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NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Scenario 3: Upper GI Bleed

A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.

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Question:

1.     What are the variables here that contribute to an upper GI bleed? 
Selected Answer: Bleeding within the GI tract itself is not a disease, but rather a symptom of a disease. This bleeding may be divided into upper and lower GI bleeding The gastrointestinal (GI) tract begins in the mouth and works its way down the esophagus, through the stomach, small and large intestines, and rectum, before terminating at the anus. Bleeding anywhere along this pathway may be acute or chronic and can be due to a host of factors.                                                                                                                                                                                          Bleeds from the upper GI tract are significant causes of morbidity and mortality and are much more common than lower GI bleeds. Important to note that mortality associated with upper GI bleeds is often because of comorbidities rather than the actual bleeding itself.

signs of upper GI bleed include Melena or dark, tarry stool that is almost black in color, pale skin, Nausea, vomiting blood, shortness of breath, sweating, alterations of consciousness, and epigastric and diffuse abdominal pain.

The major causes of upper GI bleeding include: peptic ulcer bleeding,  erosive esophagitis and erosive gastritis, esophageal inflammation due to acid reflux, esophageal varicies, or abnormally dilated vessels; typically seen in patients with portal hypertension and chronic liver disease and these patients are at an increased risk for hemorrhage. also, Mallory-Weiss syndrome (caused by violent coughing or vomiting; results in a tear of mucous membrane most commonly were stomach and esophagus meet).                                                                    Patients in shock due to trauma, sepsis, or organ failure can also have upper GI bleeds as a result of erosions occurring in the presence of decreased blood flow and altered acidity of the gastric lumen, and cancer.

Common risk factors for upper GI bleeding include:  prior upper GI bleeding, anticoagulant use, high-dose nonsteroidal anti-inflammatory drug use, and older age.

The most common conditions associated with lower GI bleeding include diverticulitis, infections, polyps, inflammatory bowel disease, hemorrhoids, anal fissures, and cancer.
Correct Answer: UGI bleeds can be caused by Peptic ulcer disease (PUD) which remains the most common cause of UGIB. Esophageal bleeding from a Mallory-Weiss tear (caused by repeated vomiting, retching, erosions of the mucosa), gastric carcinomas.
Response Feedback: [None Given]

In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:

  • Ulcers
  • Hepatitis markers
  • After HP shots
  • Gastroesophageal Reflux Disease
  • Pancreatitis
  • Liver failure—acute and chronic
  • Gall bladder disease
  • Inflammatory bowel disease
  • Diverticulitis
  • Jaundice
  • Bilirubin
  • Gastrointestinal bleed – upper and lower
  • Hepatic encephalopathy
  • Intra-abdominal infections (e.g., appendicitis)
  • Renal blood flow
  • Glomerular filtration rate
  • Kidney stones
  • Infections – urinary tract infections, pyelonephritis
  • Acute kidney injury
  • Renal failure – acute and chronic

Also Read:

What’s Coming Up in Module 4?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 4, you will analyze processes related to endocrine disorders. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, that may impact physiological functioning and altered physiology. NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

For some disorders, treatments can include surgery.

NURS 6501 Knowledge Check Gastrointestinal and Hepatobiliary Disorders

Gastrointestinal conditions, such as ulcers, diverticulitis, and pancreatitis, often cause varying levels of pain and discomfort. Hepatobiliary conditions can also bring significant changes to patient routines and well-being.

This week, you examine . You explore common disorders in these categories, and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.

Jenele, 

I would agree that females have a higher rate of experiencing severe respiratory issues than males regarding CF. Shum, et al. found specialized pro-resolving mediators (SPMs) were significantly lower in females than in males with CF; SPMs are cells that act as agonists and activate the resolution of inflammation (2022). With these being lower in women inflammation caused by dehydration of the respiratory system is increased causing greater severity of symptoms.  

From a genetic perspective, mutations in the CFTR are responsible for the expression of CF and there are 2065 variants of mutations of the CFTR as of 2019, according to the CF Mutation Database (Sharma & Cutting, 2020). With so many variants, the expression and severity of symptoms can also be determined by the mutations in specific variants.  

References 

Sharma, N., & Cutting, G. R. (2020). The genetics and genomics of cystic fibrosis. Journal of Cystic  Fibrosis, 19(Supplement 1), S5–S9.  

