Chapter 40: Structure and Function of the Digestive System

MULTIPLE CHOICE
1. In the mouth and stomach, salivary -amylase initiates the digestion of which nutrients?
a. Proteins
c. Fats
b. Carbohydrates
d. Fiber
ANS: B

Salivary -amylase is an enzyme that initiates only carbohydrate digestion in the mouth and
stomach.
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REF: Page 1395

2. Which elements in saliva protect against tooth decay?

a. Salivary -amylase and ptyalin
b. Secretin and IgA
c. Endogenous enamelin and salivary -amylase
d. Exogenous fluoride and a pH of 7.4
ANS: D

The bicarbonate concentration of saliva sustains a pH of approximately 7.4, which neutralizes

bacterial acids and prevents tooth decay. Exogenous fluoride (e.g., fluoride in drinking water)
is absorbed and then secreted in the saliva, providing additional protection against tooth
decay. Decay prevention is not associated with any of the other options.
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REF: Page 1395

3. Saliva contains which immunoglobulin (Ig)?

a. IgA
c. IgG
b. IgE
d. IgM
ANS: A

Saliva contains only IgA, which helps prevent infection.

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REF: Page 1395

4. What effect is a result of inhibiting the parasympathetic nervous system with a drug such as

atropine?
a. Salivation becomes thinner.
b. Salivation decreases.

c. The pH of saliva changes.

d. Digestive enzymes are inhibited.

ANS: B

The sympathetic and parasympathetic divisions of the autonomic nervous system control
salivation. Because cholinergic parasympathetic fibers stimulate the salivary glands, atropine
(an anticholinergic agent) inhibits salivation and makes the mouth dry. None of the other
options is a result of drugs such as atropine.
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REF: Page 1395

5. Food enters the stomach via which sphincter?

a. Cardiac
b. Upper esophageal

c. Gastric
d. Fundal

ANS: A

Each end of the esophagus is opened and closed by a sphincter. The upper esophageal
sphincter (cricopharyngeal muscle) prevents entry of air into the esophagus during
respiration. The lower esophageal sphincter (cardiac sphincter) prevents regurgitation from
the stomach. The lower esophageal sphincter is located near the esophageal hiatusthe
opening in the diaphragm where the esophagus ends at the stomach. The cardiac sphincter is
the only option that fulfills the function described in the question.
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REF: Page 1395

6. Which gastric cells secrete hydrochloric acid and intrinsic factor?

a. Parietal
c. G
b. Chief
d. H
ANS: A

Of the available options, only the parietal cells (oxyntic cells) secrete hydrochloric acid and
intrinsic factor.
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REF: Page 1398

7. Which cells in the stomach secrete histamine?

a. Oxyntic
c. D
b. Chief
d. Enterochromaffin-like
ANS: D

Of the available options, only enterochromaffin-like cells secrete histamine.

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REF: Page 1398

8. The presence of chyme in the duodenum stimulates which hormones?

a. Motilin and histamine
b. Secretin and cholecystokinin
c. Enteroglucagon and gastric inhibitory peptide
d. Somatostatin and acetylcholine
ANS: B

The movement of chyme from the stomach into the duodenum initiates the intestinal phase of
secretion. This phase represents a slowdown of the gastric secretory response; however, the
presence of digested protein and amino acids in the duodenum continue to stimulate some
gastric secretion. The release of secretin and cholecystokinin stimulate pancreatic secretions
and inhibit gastric secretions. This selection is the only option that correctly identifies the
hormones that are stimulated by the presence of chyme in the duodenum.
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REF: Page 1400

9. Which gastric hormone inhibits acid and pepsinogen secretion, as well as decrease the release

of gastrin?
a. Bombesin
b. Histamine

c. Somatostatin
d. Acetylcholine

ANS: C

Of the options available, only somatostatin inhibits the secretion of acid and pepsinogen and
decreases gastrin release.
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REF: Page 1397 | Table 40-1

10. Which enzyme breaks down protein-forming polypeptides in the stomach?

a. Acetylcholine
c. Gastrin
b. Pepsin
d. Secretin
ANS: B

Of the options available, only pepsin, a proteolytic enzyme, breaks down protein-forming
polypeptides in the stomach.
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REF: Page 1399

