The Digestive System

Part 1

Food starts the digestive process when you place it in your mouth. The teeth mechanically break the food into smaller and smaller pieces and mix the food with saliva produced by the salivary glands. Saliva serves to moisten and lubricate food, making it easier to swallow, it also contains enzymes that begins digestion of carbohydrates, although, the enzymatic action of saliva is negligible. Swallowing moves the food, now called a bolus, into the oropharynx, past the opening to the larynx, which is closed, as part of the swallowing reflex, by a flap-like structure called the epiglottis, and into the 25 cm long esophagus. The esophagus is a muscular tube, which undergoes peristalsis which pushes the bolus into the stomach.

The stomach is a “J” shaped, hollow, muscular organ that serves to store food temporarily and serve as the place where chemical digestion (mainly of proteins) begins. The two major chemical agents in the stomach are HCl and the enzyme pepsin. Together they enzymatically digest large proteins into smaller protein fragments. Additionally, the food is mixed with water secreted by the stomach to create a watery mixture called chyme. The chyme is released slowly from the stomach, under the control of hormones, into the 6 m long small intestines for further digestion.

The small intestines handle the vast majority of the chemical (enzymatic) digestion of food. Enzymes come not only from the wall of the small intestine itself, but from the pancreas. The pancreatic duct opens into the proximal part of the small intestine, called the duodenum. In addition, the duodenum also receives substances from the liver which aid in the digestion of lipids. The duct from the liver (common bile), usually shares a common opening with the pancreatic duct into the duodenum. As the watery mixture of food and enzymes move through the distal two parts of the small intestines, the jejunum and the ileum, the nutrient products of digestion are absorbed through the wall of the small intestine into the blood. The wall of the small intestine is highly modified and has an enormous surface area, which allows it to effectively absorb virtually all the nutrient material from the food you eat.

The undigested material leaves the small intestine and enters the 1.5 m long large intestine. The primary function of the large intestine is to process what is left into feces. An important function of the large intestine is to reabsorb most of the water that had been mixed with the chyme as it passed through the stomach and the small intestines. Diarrhea results when this reabsorptive function is impaired. The large intestines also absorb certain vitamins and minerals as well. The rectum is near the distal end of the large intestine, the rectum is where feces can be stored until a convenient time for defecation.

Don’t’ confuse the term colon and large intestine. Sometimes you will hear the terms used interchangeably – however, this is technically not correct. The colon is a subdivision of the large intestine.

The digestive tract must me viewed as a long tube, which starts at the mouth and ends at the anus. In anatomy, when discussing tube-like structures, in which movement is unidirectional, it is common to refer to structures along the path of the tube using the words proximal and distal. For example, the stomach is distal to the esophagus or the esophagus is proximal to the stomach.

1. swallow
2. negligible
3. reflex
4. hollow
5. agents
6. fragments
7. secreted
8. handle
9. vast
10. aid
11. absorbed
12. modified
13. enormous
14. leaves
15. primary
16. impaired
17. stored
18. convenient
19. viewed
20. unidirectional

1. small part of something
2. amassed / accumulated
3. considerable / substantial / large part of something
4. considered / thought of as
5. dysfunctional / not working correctly
6. great / large / huge
7. having a space or cavity inside
8. involuntary set of purposeful muscle contractions
9. main / most important / most significant
10. of little significance / of little importance
11. opportune / suitable
12. something that has power to do something
13. to change something for a special purpose
14. to discharge / to release
15. to exit
16. to help
17. to manage something / to take care of some task
18. to move forward but not backwards along a path or route
19. to take in something / to take up something
20. to take into the stomach

Useful Vocabulary

1. Glandular organ (organ that produces substances that are released into the body)
2. Bile
3. Reddish-brown (mixture of two colors in which the -ish color is the weaker color)
4. Portion
5. Blood-borne (carried by or carried in the blood)
6. Attaches
7. Replicates
8. Infects
9. Shuts down (dysfunction)
10. Jaundice
11. Scarring
12. Cirrhosis

1. prosess
2. brake
3. moisen
4. easyer
5. enzimes
6. larinks
7. orjan
8. protiens
9. chime
10. intestins
11. hormoanes
12. handel
13. pankreas
14. recieves
15. kommon
16. blood streem
17. esofagus
18. diarrea
19. impared
20. rektum
21. defekation
22. veiwed
23. neglijible
24. mixxed
25. dukt

Digestive System

1. Appendix Check your answer

2. Common bile duct Check your answer

3. Duodenum Check your answer

4. Esophagus Check your answer

5. Gall bladder Check your answer

6. Large intestines Check your answer

7. Liver Check your answer

8. Pancreas Check your answer

9. Rectum Check your answer

10. Salivary gland Check your answer

11. Small intestines Check your answer

12. Stomach Check your answer
     

Achalasia: failure of a digestive sphincter to relax.
Anorexia: loss of appetite and inability to eat. (Sometimes the terms anorexia is used as a shortened form for Anorexia Nervosa which is a psychiatric eating disorder.)
Appendicitis: inflammation of the appendix.
Binge: brief excessive consumption of food.
Bolus: food that has been chewed and mixed with saliva and is ready for swallowing.
Bowels: the intestines or part of the intestines i.e. large bowel.
Bulimia (hyperphagia): an unusually large and constant appetite. As a psychiatric eating disorder it is sometime called binge and purge syndrome.
Cholecystitis: inflammation of the gallbladder.
Cholelithiasis: presence of gallstones in the gallbladder or bile ducts.
Chyme: food that has been swallowed and has mixed with water and digestive enzymes and is passing through the small intestines. As the chyme exits the small intestines and is dehydrated by the large intestines it becomes feces.
Cirrhosis: a liver condition (disease) characterized by an increase in the amount of connective tissue.
Colitis: inflammation of the colon.
Colostomy: an open from the colon through the abdominal wall. The opening allows the contents of the colon to exit and by-pass a distal diseased or injured region.
Constipation: condition of difficult defecation caused by dry, hardened feces.
Diarrhea: increased frequency and fluidity of bowel movements.
Diverticulosis: a condition of sac-like (pockets) herniation of mucosa of the colon.
Emesis: to vomiting.
Enteritis: inflammation of the small intestines.
Esophagitis: inflammation of the esophagus.
Gastritis: inflammation of the stomach.
Gastroenteritis: inflammation of both the stomach and the small intestines.
Gastroesophageal reflux disease (GERD): a condition in which a weak or damages lower esophageal sphincter allows the acidic contents of the stomach to reflux into the lower part of the esophagus which causes inflammation and damage to the mucosal lining.
Gastroscope: a lighted, flexible tube that can be inserted through the mouth to examine the esophagus, stomach and duodenum.
Gingiva: gums or mucosa of the mouth on the mandible and maxilla.
Hemorrhoids: an itching, painful mass of dilated veins either just inside the anal sphincter or protruding outside the anal sphincter. Hemorrhoids are a common cause of frank bleeding during defecation. The condition is associated with excessive straining during defecation.
Hepatitis: inflammation of the liver.
Jaundice: a yellow discoloration of the skin and the whites of the eyes caused by an accumulation of bile pigments in the blood. Often associated with liver disease such as hepatitis.
Laxative: a medicine or agent used to relieve constipation; also called a purgative.
Mumps: a viral infection of the parotid salivary gland. The second “M” in the MMR vaccine.
Pancreatitis: inflammation of the pancreas; usually caused by blockage of the pancreatic secretions or alcohol abuse.
Peptic ulcer: erosion (ulcer) of the mucosa of the esophagus, stomach or duodenum caused by stomach acid.
Periodontal disease: disease of the periodontal ligament which holds each tooth in the alveoli of the mandible and maxilla. The result is a loosing of the teeth in their sockets.
Purge: to remove or cleanse of something. The term is often used in association with eating disorders in which vomiting or laxatives are used to eliminate food consumed during a binge.
Steatorrhea: fat in the stools.
Stools: common term for feces.
Tarry stools: refers to the consistency of stools which contain blood from internal bleeding into the GI tract. The word tarry means sticky and black.

Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly due to peritonitis and shock.
 

Obstruction of the appendiceal lumen has been attributed to a number of common sources including fecaliths (a hard mass of fecal matter), normal stool, viral induced ulcers, and lymphoid hyperplasia. Once this obstruction occurs the appendix subsequently becomes filled with mucus and distends, increasing intraluminal (within the lumen of the appendix) and intramural (across the wall of the appendix) pressures. As these progress, the appendix becomes ischemic and then necrotic. As the walls of the appendix began to break down, pus begins to leak out of the appendix (suppuration) and into the peritoneal cavity. The end result of this cascade is a rupture of the appendix causing peritonitis, which may lead to septicemia, a potentially life threatening condition.
 

