The University of Alabama
NUR 529 Exam 3 Blueprint
Unit 11. Disorders of GI Function. Chapters 36-39. There are 10 questions from this unit.
1. Chapter 36. Intestinal flora, roles. Essential vitamins in clotting, what are they and how
are they made? Pg. 1067.
Functions of the intestinal flora is:
o Metabolic activities that salvage energy & absorbable nutrients
o Trophic effects on intestinal epithelial cells
o Protection of the colonized host against invasion by pathogenic organisms
Major metabolic function of colonic microflora is the fermentation of undigestible
dietary residue & endogenous mucus produced by the epithelial cells.
Fermentation of carbohydrates, including resistant starches, cellulose, pectins,
unabsorbed sugars, is a major energy source in the colon
Colonic microorganisms help with vitamin synthesis and absorption of calcium,
magnesium, and iron
o Colonic flora synthesizes vitamin K (essential for clotting & wound healing),
after first week of life
Resident gut flora provides resistance to colonization by exogenous
microbes/pathogens
o Antibiotics can disrupt the microbial balance and allow overgrowth of species
with pathogenicity (i.e. C.diff)
Probiotics (lactobacilli, bifidobacterial, escheria coli) can modify the composition of
enteral microflora & can help maintain remission in ulcerative colitis
,2. Chapter 37. Disorders of Gastrointestinal Function. Alterations in intestinal absorption.
Celiac disease. What are the dietary recommendations for celiac disease? Pg. 1107.
(note: I am not expecting you to learn Table 37.2 but I do recommend printing this table and
putting it in your notebook/clipboard for clinicals).
Celiac disease (gluten-sensitive enteropathy) – immune-mediated disorder (T-cell)
triggered by ingestion of gluten containing grains (most common genetic diseases
today 1-6%)
o Inflammation reaction that results in the loss of absorptive villi from the
intestine impaired absorption of macronutrients (proteins, carbs, fats) and
micronutrients (vitamins, minerals)
o Exposure to gluten is most prominent in the proximal part of small intestine
o Dx is based on clinical manifestations (S&S), serologic tests, intestinal small
bowel biopsy, IgA antihuman tissue transgluaminase (TTG) and IgA
endomysial antibody immunofluorescence (EMA), common to get iron
deficiency anemia (IDA) if positive
o Dietary recommendations are complete elimination of gluten. Meats,
vegetables, fruits, and dairy are safe options provided they are not
contaminated during processing
3. Chapter 37. Disorders of the Stomach. Gastric mucosal layers. Which medications affect the
mucosal layer? Which ones increase the risk for GI bleeding? Pg. 1083.
NSAIDS, ASA, and infections with H. Pylori cause gastric irritation
4. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Bilirubin
elimination and jaundice. How do we get rid of bilirubin? Pg. 1122.
, Bilirubin is the final product of the breakdown of heme contained in aged RBCs and
it gives bile its color.
free bilirubin is transported through blood attached to plasma albumin until it reaches
the liver where it is made into conjugated bilirubin and becomes soluble in bile and
thus secreted as a constituent of bile which enables it to bass through the bile ducts
into the small intestine. In the interesting ~50% of bilirubin become urobilinogen by
the intestinal flora and is excreted in the feces
normal <1.5 mg/dL
5. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Bile production and
cholestasis. How does the body break down and digest fat? Pg. 1122.
The secretion of bile is necessary for digestion & absorption of dietary fats and fat
soluble vitamins.
Bile salts (formed from cholesterol) are important in digestion;
o they help emulsify dietary fats
o they’re necessary for the formation of the micelles that transport fatty acids
and fat-soluble vitamins to the surface of the intestinal mucosa for absorption
6. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Bile production and
cholestasis. What is the function/role of bile? Pg. 1122.
Bile is a fluid made by the liver, stored in the gallbladder and helps with digestion by
breaking down fats into fatty acids so they can be absorbed by the body through the
digestive tract
Bile contains water, bile salts, bilirubin, cholesterol, and certain by-products of
metabolism
7. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Page 1127-1130.
Compare and contrast the transmission of hepatitis A, B, and C.
Hepatitis A (HAV) - fecal-oral route, drinking contaminated milk or water or
shellfish from dirty water can also be common
o 14-28 days incubation, HAV replicates in the liver, excreted in bild, shed in
feces
o young kids are asymptomatic (epidemics happen with kids; poor potty
training)
Hep B (HBV) – infected blood (needle-stick) or serum (sexual), more serious, longer
incubation
Hep C (HCV) – contaminated blood transfusions/products (rare in the US)
8. Chapter 39. Alterations in Nutritional Status. Malnutrition and Starvation. What diagnostic
labs support a malnutrition diagnosis? Pg. 1167.
Albumin (20 day half-life), Prealbumin (shorter half-life), evaluation of intake,
anthropometric measurements (BMI)
9. Chapter 39. Alterations in Nutritional Status. Energy storage. Adipose tissue is an endocrine
organ and controls appetite, how does it do this? Pg. 1155.