11. Exposure to which substance protects the mucosal barrier of the stomach?
a. Prostaglandins
c. Helicobacter pylori
b. Aspirin
d. Regurgitated bile
ANS: A

Prostaglandins and enterogastrones, such as gastric inhibitory peptide, somatostatin, and

secretin, inhibit acid secretion. This selection is the only option that accurately identifies a
substance that protects the mucosal barrier of the stomach.
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REF: Page 1399

12. The ileum and jejunum are suspended by folds of the peritoneum that contain an extensive

vascular and nervous network. What are these folds called?

a. Ligament of Treitz
c. Auerbach folds
b. Mesentery
d. Lamina propria
ANS: B

The ileum and jejunum are suspended in loose folds from the posterior abdominal wall by a
peritoneal membrane called the mesentery. The mesentery facilitates intestinal motility and
supports blood vessels, nerves, and lymphatics. None of the other options accurately fills this
description.
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REF: Page 1401

13. Where in the small intestines are lymphocytes, plasma cells, and macrophages produced?
a. Brush border
c. Lamina propria
b. Microvilli
d. Crypts of Lieberkhn
ANS: C

The lamina propria, which is a connective tissue layer of the mucous membrane, lies beneath
the epithelial cells of the villi and contains lymphocytes, plasma cells, which produce
immunoglobulins, and macrophages. None of the other options performs the described
function.
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REF: Page 1401

14. Why are water and electrolytes transported in both directions through tight junctions and

intercellular spaces rather than across cell membranes?

a. The intercellular hydrostatic pressure is inadequate to push the water and

electrolytes across the cell membranes.

b. A balance of cations and ions among the electrolytes on each side of the cell

membranes cannot be maintained.

c. The epithelial cell membranes are formed of lipids that are hydrophobic and

therefore repel water.

d. Receptors on those cell membranes are occupied with a diffusion of amino acids
and monosaccharides.
ANS: C

The epithelial cell membranes of the small intestine are formed of lipids and are hydrophobic
or tend to repel water. Therefore water and electrolytes are transported in both directions
toward the capillary blood or toward the intestinal lumenthrough the tight junctions and
intercellular spaces rather than across cell membranes. This selection is the only option that
accurately describes why water and electrolytes are transported in both directions.
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REF: Pages 1401-1402

15. Which statement best describes the gastrointestinal tract?

a. The gastrointestinal tract is a muscular tube that transports food from the mouth to

the stomach.
b. The gastrointestinal tract is a hollow tube that extends from the mouth to the anus.
c. The gastrointestinal tract is a baglike structure that propels partially digested food

(chyme).
d. The structure is 5 m long and consists of three segments.
ANS: B

The gastrointestinal tract is a hollow tube that extends from the mouth to the anus. The
esophagus is a muscular tube that transports food from the mouth to the stomach. The stomach
is a baglike structure that secretes digestive juices, mixes and stores food, and propels partially
digested food (chyme) into the duodenum. The small intestine is 5 m long and has three
segments.
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REF: Page 1395

16. Glucose transport enhances the absorption of which electrolyte?

a. Sodium
c. Potassium
b. Phosphate
d. Chloride
ANS: A

Sodium passes through the tight junctions and is actively transported across cell membranes.
Sodium and glucose share a common active transport carrier (sodium-glucose ligand
transporter 1 [SGLT1]). This statement is not true of any other option.
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REF: Page 1402

17. What process is capable of increasing both intrathoracic and intraabdominal pressure, thereby

facilitating defecation?
a. Relaxation of the internal anal sphincter

b. Intestinal peristalsis
c. Valsalva maneuver
d. Ileogastric reflex
ANS: C

Squatting or sitting facilitate defecation; these positions straighten the angle between the
rectum and anal canal and increase the efficiency of straining (increasing intraabdominal
pressure). Initiating the Valsalva maneuver increases intraabdominal pressure. This maneuver
consists of inhaling and forcing the diaphragm and chest muscles against the closed glottis
and increases both intrathoracic and intraabdominal pressure, which is transmitted to the
rectum. None of the other options facilitate defecation as described.
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REF: Page 1408

18. Which pancreatic enzyme is responsible for the breakdown of carbohydrates?

a. Trypsin
c. Lipase
b. Amylase
d. Chymotrypsin
ANS: B

Salivary and pancreatic amylases break down starches to oligosaccharides by splitting -1,4glucosidic linkages of long-chain molecules. None of the other options is relevant to this
process.
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REF: Page 1402

19. The formation of water-soluble molecules to facilitate the absorption of the by-products of

lipid hydrolysis is accomplished by:

a. Micelles
b. Phospholipase

c. Chylomicrons
d. Colipase

ANS: A

The products of lipid hydrolysis must be made water soluble if they are to be efficiently
absorbed from the intestinal lumen. The formation of water-soluble molecules known as
micelles (see Figure 40-14) accomplishes this process. This selection is the only option that
accurately identifies the molecule needed to facilitate lipid hydrolysis.
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REF: Page 1404

20. What is the primary source of physiologic iron?

a. Transferrin from plasma
c. Bile from bilirubin
b. Pepsin form pepsinogen
d. Heme from animal protein
ANS: D

The primary source of iron is heme from animal protein. The other options are not considered
primary sources of physiologic iron.
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REF: Page 1405

21. Which statement is incorrect regarding the characteristics of vitamin B12?

a. Vitamin B12 is absorbed in the terminal ileum.
b. Vitamin B12 is absorbed in its free (unbound) form but only in small amounts.
c. Vitamin B12 is necessary for platelet maturation.

d. Vitamin B12 binds to intrinsic factor.

ANS: C

Vitamin B12 is not necessary for platelet maturation. Most vitamin B12 (cobalamin) is bound
to intrinsic factor (making it resistant to digestion) and is absorbed in the terminal ileum,
although a small amount of the vitamin is absorbed in its free (unbound) form.
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REF: Page 1406

22. Which water-soluble vitamin is absorbed by passive diffusion?

a. Vitamin B6
c. Vitamin K
b. Vitamin B1
d. Folic acid
ANS: A

Of the options available, only Vitamin B6 is the water-soluble vitamin absorbed by passive
diffusion.
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REF: Page 1406 | Table 40-2

23. Which vitamin facilitates the absorption of iron by the epithelial cells of the duodenum and

jejunum?
a. B6
b. C

c. E
d. B12

ANS: B

Of the options available, only vitamin C reduces ferric iron to ferrous iron, which is the form
more easily absorbed by the epithelial cells of the duodenum and jejunum.
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REF: Page 1405

24. What is the role of the normal intestinal bacterial flora?

a. Metabolizing bile salts, estrogens, and lipids
b. Breaking down proteins into amino acids
c. Facilitating the motility of the colon
d. Metabolizing aldosterone and insulin
ANS: A

The intestinal bacteria play a role in the metabolism of bile salts, contributing to the intestinal
reabsorption of bile and the elimination of toxic bile metabolites. These bacteria also play a
role in the metabolism of estrogens, androgens, and lipids, as well as in the conversion of
unabsorbed carbohydrates to absorbable organic acids, the synthesis of vitamin K2, and the
metabolism of various nitrogenous substances and drugs. This selection is the only option that
accurately describes the role of normal intestinal bacterial flora.
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REF: Page 1409

25. Kupffer cells are best described as:

a. Natural killer cells that produce interferon-gamma (IFN-)
b. Contractile and therefore capable of regulating the sinusoid blood flow
c. Bactericidal and therefore central to innate immunity
d. Able to metabolize estrogen, progesterone, and androgens

ANS: C

The sinusoids are lined with phagocytic cells, known as Kupffer cells, which are part of the
mononuclear phagocyte system and are the largest population of tissue macrophages in the
body. They are bactericidal and central to innate immunity. None of the other options
accurately describe Kupffer cells.
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REF: Pages 1409-1410

26. Bilirubin is a by-product of the destruction of which aged cells?

a. Platelets
c. Leukocytes
b. Protein
d. Erythrocytes
ANS: D

Bilirubin is a by-product of only the destruction of aged red blood cells or erythrocytes.
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REF: Page 1411

27. The process of conjugation of bilirubin in the liver is best described as which transformation?
a. Unconjugated (fat-soluble) bilirubin into urobilinogen
b. Unconjugated (fat-soluble) bilirubin into conjugated (water-soluble) bilirubin
c. Conjugated (water-soluble) bilirubin into unconjugated (fat-soluble) bilirubin
d. Conjugated (water-soluble) bilirubin into urobilinogen
ANS: B

