Question 1

Which of the following is NOT true for diet recommendations after Nissen fundoplication?&#10;A) Start with clear liquid diet.&#10;B) Advance to full liquid diet.&#10;C) Consume multiple, small meals.&#10;D) Avoid dry, hard foods.

Accepted Answer

Nissen fundoplication is a surgical treatment for severe reflux esophagitis. The fundus or top portion of the stomach is wrapped 360 degrees around the lower esophagus. Recommendations after surgery are to start with clear liquid and advance to small meals of soft, most foods. Dry, hard foods such as meat, nuts, rolls and bread, and raw fruits should be avoided for 3 to 6 months. A full liquid diet is no longer recommended.

Question 2

When an H₂ blocker is used in the treatment of peptic ulcer disease, the patient may be at risk for deficiency of which nutrient? A) Vitamin A B) Vitamin B₆ C) Vitamin B₁₂ D) Vitamin D

Accepted Answer

An H₂ blocker is used to decrease stomach acid production. This can result in the development of achlorhydria and the loss of intrinsic factor. Patients should be monitored for serum vitamin B₁₂ level to ensure that a deficiency in this vitamin does not develop.

Question 3

Which of the following is a condition involving the cells lining the distal esophagus becoming abnormal and premalignant?&#10;A) Gastroesophageal reflux disease&#10;B) Esophageal stricture&#10;C) Hiatal hernia&#10;D) Barrett esophagus

Accepted Answer

Barrett esophagus is partly responsible for the development of adenocarcinoma of the esophagus, although esophageal cancer may develop in the absence of Barrett esophagus. GERD is also a risk factor for esophageal cancer; however, the condition does not necessarily involve the histologic changes seen in Barrett esophagus. An esophageal stricture may result from a variety of conditions that lead to decreased esophageal tone and narrowing of the esophageal lumen. Hiatal hernia involves an outpouching of the stomach through the diaphragm.

Question 4

What symptoms of dumping syndrome follow the total or subtotal removal of the stomach?&#10;A) Nausea, abdominal cramping, and diarrhea&#10;B) Elevated blood pressure, headache, and substernal pain&#10;C) Heartburn, vomiting blood, and hypoglycemia&#10;D) Decreased saliva production, steatorrhea, and bloating

Accepted Answer

Signs and symptoms in the early stage of dumping syndrome include abdominal fullness and nausea within 10 to 20 minutes after eating, flushing, rapid heartbeat, faintness, and sweating. In the intermediate stage of dumping syndrome, 20 to 60 minutes after eating, symptoms include abdominal bloating, flatulence, cramping pains, and diarrhea. In the late stage, 1 to 3 hours after eating, patients experience reactive hypoglycemia, which is exhibited through sweating and feelings of anxiety, weakness, or hunger.

Question 5

A recommendation to a patient with gastroparesis who needs to gain weight would be:&#10;A) increase the amount of dietary fiber.&#10;B) ingest liquids or pureed foods.&#10;C) eat more high-fat foods.&#10;D) eat meals and avoid snacks.

Accepted Answer

Patients with gastroparesis often have preserved emptying of liquids, so shifting the diet to a more pureed and liquefied form is often useful. Fiber and fat slow gastric emptying and can therefore worsen symptoms. Small, frequent meals are often helpful.

Question 6

Which of the following dietary modifications minimize the problems associated with a gastrectomy with a vagotomy?&#10;A) Increasing carbohydrate intake, particularly simple sugars, and decreasing fat and protein&#10;B) Decreasing intake of liquids and simple sugars with meals&#10;C) Reducing the intake of fiber from fruits and vegetables&#10;D) Increasing the intake of milk at mealtimes and between meals

Accepted Answer

Dumping syndrome is a common problem that occurs after a gastrectomy with a vagotomy. Dietary management for dumping syndrome focuses on limiting hypertonic simple sugars, which can draw fluids into the gastrointestinal system and produce the side effects of the dumping syndrome. Because of the smaller stomach capacity and impaired control of gastric emptying, the intake of fluids with meals could promote rapid gastric emptying. A high-protein, moderate-fat diet including fibrous foods and complex carbohydrates is recommended. Patients may experience lactose intolerance after these surgeries; therefore, milk and dairy portions should be limited in quantity.

Question 7

What is the major difference between gastric and duodenal ulcers? A) Gastric ulcers can develop with low acid output, and duodenal ulcers develop with high acid secretion. B) Gastric ulcers develop with high acid secretion, and duodenal ulcers develop with low acid output. C) H. pylori is the primary cause of gastric ulcers. D) Gastric ulcers are treated with proton pump inhibitors, and duodenal ulcers are treated with H₂-receptor antagonists.

Accepted Answer

Because gastric ulcers occur most frequently along the lesser curvature of the stomach, they may develop even when acid secretion is decreased. Duodenal ulcers occur as a result of constant exposure to high acid secretion. H. pylori is involved with the development of both types of ulcers. Because the activity of both proton pump inhibitors and H₂-receptor antagonists is to decrease acid secretion, either may be used in the treatment of both gastric and duodenal ulcers.