The typical history includes pain starting centrally (periumbilical) before localizing to the right iliac fossa, an area called McBurney’s Point (in the lower right quadrant of the abdomen). The pain is usually associated with loss of appetite and fever. Nausea or vomiting may or may not occur. The abdominal wall becomes very sensitive to gentle pressure (palpation) and tapping (percussion). Coughing causes point tenderness in the area of McBurney's Point and this is the least painful way to localize the inflamed appendix. If the abdomen, on palpation, is also involuntarily guarded (rigid), there should be a strong suspicion of peritonitis requiring urgent surgical intervention.

Treatment begins by keeping the patient from eating or drinking anything (NPO = nothing by mouth), in preparation for surgery. Hydration can be supplied through an intravenous drip. Antibiotics such as cefuroxime and metronidazole may be administered, by IV, early to help kill bacteria and reduce the spread of infection in the abdomen and minimize postoperative complications in the abdomen or incision. The surgical procedure for the removal of the appendix is called either an appendicectomy or an appendectomy.

Useful Vocabulary

1. Finger-shaped (something shaped like a finger)
2. Pouch
3. Swollen (enlarged)
4. Tenderness
5. Inflamed
6. Navel
7. Low-grade fever
8. Accompany
9. Incidence
10. Rupture

A

B

1. Characterized
2. Mild
3. Resolve
4. Attributed
5. Sources
6. Subsequently
7. Break down
8. Leak
9. Cascade
10. Rupture
11. Localizing
12. Quadrant
13. Nausea
14. Vomiting
15. Tenderness
16. Guarded
17. NPO
18. Administer

1. Sequence of events that are hard to stop
2. Blamed on
3. Causes
4. Disintegrate
5. Distinguished / differentiated
6. Emesis
7. Next / later
8. Nothing by mouth
9. One-forth of an area
10. Protected
11. Queasiness / upset stomach
12. Sensitive
13. Slight / minor
14. To be confined / to be focused
15. To break open / to burst / perforate
16. To get better / to clear up
17. To give a medication
18. To spill slowly / escape / seep out of

uneventful / acute / overnight / localized /
procedure / shift / transition / proceed / recovery /
diagnosis / sharper / emanate / present /
constipation / radiate / stays / defined

1. The first symptoms of an appendicitis are usually vague and not well _____________.

2. As time passes, the symptoms of an appendicitis become more _____________ and better _____________.

3. The pain of an appendicitis begins to _____________ to the lower right quadrant of the abdomen.

4. The _____________ from a vague, poorly define pain to a well defined point of tenderness can _____________ in a matter of hours.

5. As the pain become more localized it becomes _____________ and more intense.

6. Because of the neural net supplying the abdomen, the pain may appear to _____________ or even _____________ from various locations around the abdomen. This feature can sometimes make a _____________ more difficult.

7. In addition to tenderness in the lower right quadrant, a patient with an appendicitis can _____________ with many other symptoms as well; these include fever, nausea, vomiting, poor appetite, and _____________.