In the liver, unconjugated bilirubin moves from plasma in the sinusoids into the hepatocytes.
Within hepatocytes it joins with glucuronic acid to form conjugated bilirubin, which is watersoluble. This selection is the only option that accurately describes the transformation
associated with the conjugation of bilirubin.
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REF: Pages 1411-1412

28. Which statement is incorrect regarding gallbladder function?

a. Within 30 minutes of eating, the gallbladder forces bile into the stomach.
b. Cholinergic branches of the vagus nerve mediate gallbladder contraction.
c. Cholecystokinin provides hormonal regulation of gallbladder contraction.
d. The sphincter of Oddi controls the flow of bile from the gallbladder.
ANS: A

Within 30 minutes after eating, the gallbladder begins to contract and the sphincter of Oddi
relaxes, forcing bile into the duodenum through the major duodenal papilla. The other options
are correct statements regarding the functioning of the gallbladder.
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REF: Page 1413

29. Which structure synthesizes clotting factors and the vitamin K necessary for hemostasis?
a. Colon
c. Gallbladder
b. Spleen
d. Liver
ANS: D

The liver has hemostatic functions. It synthesizes prothrombin, fibrinogen, and factors I, II,
VII, IX, and X, all of which are necessary for effective clotting. Vitamin K, a fat-soluble
vitamin, is essential for the synthesis of other clotting factors. Because bile salts are needed
for the absorption of fats, vitamin K absorption depends on adequate bile production in the
liver. Impairment of vitamin K absorption diminishes the production of clotting factors and
increases the risk of bleeding. The other structures mentioned are not associated with
synthesizing of clotting factors and vitamin K.
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REF: Page 1412

30. How many days does it take for the entire epithelial population of the small intestines to be

replaced?
a. 30 to 45
b. 15 to 25

c. 7 to 15
d. 4 to 7

ANS: D

The entire epithelial population is replaced approximately every 4 to 7 days.

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REF: Page 1401

31. Which statement is true regarding the state of the intestinal tract at birth?
a. The intestinal tract is colonized by Escherichia coli.
b. The intestinal tract is sterile.
c. Clostridium welchii is present in the intestinal tract but in very small numbers.
d. Streptococcus colonization in the intestinal tract has begun.
ANS: B

The intestinal tract is sterile at birth but becomes colonized with Escherichia coli, Clostridium
welchii, and Streptococcus within a few hours.
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REF: Page 1409

MULTIPLE RESPONSE
32. Gastric emptying is delayed by the presence of which substances? (Select all that apply.)
a. Solids
b. Carbohydrates
c. Nonisotonic solutions
d. Bacteria
e. Fats
ANS: A, C, E

Of the available options, only solids, fats, and nonisotonic solutions delay gastric emptying.
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REF: Page 1397

33. Which statements are true regarding the ileogastric reflex? (Select all that apply.)
a. The purpose of ileogastric reflex is to inhibit gastric motility.
b. Ileum distension triggers the ileogastric reflex.
c. The ileogastric reflex causes the relaxation of the ileocecal sphincter.
d. Increased gastric secretion triggers the ileogastric reflex.

e. The ileogastric reflex stimulates an increase in ileal motility.

ANS: A, B

The ileogastric reflex inhibits gastric motility when the ileum becomes distended. The
gastroileal reflex, which is activated by an increase in gastric motility and secretion,
stimulates an increase in ileal motility and the relaxation of the ileocecal sphincter.
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REF: Page 1407

34. Which hormones are involved in the relaxation of the stomachs fundus during swallowing?

(Select all that apply.)

Progesterone
Glucagon
Motilin
Gastrin
Cholecystokinin

a.
b.
c.
d.
e.

ANS: D, E

Swallowing causes the fundus to relax (receptive relaxation) to receive a bolus of food from
the esophagus. Relaxation is coordinated by efferent, nonadrenergic, noncholinergic vagal
fibers and, of the available options, is facilitated only by gastrin and cholecystokinin, two
polypeptide hormones secreted by the gastrointestinal mucosa.
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REF: Page 1397

35. Which hormones are involved in regulating gastric motility by making the threshold potential

of muscle fibers more negative? (Select all that apply.)