Question 8

Which of the following is NOT one of the benefits of using pectin to manage dumping syndrome?&#10;A) Reduced upper gastrointestinal tract transit time&#10;B) Reduced glycemic load and decreased insulin response&#10;C) Increased glucose absorption and insulin response&#10;D) Slow carbohydrate absorption

Accepted Answer

Pectin and guar gums used in the treatment of patients with dumping syndrome provide the benefits of reducing upper GI transit time, slowing down or decreasing the rate of glucose absorption and the glycemic load, and decreasing the insulin response. A potential caution in regard to using pectin or bulk fiber sources is in regard to the development of intestinal obstructions from using large amounts.

Question 9

Treating esophagitis with cimetidine, a histamine H₂-receptor blocking agent, is effective because it A) provides a viscous protective barrier. B) decreases gastric acid production. C) increases LES pressure. D) promotes gastric emptying.

Accepted Answer

Cimetidine and ranitidine are two H₂-receptor blocking agents commonly used in the treatment of patients with gastrointestinal disorders. In the management of mild cases of esophageal reflux that results in esophagitis, these medications reduce gastric acid production. Sucralfate is a mucoprotective agent used in the treatment of patients with ulcer disease. Lifestyle and dietary management are used to promote LES pressure. Prokinetic agents are used to stimulate gastric emptying.

Question 10

Which of the following surgeries would be used to treat a patient with GERD?&#10;A) Billroth I&#10;B) Billroth II&#10;C) Fundoplication&#10;D) Roux-en-Y procedure

Accepted Answer

In a fundoplication surgery, the fundus of the stomach is wrapped around the lower esophagus to limit reflux. Billroth I, Billroth II, and the roux-en-Y procedure are different gastric surgeries that involve either gastrectomy or gastric partitioning.

Question 11

What type(s) of foods should be avoided in a patient with GERD because it(they) decrease(s) LES pressure?&#10;A) High-acid foods&#10;B) Low-fat milk and yogurt&#10;C) High-protein foods&#10;D) Peppermint

Accepted Answer

The answer of What type(s) of foods should be avoided...

Question 12

The gastrointestinal effects of smoking include&#10;A) reduction of LES pressure.&#10;B) lower duodenal pH.&#10;C) inhibition of pancreatic bicarbonate secretion.&#10;D) all of the above.

Accepted Answer

The answer of The gastrointestinal effects of smoking include&#10;A) reduction...

Question 13

Evaluation of which of the following should be included in the nutritional assessment of patients with atrophic gastritis? A) Essential fatty acid deficiency B) Vitamin B₆ status C) Vitamin B₁₂ status D) Iron deficiency anemia

Accepted Answer

The answer of Evaluation of which of the following should...

Question 14

What causes the hypoglycemia that occurs after meals in patients who have had a gastrectomy?&#10;A) Poor dietary intake&#10;B) Rapid digestion and absorption of sugars and elevation of insulin levels&#10;C) Pancreatic insufficiency&#10;D) Elevated levels of secretin and pancreozymin

Accepted Answer

The answer of What causes the hypoglycemia that occurs after...

Question 15

Which of the following contributes to nighttime GERD?&#10;A) Delayed gastric emptying&#10;B) Increased swallowing&#10;C) Decreased digestive secretions&#10;D) Increased saliva production

Accepted Answer

The answer of Which of the following contributes to nighttime...

Question 16

When a gastrectomy is performed with an accompanying vagotomy, what physiologic changes occur?&#10;A) Antral and pyloric dysfunction, poor peristalsis, and diminished gastric acid secretion&#10;B) Antral and pyloric dysfunction, poor peristalsis, and high gastric acid secretion&#10;C) Impaired digestion leading to the need for parenteral nutrition almost all the time&#10;D) Dysphagia because of a relaxed LES

Accepted Answer

The answer of When a gastrectomy is performed with an...

Question 17

Which of the following is NOT associated with dyspepsia?&#10;A) Diet&#10;B) Abnormal gastric emptying&#10;C) Being underweight&#10;D) Upper abdominal discomfort

Accepted Answer

The answer of Which of the following is NOT associated...

Question 18

A patient with gastroparesis may benefit by which of these drugs?&#10;A) Metoclopramide&#10;B) Aspirin&#10;C) Acarbose&#10;D) Simethicone

Accepted Answer

The answer of A patient with gastroparesis may benefit by...

Question 19

Which of the following statements is NOT associated with Helicobacter pylori?&#10;A) H. pylori increases the risk of atrophic gastritis and gastric cancer.&#10;B) H. pylori is a viral infection found in the intestine.&#10;C) H. pylori is a bacterial infection found in the gastric mucosa.&#10;D) H. pylori infection may be treated with antibiotics and acid suppression therapies.

Accepted Answer

The answer of Which of the following statements is NOT...

Question 20

Which factor has been associated with developing gastric cancer?&#10;A) Smoking&#10;B) Obesity&#10;C) A diet high in salt and fat&#10;D) All of the above

Accepted Answer

The answer of Which factor has been associated with developing...

Deck 27: Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders