The Digestive System

1.

Match the following terms on the left, 1-22, with their definitions on the
right, a-v:

1.

anus

2.

appendix

3.

ascending colon

4.

bile

5.

caecum

6.
7.

chyme
descending
colon

8.

duodenum

9. epiglottis
10. gall bladder
11. ileum
12. jejunum
13. liver
14. mouth
15. oesophagus
16. pancreas
17. peristalsis
18. rectum
19. salivary glands
20. sigmoid colon

a.

a bag-like, muscular organ that is attached to the

oesophagus; both chemical and mechanical digestion
take place here
b. a digestive chemical that is produced in the liver, stored
in the gall bladder, and secreted into the small intestine
c. a small, sac-like organ located by the duodenum, it
stores and releases bile into the small intestine
d. an enzyme-producing gland located below the stomach
and above the intestines
e. food in the stomach that is partly digested and mixed
with stomach acids
f. glands located in the mouth that produce saliva
g. large organ located above and in front of the stomach
that filters toxins from the blood, and makes bile (which
breaks down fats) and some blood proteins
h. rhythmic muscle movements that force food in the
oesophagus from the throat into the stomach
i. small sac located on the caecum
j. the first part of the digestive system, where food enters
the body
k. the first part of the large intestine; the appendix is
connected to it
l. the first part of the small intestine; it is C-shaped and
runs from the stomach to the jejunum
m. the flap at the back of the tongue that keeps chewed
food from going down the windpipe to the lungs
n. the last part of the small intestine before the large
intestine begins
o. the long tube between the mouth and the stomach
p. the long, coiled mid-section of the small intestine; it is
between the duodenum and the ileum
q. the lower part of the large intestine, where faeces are
stored before they are excreted
r. the opening at the end of the digestive system from
which faeces exits the body
s. the part of the large intestine between the descending
colon and the rectum
t. the part of the large intestine that runs downwards after

21. stomach

u.

22. transverse
colon

v.

2.

the transverse colon and before the sigmoid colon

the part of the large intestine that runs upwards, located
after the caecum
the part of the large intestine that runs horizontally
across the abdomen

For gaps 23-40, use ONE word only:

Many people spend 23. ...... third of their time consciously trying to control
how to get food into their digestive tracts and another third thinking about how that
food is doing when it gets 24. ...... their digestive tracts and another third of their time
consciously trying to control how to get their food intake out of their digestive tracts.
However, once food is swallowed, the conscious ability to control the passage 25. ......
food is almost completely lost. When the food reaches the point of elimination some
conscious control is again re-established in the digestive system. The gastrointestinal
track or 26. ...... people call it, the digestive system, 27. ...... the main purpose of
breaking food down, both solid and fluid into sustenance 28. ...... the various tissues
and systems in the body. A normal digestive tract squeezes the utmost benefit from
what it eats. Faeces are the products left over when the body has selected everything
that is 29. ...... use from the food that has 30. ...... eaten. The digestive system distance
ranges from the mouth to the bottom of the trunk, which when looked 31. ...... , seems
like no more than one meter, but 32. ...... in fact about ten times longer. From the
moment the three main types of food carbohydrates, fats and proteins enter the
mouth, they are exposed 33. ...... chemical and mechanical actions that begin to break
them apart 34. ...... that they can be absorbed through the intestinal walls into the
circulatory system.
At its simplest, the digestive system is a tube running from mouth to anus. Its
chief goal is to break down huge macromolecules (proteins, fats and starch), which
35. ...... be absorbed intact, into smaller molecules (amino acids, fatty acids and
glucose) that can be absorbed across the wall of the tube, and into the circulatory
system 36. ...... dissemination throughout the body. The digestive system can be
divided 37. ...... two main parts: the alimentary tract 38. ...... accessory organs. The
alimentary tract of the digestive system is composed 39. ...... the mouth, pharynx,
oesophagus, stomach, small and large intestines, rectum and anus. Associated 40. ......
the alimentary tract are the following accessory organs: salivary glands, liver,
gallbladder, and pancreas.

The Digestive System

3.

For questions 41-55 choose the best alternative:

The mouth, or oral cavity, is the first part of the digestive 41. ...... . It is
adapted to 42. ...... food by ingestion, break it into small particles by mastication, and
mix it with saliva. The lips, cheeks, and palate form the boundaries. The oral cavity
contains the teeth and tongue and receives the secretions from the salivary glands.
The pharynx is a fibromuscular passageway that 43. ...... the nasal and oral
cavities to the larynx and oesophagus. It 44. ...... both the respiratory and digestive
systems 45. ...... a channel for air and food. The upper region, the nasopharynx, is
posterior to the nasal cavity. It contains the pharyngeal tonsils, or adenoids, functions
as a passageway for air, and has no function in the digestive system. The middle
region posterior to the oral cavity is the oropharynx. This is the first 46. ...... food
enters when it is swallowed. The opening from the oral cavity into the oropharynx is
called the fauces. Masses of lymphoid tissue, the palatine tonsils, are near the fauces.
The lower region, posterior to the larynx, is the laryngopharynx, or hypopharynx. The
laryngopharynx 47. ...... into both the oesophagus and the larynx. Food is forced into
the pharynx by the tongue. When food reaches the opening, sensory receptors around
the fauces 48. ...... and initiate an involuntary swallowing reflex. This reflex action has
several parts. The uvula is elevated to 49. ...... food from entering the nasopharynx.
The epiglottis drops downward to prevent food from entering the larynx and trachea
in order to direct the food into the oesophagus. Peristaltic movements 50. ...... the food
from the pharynx into the oesophagus.
The oesophagus is a collapsible muscular tube that serves as a passageway
between the pharynx and stomach. As it descends, it is posterior to the trachea and
anterior to the vertebral column. It passes through an opening in the diaphragm, called
the oesophageal hiatus, and then empties into the stomach. The mucosa has glands
that 51. ...... mucus to keep the lining moist and well lubricated to ease the passage of
food. The muscular layers of the oesophagus are normally pinched together at both
the upper and lower ends by muscles called sphincters. When a person swallows, the
sphincters relax automatically to allow food or drink to pass from the mouth into the
stomach. The muscles then close 52. ...... to prevent the swallowed food or drink from
leaking out of the stomach back into the oesophagus or into the mouth. These
sphincters make it possible to swallow while lying down or even upside-down. When
people belch to release swallowed air or gas from carbonated beverages, the
sphincters relax and small amounts of food or drink may come back up briefly; this
condition is called reflux. The oesophagus quickly 53. ...... the material back into the
stomach. This amount of reflux and the reaction to it by the oesophagus are
considered normal.
The stomach, which receives food from the oesophagus, is located in the
upper left 54. ...... of the abdomen. The stomach is divided into the fundic, cardiac,
body, and pyloric regions. The lesser and greater 55. ...... are on the right and left
sides, respectively, of the stomach.

41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
4.

A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.

way
receive
attaches
works
like
region
opens
answers
evade
push
ooze
rapidly
grips
quadrant
bends

B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.

tract
attract
fastens
serves
as
zone
releases
reacts
avoid
propel
conceal
hastily
clutches
square
curvatures

C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.

route
obtain
connects
fulfils
similarly
sector
frees
respond
prevent
thrust
secrete
hurriedly
squeezes
rectangle
coils

For gaps 56-80 make a new word from the one in brackets:

The mucosal lining of the stomach is simple 56. ...... (COLUMN) epithelium
with numerous 57. ...... (TUBE) gastric glands. The gastric glands open to the surface
of the mucosa through tiny holes called gastric pits. Four 58. ...... (DIFFER) types of
cells make up the gastric glands:
- 59. ...... (MUCUS) cells
- parietal cells
- chief cells
- endocrine cells
The secretions of the exocrine gastric glands 60. ...... (COMPOSE) of the
mucous, parietal, and chief cells make up the gastric juice. The products of the
endocrine cells are secreted directly into the bloodstream and are not a part of the
gastric juice. The endocrine cells secrete the hormone gastrin, which functions in the
61. ...... (REGULATE) of gastric activity. The regulation of gastric secretion is
accomplished through neural and 62. ...... (HORMONE) mechanisms. Gastric juice is
produced all the time but the amount varies subject to the 63. ...... (REGULATE)
factors. Regulation of gastric secretions may be divided into cephalic, gastric, and
intestinal phases. Thoughts and smells of food start the cephalic phase of gastric
secretion; the presence of food in the stomach initiates the gastric phase; and the
presence of acid chyme in the small intestine begins the intestinal phase. 64. ......
(RELAX) of the pyloric sphincter allows chyme to pass from the stomach into the
small intestine. The rate at which this occurs depends on the nature of the chyme and
the 65. ...... (RECEPTIVE) of the small intestine.
2

The Digestive System

The small intestine is the longest organ of the digestive tract. It is divided up
66. ...... (DISCRIMINATE) into three sections: the duodenum, the jejunum, and the
ileum. It extends from the pyloric sphincter to the ileocecal valve, where it empties
into the large intestine. The small intestine finishes the process of 67. ...... (DIGEST),
absorbs the nutrients, and passes the residue on to the large intestine. The liver,
gallbladder, and pancreas are accessory organs of the digestive system that are closely
associated with the small intestine. It follows the general structure of the digestive
tract in that the wall has a mucosa with simple columnar epithelium, submucosa,
smooth muscle with inner circular and outer 68. ...... (LONGITUDE) layers, and
serosa. Exocrine cells in the mucosa of the small intestine secrete mucus, peptidase,
sucrase, maltase, lactase, lipase, and enterokinase. The most important factor for
regulating secretions in the small intestine is the 69. ...... (PRESENT) of chyme. This
is largely a local reflex action in response to chemical and mechanical 70. ......
(IRRITATE) from the chyme and in response to distension of the intestinal wall. This
is a direct reflex action, thus the greater the amount of chyme, the greater the
secretion. This is the place where the ultimate 71. ...... (DESTROY) of food digestion
reaches its 72. ...... (COMPLETE) and where the acidity of chyme is 73. ...... (NULL).
Carbohydrates are diminished into simpler sugars; proteins to amino acids; and fats to
fatty acids and glycerol. Enzymes are secreted by the walls of the duodenum and unite
with the bile and pancreatic enzymes in the duodenum.
Peristalsis pushes the nutrient liquid out of the duodenum into the first parts
of the jejunum. A greater number of villi, microscopic, hair like structures, begin to
absorb amino acids, sugars, fatty acids and glycerol from the digested contents of the
small intestine, and starts them on their way to other parts of the body. This part of the
small intestine executes a digestive 74. ...... (OPERATE) so that what is passed on to
the large intestine is a thin 75. ...... (WATER) substance almost completely devoid of
nutrients.
This is the place which is about a third of the small intestine. The greatest
number of the estimated five or six million villi in the small intestine are found along
the ileum making it the main 76. ...... (ABSORB) locale of the gastrointestinal tract.
The villi here are always in a fretful movement: oscillating, pulsating, 77. ......
(LENGTH), shortening, growing narrower then wider, extorting every particle of
nutrient.
The large intestine is larger in diameter than the small intestine. It begins at
the ileocecal junction, where the ileum enters the large intestine, and ends at the anus.
The large intestine consists of the colon, rectum, and anal canal. The wall of the large
intestine has the same types of tissue that are found in other parts of the digestive tract
but there are some distinguishing 78. ...... (CHARACTER). The mucosa has a large
number of goblet cells but does not have any villi. The longitudinal muscle layer,
although present, is 79. ...... (COMPLETE). The longitudinal muscle is limited to
three distinct bands, called teniae coli that run the entire length of the colon. 80. ......
(CONTRACT) of the teniae coli exerts pressure on the wall and creates a series of

pouches, called haustra, along the colon. Unlike the small intestine, the large intestine
produces no digestive enzymes. Chemical digestion is completed in the small intestine
before the chyme reaches the large intestine. Functions of the large intestine include
the absorption of water and electrolytes and the elimination of faeces.
5.

For gaps 81-90 choose the most suitable ending A-J:

The rectum continues from the sigmoid colon to the anal canal 81. ...... . It
follows the curvature of the sacrum and is firmly attached to it by connective tissue.
The rectum ends about 5 cm below the tip of the coccyx, at the beginning of the anal
canal. The last 2 to 3 cm of the digestive tract is the anal canal, which continues from
the rectum 82. ...... . The mucosa of the rectum is folded to form longitudinal anal
columns. The smooth muscle layer is thick 83. ...... . This sphincter is under
involuntary control. There is an external anal sphincter at the inferior end of the anal
canal. This sphincter is composed of skeletal muscle 84. ...... .
Mechanical digestion takes place in the mouth, where the saliva, teeth, and
tongue all play an important role in this digestive process. The smallest taste, smell,
and anticipation of food sends signals to the brain. The brain in turn sends messages
to a system of salivary glands. Saliva is essentially made up of water 85. ...... . Besides
water there is also a very special substance, an enzyme called pytalin, whose main
task is to breakdown the food into simpler forms. The aftermath of the action of the
teeth in digestion results in two outcomes: havoc and devastation. The teeth are gears
to demolish chunks of food by a series of actions such as clamping, slashing, piercing,
grinding and crushing. The teeth do the first drastic destruction to food in the
digestive system.
The tongue consists of four types of taste buds salty, sweet, sour, and bitter
86. ...... . It helps to remove, and dislocate food particles in the teeth 87. ...... . The
act of swallowing food, which at this place in the system is called a bolus, brings
many organs into action. As the top of the tongue presses up against the hard palate,
the roof of the mouth, food is shoved to the back of the mouth. This action in turn
brings the soft palate 88. ...... . They keep the food from being misguided toward the
nose. Once past the soft palate, the food is in the pharynx, a passage with two ways,
one leading to the trachea (windpipe), the other to the oesophagus (food tube). The
epiglottis projects out from the trachea side and helps to admit free movement of air
as it is swallowed 89. ...... . The larynx provides the epiglottis with most of its muscle
for movement. It applies an upward force that helps to relax some tension on the
oesophagus, so that food enters where it is meant to go, down the oesophagus 90. ......
. Many people have experienced it at some time or another when the swallowing
action did not go as it was supposed to.
A. and at the same time restricts entrance to the oesophagus
B. and begins to soften up the food so it can pass more smoothly down the
3

The Digestive System

J.

throat
and forms the internal anal sphincter at the superior end of the anal canal
and has a thick muscular layer
and is a very manoeuvrable and pliable arrangement of muscle
and is under voluntary control
and not down the windpipe
and opens to the outside at the anus
and shifts food around in the mouth in order to assist with the all important
act of swallowing
and uvula into action

6.

Fill in gaps 91-105 with ONE word only:

C.
D.
E.
F.
G.
H.
I.

The salivary glands, liver, gallbladder, and pancreas are not 91. ...... of the
digestive tract, but they have a role in digestive activities 92. ...... are considered
accessory organs.
Three pairs of major salivary glands (parotid, submandibular, and sublingual
glands) and numerous smaller ones secrete saliva into the oral cavity, 93. ...... it is
mixed with food 94. ...... mastication. Saliva contains water, mucus, and enzyme
amylase. Functions of saliva include the following:
- it has a cleansing action on the teeth
- it moistens and lubricates food during mastication and swallowing
- it dissolves certain molecules so 95. ...... food can be tasted
- it begins the chemical digestion of starches 96. ...... the action of amylase,
which breaks 97. ...... polysaccharides into disaccharides
The gallbladder is a pear-shaped sac that is attached 98. ...... the visceral
surface of the liver 99. ...... the cystic duct. The principal function of the gallbladder is
to serve as a storage reservoir 100. ...... bile. Bile is a yellowish-green fluid produced
by liver cells. The main components of bile are water, bile salts, bile pigments, and
cholesterol. Bile salts act 101. ...... emulsifying agents in the digestion and absorption
of fats. Cholesterol and bile pigments from the breakdown of haemoglobin are
excreted 102. ...... the body in the bile.
This mechanical action 103. ...... to do with sets of muscles that cooperate to
move 104. ...... liquid and solid food along the digestive tract. It pushes food along the
oesophagus, stomach, and intestine. Gravitational pull is lessened in a sense when
food enters the oesophagus because of peristalsis. Peristalsis helps a person to
swallow lying down or even standing on their head. Peristalsis has another essential
task 105. ...... assisting in the movement of food through the body.

7.