8. The surgical _____________ for an appendicitis is generally _____________ and takes about 15 minutes.

9. Hospital _____________ following an appendectomy are usually short, either _____________ or one additional day.

10. Depending on the procedure used, _____________ is rapid, usually less than 3 weeks.

Globally, _______ most common cause of acute pancreatitis is _______ gallstones, with excessive alcohol use often cited as _______ second most common cause. Gallstones coming down _______ common bile duct from _______ gallbladder can lodge in _______ hepatopancreatic duct. _______ hepatopancreatic duct is where _______ common bile duct and _______ pancreatic duct come together and enter _______ duodenum. When _______ duct is blocked, it prevents _______ pancreatic digestive enzymes and pancreatic bicarbonate, which neutralizes _______ acid chyme coming from _______ stomach, from exiting _______ pancreas and entering _______ small intestines. Once blocked, _______ enzymes begin to digest _______ pancreatic tissues. It is worth noting that pancreatic cancer is seldom _______ cause of pancreatitis. If _______ acute pancreatitis is caused by alcohol consumption, _______ pancreatitis may clear up on its own. Depending on how much damage has been done to _______ pancreas, drugs can be used to limit pancreatic production of _______ enzymes while _______ pancreas heals. In more severe cases, _______ patient may need total parenteral nutrition for 3 to 6 weeks. This prevents _______ need for _______ pancreas to function in order to digest _______ food consumed by _______ patient.
Severe upper abdominal pain, with radiation through to _______ back, is _______ hallmark of _______ pancreatitis. Nausea and vomiting are prominent symptoms. Findings on _______ physical exam will vary according to _______ severity of _______ pancreatitis attack, and whether or not it is associated with significant internal bleeding. _______ blood pressure may be high (when pain is prominent) or low (if internal bleeding or dehydration has occurred). Typically, both _______ heart and respiratory rates are elevated. Abdominal tenderness is usually found but may be less severe than expected given _______ patient's degree of abdominal pain. Bowel sounds may be reduced as _______ reflection of _______ reflex bowel paralysis (i.e. ileus) that may accompany any abdominal catastrophe*.

*Catastrophe is NOT the best possible word choice. It would be better to say "any serious abdominal problem." In English catastrophe is reserved for "natural" disasters such as earthquakes, storms, or volcanoes.
 

1. The esophagus is ______________ to the oropharynx.
2. The cecum is _______________ to the ileum.
3. The ascending colon is _______________ to the transverse colon.
4. The stomach is _______________ to the duodenum.
5. The anus is _______________ to the rectum.
6. The jejunum is _______________ to the ileum.
7. The descending colon is _______________ to the sigmoid colon.
8. The large intestines are _______________ to the small intestines.
9. The duodenum is _______________ to the esophagus.
10. The oral cavity is _______________ to the oropharynx.

A

B

1. liver / gallbladder
2. transverse colon / stomach
3. spleen / liver
4. stomach / pancreas
5. hepatic duct / common bile duct
6. urethra / urinary bladder
7. heart / lungs
8. trachea / esophagus
9. nasal cavity / oral cavity
10. larynx / trachea (remember airflow is bidirectional)

--10 minutes later--
38. D: Feeling better?
39. P: A little.
40. D: Are you still eating and drinking?
41. P: My appetite is off, but I still drink some.
42. D: Are you taking any prescription medicines – in particular – any antibiotics?
43. P: No.
44. D: No antibiotics and no prescriptions medicine?
45. P: That’s right.
46. D: Have you taken any over-the-counter laxatives?
47. P: No.
48. D: Have you taken any anti-diarrheal medicine?
49. P: No, but I’m hoping you’ll give me some.
50. D: Have you traveled out of the country in the past month?
51. P: No.
52. D: Have you had any recent illnesses – a cold or flu or anything like that?
53. P: No.
54. D: Have you had any other recent problems with you GI tract – constipation, nausea or diarrhea?
55. P: No, I have been pretty healthy.
56. D: Can you describe the last meal you had before the diarrhea started?
57. P: I ate at home that day. I had cereal for breakfast, canned beans and franks on toast for lunch and a microwave TV dinner for dinner.
58. D: Well that pretty much rules out gastroenteritis caused by a Staph or Clostridium species.
59. P: Is that good or bad?
60. D: Neither – what about the day before, do you remember what you had to eat then?
61. P: I always have cereal for breakfast. I skipped lunch because I went to a friend’s house for bar-b-que.
62. D: What did you eat there?
63. P: I had, nachos, some fresh vegetables and for dinner I had chicken and Cole slaw.
64. D: Well I’m thinking it was something you ate there, and it is starting to sound like salmonellosis.
65. P: I’ve heard of that – you get it from eating chicken – right?
66. D: That’s a common source.
67. P: Is it easy to treat?
68. D: Well, I need to be sure. Hang on a second while I call the nurse.
69. P: Sure.
70. D: I asked the nurse to set up a sample collection unit in the toilet. You’ll see it when you go in there – it is sealed with tape and the tape has your name on it. Just break the tape before you use it. We can then send the sample to the lab for confirmation.
71. P: Okay.
72. D: Now back to your question – is it easy to treat? I have good news and bad news.
73. P: The good news first please.
74. D: Salmonellosis usually runs it course in less than 7 days. So you are half way through.
75. P: And the bad news?
76. D: We don’t usually do anything to treat it. The diarrhea is important in flushing the organism from your bowels. If I give you something to stop the diarrhea you risk the infection becoming systemic.
77. P: So three more days of this?
78. D: I am going to give you something for the vomiting and the fever. Once the fever is down, the vomiting is controlled and we get you rehydrated you should feel much better and the diarrhea should begin to improve steadily on its own.
79. P: unhappy silence
80. D: I’m also going to prescribe an oral rehydration fluid.
81. P: What’s that?
82. D: It’s something like Gator Aid – but with additional vitamins, nutrients and electrolytes. The main risk associated with you condition is dehydration. However, you are young and with rehydration treatment you should have no problems. You’re condition would be more complicated with you were over 60 or under 10.
83. P: Won’t it just go straight through me?
84. D: Yes – so you must keep drinking it. It comes in packages – each package makes a liter. I want you to drink at least 2 liters per day, starting today.
85. P: Okay, uh ….. doc!
86. D: Remember we need a sample.
87. P: Okay.
88. P: I hope you wanted a big sample.

