months of age, most children have all 32.
C) There are 24 primary teeth, and no new primary teeth appear after 13 months.
D) There are 27 primary teeth, and the molars are permanent.

90) Which of the following is true concerning the number and type of permanent teeth? 90)
A) There are 32 permanent teeth, and the wisdom teeth are the last to emerge.
B) The number of upper permanent teeth is not equal to the number of lower permanent teeth.
C) The number of permanent teeth is always equal to the number of primary teeth.
D) There are 27 permanent teeth, and the first molars are usually the last to emerge.

91) Which of the following is NOT true of saliva? 91)

A) contains enzymes that begin the breakdown of carbohydrates
B) contains acids which aid in chemical digestion
C) moistens food and aids in compacting of the bolus
D) cleanses the mouth

92) Which of the following is NOT found in saliva? 92)

A) protease B) electrolytes
C) lysozyme D) urea and uric acid

93) The bolus is liquefied in the ________ and it is now called chyme. 93)
A) esophagus B) stomach C) mouth D) small intestine

94) Peristaltic waves are ________. 94)

A) segmental regions of the gastrointestinal tract
B) churning movements of the gastrointestinal tract that aid in mechanical breakdown of chyme
C) waves of muscular contractions that propel contents from one point to another
D) pendular movements of the gastrointestinal tract

95) Pepsinogen, an inactive digestive enzyme, is secreted by the ________. 95)

A) Brunner's glands in the duodenum B) parietal cells of the stomach
C) chief cells of the stomach D) goblet cells of the small intestine

96) You have just eaten a meal high in complex carbohydrates. Which of the following enzymes will 96)
help to digest the meal?
A) trypsin B) cholecystokinin C) gastrin D) amylase

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 97) The ducts that deliver bile and pancreatic juice from the liver and pancreas, respectively, unite to 97)
form the ________.
A) hepatopancreatic ampulla B) pancreatic acini
C) bile canaliculus D) portal vein

98) Short-chain triglycerides found in foods such as butterfat molecules in milk are split by a specific 98)
enzyme in preparation for absorption. Which of the following enzymes is responsible?
A) lipase B) pepsin C) chymotrypsin D) amylase

99) Hepatocytes do NOT ________. 99)

A) store fat-soluble vitamins B) produce digestive enzymes
C) process nutrients D) detoxify toxic chemicals

100) Which vitamin requires intrinsic factor in order to be absorbed? 100)

A) C B) K C) A D) B12

101) Gastric pits, as opposed to gastric glands, are completely lined with ________. 101)
A) parietal cells B) mucous cells
C) chief cells D) enteroendocrine cells

102) Chemical digestion reduces large complex molecules to simpler compounds by the process of 102)
________.
A) excretion B) anabolism C) catabolism D) mastication

103) The ________ contains lobules with sinusoids (lined with macrophages) that lead to a central 103)
venous structure.
A) stomach B) liver C) spleen D) pancreas

104) Digestion and absorption of which of the following would be affected the most if the liver were 104)
severely damaged?
A) carbohydrates B) proteins C) lipids D) starches

105) The dental formula for an adult is 2-1-2-3. What does the 1 stand for? 105)
A) premolar tooth B) canine tooth C) molar tooth D) incisor tooth

106) The lamina propria is composed of ________. 106)

A) dense regular connective tissue B) dense irregular connective tissue
C) reticular connective tissue D) loose connective tissue

107) Which of the following is (are) NOT important as a stimulus in the gastric phase of gastric 107)
secretion?
A) carbohydrates B) low acidity C) distention D) peptides

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108) The function of goblet cells is to ________. 108)
A) produce mucus that protects parts of the digestive organs from the effects of powerful
enzymes needed for food digestion
B) secrete buffers in order to keep the pH of the digestive tract close to neutral
C) provide protection against invading bacteria and other disease -causing organisms that enter
the digestive tract in food
D) absorb nutrients from digested food and store them for future use

109) Which of the following is an essential role played by large intestine bacteria? 109)
A) absorb bilirubin B) synthesize vitamins C and D
C) synthesis of vitamin K D) produce gas

110) Nervous control of gastric secretion is provided by ________. 110)