Estrogen
Secretin
Somatostatin
Gastrin
Motilin

a.
b.
c.
d.
e.

ANS: B, D, E

Gastrin and motilin (small intestine hormones) and the vagus nerve increase contraction by
making the threshold potential of muscle fibers less negative. Sympathetic activity and
secretin (another small intestine hormone) are inhibitory and make threshold potential more
negative. The rate of peristalsis is mediated by pacemaker cells that initiate a wave of
depolarization (basic electrical rhythm), which moves from the upper part of the stomach to
the pylorus. Neither estrogen nor somatostatin inhibits gastric motility as described in the
question.
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REF: Page 1397

36. What requirements are necessary for calcium to be absorbed through the ileum at

concentrations of less than 5 mmol/L? (Select all that apply.)

Receptor site on the ileum
Vitamin D3
Vitamin K
Carboxypeptidase
A carrier protein

a.
b.
c.
d.
e.

ANS: B, E

At concentrations less than 5 mmol/L, calcium is transported actively across cell membranes,
bound to a carrier protein. The carrier formation requires the presence of the active form of
vitamin D3 (1,25-dihydroxyvitamin D). These selections are the only options relevant to the
transport of calcium.
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REF: Page 1405

37. Which water-soluble vitamins are dependent on sodium for absorption? (Select all that apply.)
a. Pantothenic acid
b. Vitamin B1
c. Vitamin C
d. Vitamin B12
e. Folic acid
ANS: C, E

Of the options available, only vitamin C and folic acid are water-soluble vitamins that are
dependent on sodium for absorption.
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REF: Page 1406 | Table 40-2

38. Which statement is correct regarding the functions of the pancreas? (Select all that apply.)
a. Cholecystokinin stimulates the release of pancreatic enzymes.
b. Bilirubin and S cells inhibit the secretion of pancreatic enzymes.
c. Pancreatic polypeptide is released after eating.
d. Acetylcholine (ACh) is liberated from the pancreatic branches of the vagus nerve.
e. ACh stimulates the release of pancreatic enzymes.
ANS: A, C, D

Enzymatic secretion follows, stimulated by cholecystokinin, which activates ACh from the
vagus nerve and the release of ACh from pancreatic stellate cells. Cholecystokinin is released
in the duodenum in response to the essential amino and fatty acids already present in chyme.
Once in the small intestine, activated pancreatic enzymes inhibit the release of more
cholecystokinin and ACh. This feedback mechanism inhibits the secretion of more pancreatic
enzymes. Pancreatic polypeptide is released after eating and inhibits postprandial pancreatic
exocrine secretion. (Table 40-1 summarizes the hormonal stimulation of pancreatic
secretions.)
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REF: Page 1415

MATCHING

Match the hormone from the small intestine with its action. Hormones may be used more than
once.
______ A. Peptide YY
______ B. Secretin
______ C. Cholecystokinin
______ D. Enteroglucagon
______ E. Pancreatic polypeptide
39. Stimulates the gallbladder to eject bile and the pancreas to secrete alkaline fluid.

40.
41.
42.
43.

Stimulates the pancreas to secrete alkaline pancreatic juices.

Delays gastric and small bowel emptying.
Decreases pancreatic and enzyme secretions.
Enhances insulin release, lipolysis, and ketogenesis.

39. ANS:
MSC:
fluid.
40. ANS:
MSC:
41. ANS:
MSC:
42. ANS:
MSC:
43. ANS:
MSC:

C
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REF: Page 1397 | Table 40-1
Cholecystokinin stimulates the gallbladder to eject bile and the pancreas to secrete alkaline
B
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REF: Page 1397 | Table 40-1
Secretin stimulates the pancreas to secrete alkaline pancreatic juice.
A
PTS: 1
REF: Page 1397 | Table 40-1
Peptide YY delays gastric and small bowel emptying.
E
PTS: 1
REF: Page 1397 | Table 40-1
Pancreatic polypeptide decreases pancreatic and enzyme secretions.
D
PTS: 1
REF: Page 1397 | Table 40-1
Enteroglucagon enhances insulin release, lipolysis, and ketogenesis.