-- 10 minutes later --
89. D: Well – here is your prescription.
90. D: I’m giving you Tylenol for your fever and promethazine for the vomiting. You can take the promethazine every 4 to 6 hours as needed for the nausea and vomiting. I’m going to give you 7 days worth which should be more than enough. Also different people have very different responses to promethazine. If it makes you feel a little sleepy that is normal – but if you experience any dizziness, anxiety, or confusion -- call and I’ll switch you to a different drug.
91. P: Okay thanks.
92. D: I also want you to stop by the nurse’s station on your way out. I want a blood sample for the lab as well.
93. P: Okay.
94. D: As I said, you’re half way through this so you should see improvement in the symptoms over the next few days – if there is no improvement or if the symptoms get worse you need to call me right away.
95. P: Okay – Oh when can I start eating?
96. D: It depends on the nausea – but your food should be bland – cereal, crackers, fruit should be fine. In three days you should feel like eating again – but I would keep the foods simple and easy to digest until your digestive tract has fully recovered – and that might take an additional week.
97. P: Okay thanks.
98. D: Call if you need to.
99. P: I will – do I need a follow-up appointment.
100. D: No, not if you are improving and are feeling fine in 3-4 days. If the lab reports come back different than I expect I will call you and ask you to come in again. I’ll have my nurse call you and let you know what the lab report indicates.
101. P: Okay – great.
102. D: Bye.
103. P: Bye.

1. What is the patient’s chief complaint?
2. Based on the interview, what is the minimum and maximum age you would predict for this patient? What is the rationale for your conclusion?
3. Is this patient seeing any other doctors for health issues?
4. How long has the patient been experiencing the chief complaint?
5. What symptoms does the patient include as part of the description of their CC?
6. What is the initial diagnosis? What leads the doctor to this diagnosis?
7. Why is the doctor interested in the patient’s previous travels?
8. Why does the doctor rule out the foods eaten on the day the CC started as the source of the problem?
9. Describe the medications included in the treatment plan. What is the purpose of each?
10. Why is the doctor concerned about the patient’s hydration status?

1)     Introductions

a)     Give your name and get the patient’s name, address, age, etc.

b)     Ask an “open-ended” question about the patient’s CC.

i)      What problem brought you in today?

ii)    How can I help you today?

2)     History of CC.

a)     Weight change

i) How much

ii)    Over what time period

b)     Energy levels or lethargy

c)     Signs of anemia

i) Pale skin

ii)    Rapid heart rate

iii)  Short of breath

iv)   Poor capillary refill

v)     Pale oral mucosa

d)     Dysphagia

i) Liquids / solids / both

ii)    Pain in chest on swallowing

iii)  Choking

e)     Dyspepsia

i) Reflux

ii)    Abdominal pain

(1)  Location

(2)  Onset

(3)  Relieving / aggravating conditions

(4)  Duration after onset

(5)  Radiation

f)      Nausea and/or vomiting

i)      Frequency

ii)    Quantity

iii)  Appearance

(1)  Blood

g)     Abdominal pain

i) Nature of the pain

(1)  Episodes

(2)  Steady

ii)    Location of pain

(1)  Well localized

(2)  Poorly localized

iii)  Duration

iv)   Radiation

v)     Onset

vi)   Relieving / aggravating factors

vii) Abdominal referred pain locations

(1)  Shoulder region

(2)  Scapular region

(3)  Flank pain

(4)  Lower back pain

h)     Swollen abdomen

i) Duration

ii)    Onset

i)      Diarrhea

i) Frequency

ii)    Fluidity

iii)  Appearance

iv)   Volume

v)     Onset

vi)   Duration

vii) Pain

j)      Bleeding from rectum

i) Nature

ii)    Quantity

k)     Stools

i) Appearance

ii)    Consistency

l)      Defecation

i) Level of difficulty

ii)    Frequency

3)     Past medical history

a)     Surgical procedures associated with the digestive system

b)     Ulcers

c)     History of diarrhea or constipation

4)     Drug history (drug and dosage)