A) somatic neurons in the spinal cord
B) the rubrospinal tracts
C) the reticulospinal and vestibulospinal tracts
D) the vagus nerve and enteric plexus

111) Which of the following are types of papillae on the tongue that contain taste buds? 111)
A) palatine and circumvallate B) circumvallate and filiform
C) fungiform, circumvallate, and filiform D) fungiform and circumvallate

112) Which of the following produce intrinsic factor? 112)

A) enteroendocrine cells B) zymogenic cells
C) parietal cells D) mucous neck cells

113) Which of the following enzymes would be most active in the presence of high concentrations of 113)
protein fragments?
A) trypsin B) amylase C) dextrinase D) lipase

114) A child with restricted tongue movement may have a surgery that involves the cutting of the 114)
________.
A) lingual frenulum B) palatine tonsils
C) terminal sulcus D) uvula

115) Which of the following is NOT characteristic of the large intestine? 115)
A) It exhibits external muscular bands called teniae coli.
B) It has pocket-like sacs called haustra.
C) It does not contain villi.
D) It is longer than the small intestine.

116) What stomach secretion is necessary for normal hemoglobin production in RBCs? 116)
A) gastric lipase B) HCl C) pepsinogen D) intrinsic factor

117) Select the correct statement about the regulation of gastric secretion. 117)
A) The presence of food in the stomach prevents hormonal control of gastric secretion.
B) Gastric secretion can be stimulated before food has entered the mouth.
C) Vagus stimulation of the stomach results in decreased secretion of gastric juice.
D) Gastric secretion is enhanced by very low pH (below a pH of 2).

13
 118) Paneth cells ________. 118)
A) secrete bicarbonate ions B) secrete enzymes that kill bacteria
C) secrete hormones D) secrete digestive enzymes

119) Select the correct statement about absorption. 119)

A) Carbohydrates diffuse across the mucosal endothelium and are then actively transported into
blood capillaries.
B) In the rare case that intact, whole proteins are transported across the mucosal endothelium,
an immune response may be generated.
C) Amino acid transport is linked to chloride transport.
D) Eighty percent of ingested materials have been absorbed by the end of the large intestine.

120) Which is NOT true of lipid absorption? 120)

A) Fatty acids and monoglycerides are packaged with proteins to form chylomicrons.
B) Fatty acids and monoglycerides are absorbed passively by diffusion.
C) Products of lipid digestion are transported to the blood by the lymphatic system.
D) Enterocytes require the presence of lipoprotein lipase to effectively absorb micelles.

121) The ingestion of a meal high in fat content would cause which of the following to occur? 121)
A) Increased production of trypsinogen.
B) Bile would be released from the gallbladder to emulsify the fat in the duodenum.
C) This type of food would cause secretion of gastrin to cease, resulting in faster gastric
emptying.
D) The acid secretions from the stomach would be sufficient to digest this food but may cause
heartburn.

122) Hormones or paracrines that inhibit gastric secretion include ________. 122)
A) secretin B) histamine C) gastrin D) ACh

123) Which of these is NOT part of the splanchnic circulation? 123)

A) inferior vena cava B) hepatic portal vein
C) superior mesenteric artery D) celiac artery

124) Which of these is NOT a component of saliva? 124)

A) defensins B) metabolic waste
C) lysozyme D) a cyanide derivative

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

125) The longest portion of the small intestine is the ________. 125)

126) The principal enzyme for breaking down carbohydrates is ________. 126)

127) Cells of the stomach that secrete HCl are ________ cells. 127)

128) The chief bile pigment is ________. 128)

129) Cells are found in the sinusoids of the liver that remove debris from the blood as it flows 129)
past are called ________ macrophages.

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 130) The part of the peritoneum that covers the external surfaces of most digestive organs is the 130)
________ peritoneum.

131) The ________ ligament anchors a tooth in the alveolus of the jaw. 131)

132) The ________ phase of gastric secretions occurs when food enters the stomach. 132)

133) The protective outermost layer of the esophagus is the ________. 133)

134) Compare and contrast the structure and function of a premolar and a molar. 134)

135) What are chylomicrons? 135)

136) What is heartburn and what causes it? 136)

137) Name two regions of the digestive tract where mechanical food breakdown processes are 137)
very important. Name two organs that are primarily food conduits. Name the organ
where protein digestion is begun. Name the organ where fat digestion begins.

138) Define constipation and diarrhea. Note possible causes of each. 138)

139) Assume you have been chewing a piece of bread for 5 or 6 minutes. How would you 139)
expect its molecular chemistry to change during this time? Why?

140) Your friend suffers from heartburn and was told that he should "stop drinking caffeinated 140)
coffee because it is acidic." Explain to your friend why this is good advice but explain the
mistaken facts to him.

141) Why is it necessary for the stomach contents to be so acidic? How does the stomach 141)
protect itself from digestion?

142) Identify three ways the small intestine is modified to increase the surface area for 142)
digestion and absorption.

143) How is digestive activity provoked after eating? What activates the secretion of digestive 143)
juices into the lumen or hormones into the blood?

144) How is salivation regulated? 144)

145) What is bile and where is it produced? What is its digestive function? Where is it stored 145)
and concentrated?

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

146) 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 likely diagnosis and treatment?

15
147) 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.

148) Sami has been hospitalized with acute gastritis. Her symptoms were epigastric pressure (just above the
stomach), headache, nausea, and vomiting with traces of old dark blood. 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?

149) 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.

150) 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?

151) 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.

152) A patient has esophageal cancer and must have a feeding tube inserted. The doctor 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 would the doctor say?

153) 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.

154) 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?

16
Answer Key
Testname: UNTITLED23

1) A
2) B
3) C
4) B
5) D
6) A
7) D
8) B
9) D
10) A
11) C
12) E
13) D
14) C
15) A
16) B
17) D
18) B
19) E
20) C
21) A
22) B
23) A
24) C
25) C
26) C
27) A
28) D
29) B
30) FALSE
31) TRUE
32) TRUE
33) TRUE
34) TRUE
35) FALSE
36) TRUE
37) FALSE
38) FALSE
39) TRUE
40) TRUE
41) FALSE
42) FALSE
43) TRUE
44) FALSE
45) FALSE
46) TRUE
47) TRUE
48) TRUE
49) FALSE
50) TRUE
17
Answer Key
Testname: UNTITLED23

51) TRUE
52) TRUE
53) TRUE
54) TRUE
55) FALSE
56) FALSE
57) FALSE
58) C
59) C
60) C
61) A
62) B
63) B
64) B
65) C
66) A
67) C
68) C
69) D
70) B
71) B
72) A
73) C
74) C
75) C
76) A
77) D
78) C
79) A
80) A
81) C
82) A
83) C
84) A
85) C
86) D
87) D
88) C
89) A
90) A
91) B
92) A
93) B
94) C
95) C
96) D
97) A
98) A
99) B
100) D
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101) B
102) C
103) B
104) C
105) B
106) D
107) A
108) A
109) C
110) D
111) D
112) C
113) A
114) A
115) D
116) D
117) B
118) B
119) B
120) D
121) B
122) A
123) A
124) D
125) ileum
126) amylase
127) parietal
128) bilirubin
129) stellate
130) visceral
131) periodontal
132) gastric
133) adventitia
134) Premolars have a broad crown with rounded cusps but have only one root except the first upper molars that often
have two. Molars also have broad crowns with rounded cusps but are larger than premolars. Molars have at least two
roots.
135) Chylomicrons are tiny fatty droplets composed of triglycerides, small amounts of phospholipids, cholesterol, free fatty
acids, and some protein that circulate in the blood but have not yet been reprocessed by the liver. These are picked up
by lacteals of the lymphatics which are then transported through the lymph vessels and eventually into the systemic
circulation via the lymphatic duct.
136) Heartburn is the discomfort felt in the chest area when the acidic gastric juices get regurgitated into the esophagus.
This may happen when someone has eaten or drunk too much, or it can be caused by extreme obesity or the
discomfort of pregnancy. It is related to weakness of the gastroesophageal sphincter, frequently associated with hiatal
hernia.
137) Mechanical food processes are very important in the mouth (mastication) and stomach (contractions causing mixing of
food into chyme). The esophagus and pharynx are primarily food conduits. Protein digestion begins in the stomach.
Fat digestion begins in the small intestine.