For questions 106-120 choose the best option, A, B or C:

The liver is a large organ 106. ...... in the upper region of the abdominal
cavity, below the diaphragm. Since most compounds absorbed by the intestine pass
through the liver, it functions as a control centre that 107. ...... various metabolic
processes, regulating the traffic of fuel molecules (such as, carbohydrates, fats, and
proteins) used in energy metabolism. Hepatocytes (liver cells) 108. ...... about 60
percent of liver tissue; they 109. ...... in numerous metabolic and secretory functions.
A second class of cells, called Kupffer cells, 110. ...... the vascular networks;
their primary role is to 111. ...... red blood cells that are no longer functional. One of
its important glandular functions of the liver is the 112. ...... of bile, an alkaline
compound that aids in the digestion of lipids. 113. ...... roles include the synthesis of
blood-clotting factors (for example, blood proteins found in plasma); removal of
waste and other toxic materials; and destruction of worn-out red blood cells.
The liver can be considered a(n) 114. ...... organ its metabolic activities
essential for providing 115. ...... to the brain, muscle, and other peripheral organs,
often at the expense of its own energetic needs. Among its numerous metabolic roles
are several related to carbohydrate metabolism. The liver contributes to the 116. ......
of blood glucose levels, storing 117. ...... glucose as glycogen, and releasing glucose
into the bloodstream when levels decrease. 118. ...... the high concentration of
glycogen in liver cells, the liver does not use glucose derived from glycogen to meet
most of its own energy needs; instead, it utilises the keto acids derived from the
breakdown of amino acids. The liver cells, therefore, perform the glucose storage and
119. ...... primarily for the benefit of other organs. The liver also 120. ...... a role in
aspects of lipid metabolism, such as cholesterol synthesis.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.

A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.
A.

placed
integrates
comprise
involve
shape
salvage
secretion
Bonus
unselfish
energy
regulation
burden
In spite
free
has

B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.
B.

positioned
incorporates
consist
supply
contour
recycle
emission
Additional
humane
fuel
guideline
overload
Despite
release
functions

C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.
C.

laid
combines
contribute
participate
line
reprocess
emanation
Added
altruistic
stimulation
ruling
excess
Regardless
liberate
plays
4

The Digestive System

8.

Choose the word from the box which best fits into the gaps:
abundant
appropriately
hepatic
readily
special

adjacent
central
internal
saclike
strategically

anatomically
functional
portal
secretory
ultimately

The liver is the heaviest organ in the body. An adult human liver normally
weighs between 1.7-3.0 kilograms. Soft, pinkish-brown, and boomerang-shaped, the
liver is the second largest organ in the body (after the skin), and the largest 121. ......
organ. Located on the right side of the upper abdomen below the diaphragm, the liver
lies to the right of the stomach. The liver is connected to two distinct blood supplies.
The 122. ...... artery, which contributes about 25 percent of blood flow to the liver,
conveys oxygenated blood to the liver. The other 60-80 percent comes from the 123.
...... vein, which transports nutrient-filled blood from the stomach and the intestines.
At any given moment, the liver contains approximately 13 percent of the bodys total
blood supply. The bile produced in the liver is collected in bile canaliculi, which
merge to form bile ducts. Bile can either drain directly into the duodenum via the
common bile duct, or it can be temporarily stored in the gallbladder via the cystic
duct. The 124. ...... area where the common bile duct, portal vein, and hepatic artery
enter the liver is called the hilum. The duct, vein, and artery divide into left and right
branches, and the portions of the liver supplied by these branches constitute the 125.
...... left and right lobes. The liver has the capacity to interconvert fuel molecules; for
example, it can convert certain amino acids, and some other molecules like pyruvate
and lactate, into glucose (a process called gluconeogenesis). While the nutrient
molecule glucose is 126. ...... in the circulatory system, the liver can store it in the
form of glycogen; when the available supply of glucose in the bloodstream
diminishes, the liver returns glucose to the blood. Thus, the liver plays a crucial role
in the regulation of blood glucose levels. The liver also performs several roles in lipid
metabolism, including cholesterol synthesis and the production of triglycerides (fats).
The liver has many 127. ...... features. For example, in order to carry out its
128. ...... functions, ducts (tubes) closely connect it to the gallbladder and intestines.
Thus, bile made by the liver travels through these tubes to the gallbladder. The bile is
stored in the gallbladder between meals and then is discharged into the intestines at
mealtime to aid in digestion. For another example, the liver is 129. ...... situated in the
body to directly receive the blood that comes from the intestines (portal blood). With
this arrangement, the liver can 130. ...... process (metabolise) nutrients absorbed from
food as well as other contents of the portal blood. Because of its numerous
biochemical functions, the liver is considered the biochemical factory of the body.
Moreover, the liver is organised 131. ...... to coordinate its structure, including its
blood circulation, with its functions.

The basic unit of the liver is called an acinus (one of the small 132. ......
dilations composing a compound gland). In each acinus, the liver cells are grouped
into 3 zones that are 133. ...... related to the livers blood supply and drainage. Thus,
the blood enters zone one first, and then travels through the second and third zones
before leaving the liver. Each zone has its own special functions to perform.
Specialised areas of the walls of 134. ...... liver cells join to form bile canaliculi. These
microscopic tubes transport bile that is produced by the liver cells. Then, meeting with
other canaliculi, they 135. ...... empty into tiny bile ducts. These bile ducts join with
other bile ducts to form larger bile ducts that ultimately leave the liver.
9.

Match the terms on the left with those on the right to form associations that
fit in gaps 136-145:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

acinar
autoimmune
blood
genetic
hepatic
liver
oxygenated
porous
portal
portal

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

artery
blood
cells
defect
lining
process
supply
tracts
vein
zones

The liver has a unique, dual 136. ...... . One comes from the 137. ...... and the
other from the 138. ...... . The hepatic artery brings to the liver 139. ...... that comes
from the lungs, heart, and branches of the aortic artery. So, finally, tiny branches of
the portal vein and hepatic artery travel in the liver together with the tiny bile ducts in
tracts called 140. ...... (triads). The hepatic artery supplies blood to nourish the bile
ducts and the 141. ...... . This blood joins with the portal vein blood in tiny blood
vessels called sinusoids. Now, these sinusoids are situated on each side of single-cellthick plates of liver cells, and they have an exceptionally 142. ...... . This unique
arrangement enables passage of even large molecules (e.g., lipoproteins) through the
sinusoidal lining to and from the liver cells.
The blood travels in the sinusoids through the three 143. ...... . Finally, the
blood is drained from the liver by the hepatic veins and then heads back to the heart
and lungs. Liver disease is categorised both by the cause and the effect it has on the
liver. Causes may include infection, injury, exposure to drugs or toxic compounds, an
144. ...... , or a 145. ...... (such as haemochromatosis). These causes can lead to
hepatitis, cirrhosis, stones that develop and form blockages, fatty liver, and in rare
5

The Digestive System

instances liver cancer. Genetic defects can prevent vital liver functions and lead to the
deposition and build-up of damaging substances, such as iron or copper.
10. For gaps 146-155, make a new word from the one in brackets:
There are two major forms of hepatitis: one in which the liver is inflamed
quickly (called acute hepatitis) and one in which the liver is inflamed and damaged
slowly, over a long period of time (called chronic hepatitis). While hepatitis can be
caused by any of the means mentioned above, most commonly it is due to 146. ......
(INFECT) by one of several viruses, termed hepatitis viruses. These viruses have been
named in the order of their discovery as hepatitis A, B, C, D, and E.
Hepatitis A is spread through infected water and food and is especially
common in children. Adults may experience symptoms such as jaundice (yellowish
147. ...... (PIGMENT) of the skin), nausea, diarrhoea, and fatigue, but children often
do not even know they have been exposed to the virus.
Hepatitis B is found throughout the world and is especially common in
Southeast Asia and Africa. It is still the most common cause of acute 148. ......
(VIRUS) hepatitis in North America and Europe. Hepatitis B can be spread by
exposure to blood, through sexual relations, and from mother to baby. Symptoms of
hepatitis B may be absent, mild and flu-like, or acute. Most people will get better
without any 149. ...... (INTERVENE), but about 1-3% will become 150. ......
(CHRONIC) infected, able to continue to infect others, and often experience chronic
151. ...... (PROGRESS) damage to the liver. Those with 152. ...... (WEAK) or
compromised immune systems are at an increased risk to become chronically
infected. Newborns are especially vulnerable, with over 90% becoming chronically
infected.
Hepatitis C is spread mainly by exposure to contaminated blood. Some
mechanisms of exposure include the sharing of needles used in consuming drugs; use
of contaminated equipment for activities such as body piercing and tattooing; 153.
...... (OCCUPATION) exposure of healthcare workers to used needles or other sharp
objects; through sexual activity that results in tissue tears; from mother to baby during
childbirth; or from cuts sustained during 154. ...... (ATHLETE) or other activity.
Hepatitis C is less common than hepatitis B as a cause of acute hepatitis, but the
majority of the people who contract it become chronically infected, able to spread the
infection to others, and usually have chronic damage to the liver.
Since the liver is responsible for the metabolism of alcohol, drugs, and
environmental toxins, prolonged exposure to any of these can also cause hepatitis
and/or cirrhosis. 155. ...... (COMBINE) of drugs (for instance, acetaminophen) and
alcohol have the potential to cause life-threatening acute liver failure.