a)     OTC drugs

i) Laxatives

b)     Prescription drugs

c)     Drug allergies

5)     Family history

a)     Colon cancer

b)     Other colon conditions

6)     Lifestyle history

a)     Smoking

i) Quantify

b)     Drinking

i) Quantify

c)     Diet

i) Specify

d)     Occupation

i) Any connection to CC

ii) Level or stress

1. Why did the patient go to the hospital?
   Check your answer.

2. The patient was referred to the hospital because of  and . 
   Check your answer.

3. Both parents appear to have died from . 
   Check your answer.

4. At age 6 the patient was operated on for an . 
   Check your answer.

5. At age 18 the patient had meningitis (True or False).  
   Check your answer.

6. The patient was taking medicine for , and . 
   Check your answer.

7. The patient had a surgical repair of his aneurysm (True or False).  
   Check your answer.

8. The only laboratory test that was elevated was . 
   Check your answer.

9. The patient stopped smoking about ago. 
   Check your answer.

10. In 2000 the patient underwent , and . 
    Check your answer.

11. On examination the patient reported slight pain in . 
    Check your answer.

12. The final diagnosis was . 
    Check your answer.

The fecal occult blood test is used _____ detect blood _____ the stools of a patient. The test is simple and non-invasive and can be done _____ home. Test kits, _____ many countries are available without prescription. The test involves placing a small amount _____ feces _____ a card, cloth wipe or pad that has been treated with a chemical called quaiac. After the sample has been prepared, a second chemical (an oxidizing agent) is added. When the second chemical is added, the card, cloth wipe or pad will turn blue if blood is present. The FOBT detects the presence of hemoglobin (Hb) _____ the stools. You may recall that hemoglobin is the component _____ blood cells that binds _____ and carries oxygen. The blue color is the result of a chemical reaction _____ the heme part of hemoglobin and the quaiac. The reaction is catalyzed by the addition _____ the oxidizing agent.

There are a number _____ conditions which can release blood into the stools. For some conditions, blood _____ the stools may be the only sign of the condition. Colorectal cancer is an example of this second condition. Blood coming from the upper or proximal regions of the colon (see diagram) will not appear as red blood the patient can see. For this reason, the blood can only be detected chemically. It is important to note, that not all blood _____ the stools is caused by colorectal cancer. Some other causes include: [1] hemorrhoids, [2] anal fissures, [3] Crohn's disease, [4] polyps and even [5] stomach ulcers.

Because bleeding _____ the colon can be intermittent, the FOBT should be performed _____ three separate stool samples. This increases the chances _____ detecting blood should there be a disease condition. Before testing, certain diet restrictions must be carefully observed. There are a number _____ items (e.g. melons, radishes, turnips, liver and high does of vitamin C), which if present _____ the diet prior _____ testing, can cause a false positive test. Also drugs that can irritate the stomach, such as aspirin should also be avoided before testing. A false positive test is a test result that indicates blood _____ the stool when, _____ fact, there is no blood present. This can happen when chemicals _____ foods react with quaiac _____ a way that is similar _____ heme.