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Answer Key
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138) Watery stools are called diarrhea. Constipation is a condition in which too much water has been absorbed and the
stool becomes hard and difficult to pass. Any condition (such as irritation of the colon by bacteria) that rushes food
residue through the large intestine before that organ has had sufficient time to absorb the remaining water results in
diarrhea. Constipation may ensue from the lack of fiber in the diet, improper bowel habits, laxative abuse, or anything
that decreases motility.
139) The bread will begin to change as some of the starch is broken down into the sugar maltose due to the chemical
digestion of carbohydrates by salivary amylase.
140) Coffee's pH does not cause heartburn. However, caffeine can promote the release of gastrin hormone from G cells in
the stomach. Release of gastrin will result in the greater production of stomach acid that could worsen the pain of
heartburn.
141) HCl is necessary for the activation and optimal activity of pepsin, and it kills many of the bacteria ingested with food.
Mucous cells in the lining of the stomach secrete an alkaline mucus that clings to the stomach wall and helps to shield
it from the acid. The epithelial cells of the mucosa are joined together by tight junctions that prevent gastric juice from
leaking into underlying tissue layers. Damaged epithelial cells are shed and quickly replaced by cell division.
142) The plicae circulares, villi, and microvilli are modifications of the small intestine for digestion and absorption. The
plicae circulares are circular folds of the mucosa and submucosa. They force chyme to move spirally through the
lumen. The villi are fingerlike projections of the mucosa. They increase the absorptive surface area. Microvilli are
projections of the plasma membrane of the absorptive cells of the mucosa that bear intestinal digestive enzymes. They
also increase surface area and enhance absorption.
143) Mechanoreceptors located in the walls of the gastrointestinal tract respond to stretching by the introduction of food
into the lumen. Likewise, chemoreceptors in the walls are able to respond to changes in solute concentration and pH
as well as the presence of substrates and end products of digestion.
144) When we ingest food, chemoreceptors and pressoreceptors in the mouth send signals to the salivatory nuclei in the
brain stem. The parasympathetic nervous system activity increases and motor fibers trigger the increase in serous,
enzyme-rich saliva.
145) Bile is an alkaline solution containing bile salts, bile pigments, cholesterol, neutral fats, phospholipids, and a variety of
electrolytes. It is produced in the liver. Its digestive function is to emulsify fats. It is stored and concentrated in the
gallbladder.
146) The most likely diagnosis is appendicitis. The accepted treatment is immediate surgical removal of the appendix. You
should rule out pregnancy if she is of child bearing age. Can be an OBGYN condition.
147) 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 muscle spasm from irritation or even worse, that he has developed a
stricture (narrowing) or cancer from prolonged neglect.
148) Gastritis is an inflammation of the mucosal lining of the stomach and is suspected because of the pain location,
accompanying symptoms, and ingesting of likely causative agents. He would likely confirm the diagnosis by doing an
upper GI endoscopy. 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 that destroy the alkaline mucus barrier,
particularly alcohol or salicylate.
149) 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 (low-fiber diet) 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, as evidenced by the pain and mass.
150) Heartburn and regurgitation from gastroesophageal reflux are the most common clinical manifestations of hiatal
hernia. This patient complained of heartburn. When the patient lies down, the hernia slides upward into the thoracic
cavity, which increases the discomfort.

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151) 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
doctor suspects a bleeding ulcer. Factors such as smoking and alcohol increase hypersecretion of hydrochloric acid
and low secretion of mucus.
152) 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.
153) Cirrhosis is a diffuse and progressive chronic scarring 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) occur because the portal blood cannot flow as
easily through narrowed, scarred canaliculi, leading to a backup of pressure (portal hypertension) that causes
increased filtration loss of fluid through intestinal capillary walls.
154) 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 called esophageal varices are small, include submucosal veins in the lower esophagus and gastric
cardia, and tend to burst when forced to carry large volumes of blood. Signs of their failure include vomiting blood.

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