Shum, M., London, C. M., Briottet, M., Sy, K. A., Baillif, V., Philippe, R., Zare, A., Ghorbani-Dalini, S.,  Remus, N., Tarze, A., Escabasse, V., Epaud, R., Dubourdeau, M., & Urbach, V. (2022). CF patients’  airway eithelium and sex contribute to biosynthesis defects of pro-resolving lipids. Frontiers  in Immunology, 13, 915261.  

Learning Objectives

Students will:

  • Analyze concepts and principles of pathophysiology across the life span

Learning Resources

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

  • Chapter 38: Structure and Function of the Renal and Urological Systems including Summary Review
  • Chapter 39: Alteration of Renal and Urinary Function (stop at Fluids and electrolytes); Summary Review
  • Chapter 41: Structure and Function of the Digestive System (stop at Tests of digestive function); Summary Review
  • Chapter 42: Alterations of Digestive Function (stop at Cancer of the digestive track); Summary Review

Osna, N. A., Donohue, T. M., Jr., & Kharbanda, K. K. (2017). Alcoholic liver disease: Pathogenesis and current management. Alcohol Research: Current Reviews, 38(2), 7–21

Document: NURS 6501 Midterm Exam Review (PDF document)

 

Note: Use this document to help you as you review for your Midterm Exam in Week 6.

Required Media (click to expand/reduce)

Module 3 Overview with Dr. Tara Harris 

Dr. Tara Harris reviews the structure of Module 3 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check. (2m)

Liver Function Tests

MedCram. (2013, April 14). Liver function tests LFTs explained clearly by MedCram.com [Video file]. Retrieved from https://www.youtube.com/watch?v=bFdTgty0T0I

Note: The approximate length of the media program is 11 minutes.

Liver Diseases

MedCram. (2019, May 15). Diagnosis of key liver diseases: Hepatitis A, B C vs. alcoholic vs. ischemic (AST vs ALT labs) [Video file]. Retrieved from https://www.youtube.com/watch?v=ZZRHA2JvCGA

Note: The approximate length of the media program is 13 minutes.

Liver Pathophysiology

MedCram. (2013, April 9). Liver explained clearly: Pathophysiology, LFTs, hepatic diseases  [Video file]. Retrieved from https://www.youtube.com/watch?v=BTGkB8nOu7g

Note: The approximate length of the media program is 14 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 41 and 42 that relate to the hepatobiliary system. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at

Week 6 Knowledge Check: Endocrine Disorders

In the Week 6 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 4. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.

Also, during this week you will take your Midterm Exam. Please make sure to finalize and complete your Knowledge Check prior to completing your exam.

Next Module

To go to the next Module:

Module 4

 

  • Question 9

    1 out of 1 points

    A 65-year-old man with a history of atrial fibrillation presents to his PCP’s office 2 months after suffering from a myocardial infarction.  He declined anticoagulation due to fear he would bleed to death. He has had sudden-onset, moderately severe diffuse abdominal pain that began 18 hours ago. He has been vomiting, and he has had several episodes of diarrhea, the last of which was bloody. He has a fever of 100.9 ˚ F. CBC reveals WBC of 15,000/mm3.

    Question:

    What is the most likely mechanism behind his current symptoms?  
    Selected Answer:

    Mesenteric insufficiency particularly due to a thrombus in the superior mesenteric artery interferes with the flow of blood to the ascending colon and the small bowel. Obstructed blood flow causes mal perfusion with subsequent ischemia and infarction. In elderly patents, atherosclerosis is the primary risk factor that can cause the formation of a thrombus.
    Correct Answer:

    Thrombosis of the superior mesenteric artery, whether due to thrombotic or embolic origin, causes a sudden decrease or interruption in the primary blood flow to most of the small bowel as well as the ascending colon. This disruption leads © 2020 Walden University 6 to malperfusion of the involved end organ leading to ischemia and, ultimately, infarction. Elderly patients are at risk due to atherosclerosis which lead to thrombus formation. Embolic origins usually arise from cardiac arrythmias, usually atrial fibrillation, which leads to pooling of the blood in the atria.
    Response Feedback: [None Given]

  • Question 10

    1 out of 1 points

    A 46-year-old Caucasian female arrives at her PCP’s office complaining of severe, intermittent right upper quadrant pain for the last three days. The pain is described as sharp and radiates to her right shoulder after she ate french fries and cheeseburgers. She’s had a few bouts of vomiting “green stuff.” States had a fever and chills last night, prompting her visit to the office. She had some dark orange urine as well, but she assumed she was dehydrated.

    Physical examination reveals a slightly obese female with icteric sclera and generalized jaundice.

    Temperature 101 degrees Fahrenheit, pulse 108, and respirations 18

    The abdomen was rounded, with slightly hypoactive bowel sounds, according to the abdominal exam. + Right upper quadrant rebound tenderness on palpation There is no tenderness or rebound in the epigastrium or the other quadrants. WBC levels are elevated, as are serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). 2.5 mg/dl serum bilirubin (indirect). An abdominal ultrasound revealed an enlarged gall bladder, a dilated common bile duct, and multiple bile duct stones. The APRN diagnoses the patient with acute cholecystitis and refers her to the emergency department for further care.

    Question 1 of 2:

    Describe how gallstones are formed and why they caused the symptoms that the patient presented with. 
    Selected Answer:

    The formation of gallstones occurs from impaired metabolism f bile acids, cholesterol and bilirubin. When they accumulate, they form crystals and gradually form stones. The stones can either remain dormant or begin to move in the common and cystic ducts.
    Correct Answer:

    Gallstones are formed from impaired metabolism of cholesterol, bilirubin, and bile acids. Gallstones are always composed of cholesterol, unconjugated bilirubin, bilirubin salts, fatty acids, calcium carbonates and phosphates and mucin glycoproteins. Gallstones form in bile that is supersaturated and can begin the process of cholesterol crystal formation. More crystals aggregate thus enlarging and forming stones. These stones may lie dormant or start to move down the cystic or common bile duct. These stones can cause biliary stasis, bacterial infections, biliary parasites.
    Response Feedback: [None Given]

Module 4

Results Displayed All Answers, Submitted Answers, Correct Answers, Feedback, Incorrectly Answered Questions

Question 1

1 out of 1 points

Correct

The microvilli on the intestinal brush border contain what enzymes?
Selected Answer:
Correct

oligopeptides
Answers:
Correct

oligopeptides

amino acids

gastrin

amylase
Question 2

1 out of 1 points

Correct

Cells that secrete digestive proenzymes are called?
Selected Answer:
Correct

Pancreatic acinar cells
Answers:

Kupffer cells

Correct

Pancreatic acinar cells

Hepatocytes

Parietal cells
Question 3

1 out of 1 points

Correct

The plasma BUN level is an unreliable measure of renal function because:
Selected Answer:
Correct

BUN varies because of multiple factors such as dehydration and protein intake
Answers:

BUN has no relationship to renal function

Correct

BUN varies because of multiple factors such as dehydration and protein intake

Serum sodium levels increase the BUN falsely

Serum potassium levels render the BUN inaccurate as a measure of renal function.
Question 4

1 out of 1 points

Correct

The only manifestation of cystitis in an older adult may be development of:
Selected Answer:
Correct

confusion
Answers:
Correct

confusion

headache

pelvic pain

hypertension
Question 5

1 out of 1 points

Correct

Cirrhosis and hepatitis can cause:
Selected Answer:
Correct

intrahepatic portal hypertension
Answers:
Correct

intrahepatic portal hypertension

posthepatic portal hypertension

prehepatic portal hypertension

aortic portal hypertension
Question 6

1 out of 1 points

Correct

Cells that remove bacteria and foreign particles from blood in the hepatic sinusoids are called?
Selected Answer:
Correct

Kupffer cells
Answers:
Correct

Kupffer cells

Pancreatic acinar cells

Hepatocytes

Parietal cells
Question 7

1 out of 1 points

Correct

Cells that secrete hydrochloric acid and intrinsic factor are called?
Selected Answer:
Correct

Parietal cells
Answers:

Kupffer cells

Pancreatic acinar cells

Hepatocytes

Correct

Parietal cells
Question 8

1 out of 1 points

Correct

An alkaline urinary pH significantly increases the risk for what type of urinary stone formation?
Selected Answer:
Correct

calcium phosphate
Answers:

magnesium phosphate

uric acid

Correct

calcium phosphate

potassium phosphate
Question 9

1 out of 1 points

Correct

Sympathetic stimulation of the renal arterioles causes what reaction?
Selected Answer:
Correct

vasoconstriction
Answers:

fluid excretion

diuresis

vasodilation

Correct

vasoconstriction
Question 10

1 out of 1 points

Correct

Women who have symptoms of cystitis for more than 6 weeks with negative urine cultures may have:
Selected Answer:
Correct

interstitial cystitis
Answers:

aseptic cystitis

Correct

interstitial cystitis

septic cystitis

pyelonephritis
Question 11

1 out of 1 points

Correct

A patient with sudden onset of oliguria with elevated plasma BUN and plasma creatinine levels is experiencing classic symptoms of:
Selected Answer:
Correct

Acute kidney injury
Answers:

Renal cancer

Nephrotic syndrome

Calculus lodged in ureter

Correct

Acute kidney injury
Question 12

1 out of 1 points

Correct

A gastric enzyme that digests proteins is called __________________
Selected Answer:
Correct

Pepsin
Answers:

Trypsin

Amylase

Correct

Pepsin

Ptyalin
Question 13

1 out of 1 points

Correct

The decreased renal excretion of sodium and water is caused by what substance?
Selected Answer:
Correct

Anti diuretic hormone (ADH)
Answers:
Correct

Anti diuretic hormone (ADH)

Angiotenson

Amino acids

Natriuretic peptides
Question 14

1 out of 1 points

Correct

A patient with massive proteinuria, hypoproteinemia, hyperlipidemia, and edema is experiencing classic symptoms of:
Selected Answer:
Correct

Nephrotic syndrome
Answers:

Renal cancer

Correct

Nephrotic syndrome

Calculus lodged in ureter

Acute kidney injury
Question 15

0 out of 1 points

Incorrect

Which of these structures are located in the renal cortex?
Selected Answer:
Incorrect

Glomeruli, proximal tubules, and renal corpuscles
Answers:

Glomeruli, proximal tubules, and renal corpuscles

Glomeruli, distal tubules, and pyramids

Correct

Collecting ducts, distal tubules, and pyramids

Collecting ducts, proximal tubules, and renal corpuscles
Question 16

1 out of 1 points

Correct

A pancreatic enzyme that digests proteins is called ___________________
Selected Answer:
Correct

Trypsin
Answers:
Correct

Trypsin

Amylase

Pepsin

Ptyalin
Question 17

1 out of 1 points

Correct

A patient with hematuria, dull flank pain, weight loss and anemia in the late stages of the disease are experiencing classic symptoms of:
Selected Answer:
Correct

Renal cancer
Answers:
Correct

Renal cancer

Nephrotic syndrome

Calculus lodged in ureter

Acute kidney injury
Question 18

1 out of 1 points

Correct

A patient with severe colicky flank pain radiating to the groin, nausea and vomiting, and some hematuria is experiencing classic symptoms of:
Selected Answer:
Correct

Calculus lodged in ureter
Answers:

Renal cancer

Nephrotic syndrome

Correct

Calculus lodged in ureter

Acute kidney injury
Question 19

0 out of 1 points

Incorrect

Which of these structures are located in the renal medulla?
Selected Answer:
Incorrect

Collecting ducts, proximal tubules, and renal corpuscles
Answers:

Glomeruli, proximal tubules, and renal corpuscles

Glomeruli, distal tubules, and pyramids

Correct

Collecting ducts, distal tubules, and pyramids

Collecting ducts, proximal tubules, and renal corpuscles
Question 20

1 out of 1 points

Correct

Vitamin D is activated by the kidneys and is stimulated by what hormone?
Selected Answer:
Correct

parathyroid hormone
Answers:

calcitonin

ADH

Correct

parathyroid hormone

natriuretic peptides

Knowledge Check: Gastrointestinal and Hepatobiliary Disorders

Review Test Submission: Module 5 Knowledge Check

 

User
Course NURS-6501N-32-Advanced Pathophysiology-2021-Summer-QTR-Term-wks-1-thru-11-(05/31/2021-08/15/2021)-PT27
Test Module 5 Knowledge Check
Started 7/12/21 6:50 PM
Submitted 7/14/21 10:17 AM
Due Date 7/19/21 1:59 AM
Status Completed
Attempt Score 20 out of 20 points
Time Elapsed 39 hours, 27 minutes
Results Displayed All Answers, Submitted Answers, Correct Answers, Feedback, Incorrectly Answered Questions

  • Question 1

    1 out of 1 points

    Damage to an upper motor neuron will cause muscle ________________________
    Selected Answer:

    spasticity
    Answers:

    spasticity

    flaccidity

    tremor

    paralysis

  • Question 2

    1 out of 1 points

     Neurons need insulin in order to take in glucose.
    Selected Answer:

    False
    Answers:

    True

    False

  • Question 3

    1 out of 1 points

    Stimulation of the parasympathetic nervous system would cause:
    Selected Answer:

    Contraction of bladder detrusor muscle, bradycardia, and  increased salivation
    Answers:

     Increased diameter of pupils, dry mouth, and increased plasma free fatty acids

    Contraction of bladder detrusor muscle, bradycardia, and  increased salivation

    Decreased diameter of pupils, dry mouth, and decreased  plasma free fatty acids

    Relaxation of bladder detrusor muscle, tachycardia, and  increased salivation

  • Question 4

    1 out of 1 points

     Inflammation of the eyelid is  best described as:
    Selected Answer:

     Blepharitis
    Answers:

    Keratitis

     Blepharitis

    Chalazion

    Entropion

  • Question 5

    1 out of 1 points

    Neurons with cell bodies in the substantia nigra use _______________ as a neurotransmitter.
    Selected Answer:

    dopamine
    Answers:

    norepinephrine

    epinephrine

    dopamine

    serotonin

  • Question 6

    1 out of 1 points

    Muscle protein that stores oxygen is called:
    Selected Answer:

    Myoglobin
    Answers:

    Epiphysis

    Myoglobin

    Hyaluronate

    Diaphysis

  • Question 7

    1 out of 1 points

    Brain system that includes the amygdala, hippocampus, and thalamus is called:
    Selected Answer:

    Limbic
    Answers:

    Axon

    Dendrite

    Limbic

     Myelin

  • Question 8

    1 out of 1 points

    Damage to the cerebellum will cause what symptoms?
    Selected Answer:

    intention tremor and ataxic gait
    Answers:

    resting tremor and ataxic gait

    resting tremor and shuffling gait

    intention tremor and ataxic gait

    intention tremor and shuffling gait

  • Question 9

    1 out of 1 points

    Visual, sensory, or motor symptoms that may last up to an hour prior to the onset of a headache is called:
    Selected Answer:

    Migraine aura
    Answers:

    Headache phase

    Migraine aura

    Premonitory phase

    Recovery phase

  • Question 10

    1 out of 1 points

    Involuntary slow, twisting, writhing movement is called:
    Selected Answer:

     Athetosis
    Answers:

     Athetosis

     Apraxia

     Aphasia

    Agnosia

  • Question 11

    1 out of 1 points

    Which substances inhibit bone re absorption?
    Selected Answer:

    Osteoprotegerin (OPG) and  estrogen
    Answers:

    Osteoprotegerin (OPG) and  estrogen

    Prostaglandin E2 (PGE2) and  tumor necrosis factor-a (TNF-a)

    Osteoprotegerin (OPG) and t umor necrosis factor-a (TNF-a)

    Prostaglandin E2 (PGE2) and estrogen

  • Question 12

    1 out of 1 points

    A neuron extension that carries impulses toward the cell body is called:
    Selected Answer:

    Dendrite
    Answers:

    Axon

    Dendrite

    Limbic

     Myelin

  • Question 13

    1 out of 1 points

    Which of the following conditions are have an autoimmune cause?
    Selected Answer:

    Lichen planus and lupus erythematosus
    Answers:

    Lichen planus and lupus erythematosus

    Erysipelas and impetigo

     Tinea pedis and candidiasis

    Erysipelas and candidiasis

  • Question 14

    1 out of 1 points

    Impaired recognition of tactile, visual, or auditory stimuli is called:
    Selected Answer:

    Agnosia
    Answers:

     Athetosis

     Apraxia

     Aphasia

    Agnosia

  • Question 15

    1 out of 1 points

    Which of the following conditions are have a bacterial  cause?
    Selected Answer:

    Erysipelas and impetigo
    Answers:

    Lichen planus and lupus erythematosus

    Erysipelas and impetigo

     Tinea pedis and candidiasis

    Erysipelas and candidiasis

  • Question 16

    1 out of 1 points

    Immune defenses against bacteria and viruses are increased by:
    Selected Answer:

    fever
    Answers:

    platelets

    fever

    chills

    inflammation

  • Question 17

    1 out of 1 points

     Changes in the pupils are useful to evaluate  the function of what area of the brain?
    Selected Answer:

    brainstem
    Answers:

    grey matter

    corticol

    brainstem

    white matter

  • Question 18

    1 out of 1 points

    What brain structure is responsible for the thermoregulation and heat production in the body?
    Selected Answer:

    hypothalamus
    Answers:

    hypothalamus

    thalamus

    cerebellum

    pons

  • Question 19

    1 out of 1 points

    Inability to perform purposeful or skilled motor actions is called:
    Selected Answer:

     Apraxia
    Answers:

     Athetosis

     Apraxia

     Aphasia

    Agnosia

  • Question 20

    1 out of 1 points

    During what stage of sleep is growth hormone released?
    Selected Answer:

    slow-wave
    Answers:

    Stage N1

    REM sleep

    slow-wave

    Stage N2

Monday, March 14, 2022 6:44:11 AM EDT

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