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Immunochemial Fecal Occult Blood Test

            _____previous activity was about _____FOBT, or more specifically G-FOBT, which uses guaiac as _____reagent. This particular test is called _____qualitative test because it produces either positive or negative results. It does not measure _____amount of blood in _____stools. _____test that can measure _____amount is called _____quantitative test. _____G-FOBT also has some limitations which reduce its usefulness. _____first is that guaiac reacts with _____heme part of hemoglobin. Heme can move through _____entire digestive tract without being seriously degraded by enzymes or bacteria. Therefore, any blood from any part of _____digestive tract can reach _____stools and be detected by guaiac. Because _____FOBT is particularly interested in blood from _____large intestines, this ability to react with blood from more proximal areas can lead to false positive tests. Second, guaiac is not human specific, that is, it will produce _____positive test if blood from other animals is in _____digestive tract. This may sound strange, but whenever _____person eats red muscle tissue from cows, pigs, cats, dogs, etc., they ingest _____small amount of hemoglobin found in _____tissues of _____animal. White muscle tissue contains less blood and is less likely to produced _____false positive. Lastly, as mentioned in _____previous article, guaiac can react with certain chemicals in various vegetables as well as with certain drugs and vitamins. These factors taken together create _____real potential for false positive tests. _____risk of _____false positive test can be reduced by having _____patient restrict their diet prior to testing. However, diet restrictions do not affect _____problem of blood from proximal bleeding being detected in _____stools.

            To overcome these problems there is _____second type of FOBT that can be used. _____test is based on immuno-chemistry and not_____enzymatic reaction. _____test is called_____I-FOBT with _____“I” standing for immunochemical. _____test is also sometimes called _____ FIT (Fecal Immunochemical Test). These  tests can be either positive/negative or quantitative and, like _____G-FOBT, are easy for _____patient to use. Of interest here is _____quantitative test, which is called _____qI-FOBT. Since _____test is quantitative it can measure _____amount of blood in _____stools which gives _____test diagnostic power. Different amounts of blood are indicative of various conditions which can cause blood in _____stools. Because of its greater sensitivity (i.e. it's ability to detect very small amounts of blood) and specificity (i.e. no reactions with meats or other foods and chemicals) _____test can reduced _____number of false positive tests (specificity) and _____number of false negative tests (sensitivity).

            _____test is based on _____reaction between specially prepared antibodies and _____globin (or protein) part of hemoglobin. Antigen-antibody reactions are very specific, therefore few other compounds can react with _____antibodies designed to react with human globin. This feature dramatically reduces _____number of false positives associated with meats, vegetables, drugs and vitamins. Unlike heme, which is _____fairly robust molecule and can move _____length of _____digestive tract without destruction, _____globin part of hemoglobin is much more delicate and much more easily degraded by enzymes and bacterial action. As _____result, if human globin is detected in _____stools, _____source of _____bleeding must be much more distal. _____globin part of hemoglobin, from bleeding proximal to _____large intestines, would be destroyed before it reached _____rectum and exited in _____stools.

            As you can see, _____qI-FOBT solves all _____major issues associated with _____standard G-FOBT. Its quantitative nature, ease of use, and reduction in both false positives and false negatives all make this test _____desirable screening test. _____drawbacks of _____test include _____increased cost of _____test and _____need for special equipment to analyze _____results. However, _____benefits of better detection rates, earlier detection and increased reliability provide compelling reasons for its use.

1.               To force emesis after eating is to:
Check your answer

a.      Binge

b.     Purge

c.      Belch

d.     Have a bowel movement

2.               Tarry stools are an indication of:
Check your answer

a.      To much fat in the diet

b.     Fat malabsorption

c.      Intestinal bleeding

d.     Cirrhosis

3.               Peptic ulcers are NOT found in the:
Check your answer

a.      Stomach

b.     Cecum

c.      Esophagus

d.     Duodenum

4.               Anorexia means:
Check your answer

a.      Overeating

b.     Fat in the stools

c.      Mucus in the stools

d.     Lack of appetite

5.               Promethazine is used to treat:
Check your answer

a.      Diarrhea

b.     Constipation

c.      Vomiting and nausea

d.     Hepatitis

6.               Pancreatitis is usually caused by pancreatic cancer.
Check your answer

a.      True

b.     False

7.               McBurney’s Point is an anatomical landmark for:
Check your answer

a.      The lower esophageal sphincter

b.     The sigmoid colon

c.      The appendix

d.     The pancreas

8.               Which of the following is not part of the normal treatment for Salmonellosis?
Check your answer

a.      Antipyretics

b.     Antiemetics

c.      Antitussives

d.     Rehydration supplements

9.               The transverse colon is:
Check your answer

a.      Proximal to the descending colon

b.     Distal to the ascending colon

c.      Proximal to the sigmoid

d.     All the above

10.            The gums are found in the:
Check your answer

a.      Nasal cavity

b.     Oral cavity

c.      Pharynx

d.     Larynx