NUR 529 Exam 3 Blueprint
Unit 11. Disorders of GI Function. Chapters 36-39. There are 10 questions from this unit.
1. Chapter 36. Intestinal flora, roles. Essential vitamins in clotting, what are they and how
are they made? Pg. 1067.
Functions of the intestinal flora is:
o Metabolic activities that salvage energy & absorbable nutrients
o Trophic effects on intestinal epithelial cells
o Protection of the colonized host against invasion by pathogenic organisms
Major metabolic function of colonic microflora is the fermentation of undigestible
dietary residue & endogenous mucus produced by the epithelial cells.
Fermentation of carbohydrates, including resistant starches, cellulose, pectins,
unabsorbed sugars, is a major energy source in the colon
Colonic microorganisms help with vitamin synthesis and absorption of calcium,
magnesium, and iron
o Colonic flora synthesizes vitamin K (essential for clotting & wound healing),
after first week of life
Resident gut flora provides resistance to colonization by exogenous
microbes/pathogens
o Antibiotics can disrupt the microbial balance and allow overgrowth of species
with pathogenicity (i.e. C.diff)
Probiotics (lactobacilli, bifidobacterial, escheria coli) can modify the composition of
enteral microflora & can help maintain remission in ulcerative colitis
,2. Chapter 37. Disorders of Gastrointestinal Function. Alterations in intestinal absorption.
Celiac disease. What are the dietary recommendations for celiac disease? Pg. 1107.
(note: I am not expecting you to learn Table 37.2 but I do recommend printing this table and
putting it in your notebook/clipboard for clinicals).
Celiac disease (gluten-sensitive enteropathy) – immune-mediated disorder (T-cell)
triggered by ingestion of gluten containing grains (most common genetic diseases
today 1-6%)
o Inflammation reaction that results in the loss of absorptive villi from the
intestine impaired absorption of macronutrients (proteins, carbs, fats) and
micronutrients (vitamins, minerals)
o Exposure to gluten is most prominent in the proximal part of small intestine
o Dx is based on clinical manifestations (S&S), serologic tests, intestinal small
bowel biopsy, IgA antihuman tissue transgluaminase (TTG) and IgA
endomysial antibody immunofluorescence (EMA), common to get iron
deficiency anemia (IDA) if positive
o Dietary recommendations are complete elimination of gluten. Meats,
vegetables, fruits, and dairy are safe options provided they are not
contaminated during processing
3. Chapter 37. Disorders of the Stomach. Gastric mucosal layers. Which medications affect the
mucosal layer? Which ones increase the risk for GI bleeding? Pg. 1083.
NSAIDS, ASA, and infections with H. Pylori cause gastric irritation
4. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Bilirubin
elimination and jaundice. How do we get rid of bilirubin? Pg. 1122.
, Bilirubin is the final product of the breakdown of heme contained in aged RBCs and
it gives bile its color.
free bilirubin is transported through blood attached to plasma albumin until it reaches
the liver where it is made into conjugated bilirubin and becomes soluble in bile and
thus secreted as a constituent of bile which enables it to bass through the bile ducts
into the small intestine. In the interesting ~50% of bilirubin become urobilinogen by
the intestinal flora and is excreted in the feces
normal <1.5 mg/dL
5. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Bile production and
cholestasis. How does the body break down and digest fat? Pg. 1122.
The secretion of bile is necessary for digestion & absorption of dietary fats and fat
soluble vitamins.
Bile salts (formed from cholesterol) are important in digestion;
o they help emulsify dietary fats
o they’re necessary for the formation of the micelles that transport fatty acids
and fat-soluble vitamins to the surface of the intestinal mucosa for absorption
6. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Bile production and
cholestasis. What is the function/role of bile? Pg. 1122.
Bile is a fluid made by the liver, stored in the gallbladder and helps with digestion by
breaking down fats into fatty acids so they can be absorbed by the body through the
digestive tract
Bile contains water, bile salts, bilirubin, cholesterol, and certain by-products of
metabolism
7. Chapter 38. Disorders of Hepatobiliary and Exocrine Pancreas Function. Page 1127-1130.
Compare and contrast the transmission of hepatitis A, B, and C.
Hepatitis A (HAV) - fecal-oral route, drinking contaminated milk or water or
shellfish from dirty water can also be common
o 14-28 days incubation, HAV replicates in the liver, excreted in bild, shed in
feces
o young kids are asymptomatic (epidemics happen with kids; poor potty
training)
Hep B (HBV) – infected blood (needle-stick) or serum (sexual), more serious, longer
incubation
Hep C (HCV) – contaminated blood transfusions/products (rare in the US)
8. Chapter 39. Alterations in Nutritional Status. Malnutrition and Starvation. What diagnostic
labs support a malnutrition diagnosis? Pg. 1167.
Albumin (20 day half-life), Prealbumin (shorter half-life), evaluation of intake,
anthropometric measurements (BMI)
9. Chapter 39. Alterations in Nutritional Status. Energy storage. Adipose tissue is an endocrine
organ and controls appetite, how does it do this? Pg. 1155.