11. The words in italics 156-175 have been swapped around. Use them in their
correct position:
Fatty liver causes liver 156. transplantation, tenderness, and abnormal
liver function. The most common 157. colour is excessive alcohol consumption. It is
usually a reversible condition, resolving with abstention from 158. cause. Another
cause of fatty liver is non-alcoholic steatohepatitis (NASH), the most common 159.
irreversible hepatitis not caused by viruses. While symptoms are usually fairly mild,
it may cause 160. death. It is seen most commonly in 161. early and diabetic
individuals.
Anything that causes 162. acute ongoing injury to the liver can lead to
cirrhosis. It is marked by cell 163. fever and scar formation and is a progressive
disease that creates 164. present damage. Cirrhosis is treated by trying to limit further
damage; if it is caused by a virus or another treatable cause of liver injury, treating the
cause can stabilise the 165. enlargement and prevent deterioration in liver function.
Cirrhosis has no signs or symptoms in its 166. elevated stages, but as it progresses, it
can cause ascites, muscle wasting, bleeding from the intestines, easy bruising,
gynaecomastia, and a number of other problems. Liver function is monitored with
such tests as albumin, prothrombin time, bilirubin, and a liver panel. In extreme cases,
liver 167. disease may be needed.
Gallstones, tumours, trauma, and 168. alcohol can cause blockages or
obstructions in the ducts draining the liver (bile ducts). When an obstruction occurs,
bile and its associated wastes accumulate in the liver and the patients skin and eyes
often turn yellow (jaundice); bilirubin in the urine turns it a dark brown 169.
cirrhosis, while lack of bilirubin in the intestines causes the stool to become very
pale coloured (similar symptoms may develop in acute hepatitis and, occasionally, in
cirrhosis). Blood tests may show 170. chronic levels of bilirubin, alkaline
phosphatase (ALP), and other liver enzymes.
Cholesterol and bile pigments in the bile may form stones in the gallbladder,
where bile is stored. These stones may or may not cause 171. inflammation and
problems, depending on their size and location. If 172. overweight for a long time,
they may damage the gall bladder and prevent it from working properly; this often
causes a feeling of bloating and discomfort in the upper abdomen after meals,
especially ones 173. severe in fat. The gallstones may block the duct that drains bile
from the gallbladder, causing sharp pain to develop suddenly in the upper right part of
the abdomen, and, in many cases, leading to infection of the gallbladder and 174.
symptoms.
Obstruction of the hepatic vein, the vein from the liver, may also occur,
reducing blood flow out of the liver. This obstruction may be due to tumours pushing
against the vein or from blood clot formation within the vein. Obstructions may be
6

The Digestive System

chronic and cause few symptoms, but they can also be 175. high and life-threatening.
Some can be treated with medications; others require surgery.
12. The italicised words (176-190) are not suitable in the given context. Provide
more appropriate synonyms:
Hepatitis and cirrhosis may 176. conduct to liver cancer in some cases, but
more frequently cancer starts in other parts of the body and then metastasises
(spreads) to the liver. When cancer does arise in the liver, it is 177. entitled primary
liver cancer. The most common 178. brand is hepatocellular carcinoma, cancer that
develops in the livers hepatocyte cells. This type encompasses about 3 out of 4 179.
places of primary liver cancer. Another 1 or 2 cases out of 10 are
cholangiocarcinomas, cancers that start in the bile 180. ways. People who have
chronic hepatitis or cirrhosis may be 181. investigated on a regular basis for cancer,
often with an alpha-fetoprotein (AFP) test and/or an 182. super noise.
Haemochromatosis is the most common 183. inborn liver disorder. It
involves excess iron 184. custody and is usually diagnosed in adults. There are
numerous genetic liver diseases that affect 185. offspring. The most common is alpha
1-antitrypsin 186. lack. Most of the genetic liver diseases involve a missing enzyme
or protein that leads to damaging deposits in the liver. Although not genetic, a
defective 187. piece that results in liver injury may also cause problems with 188.
nonstandard liver function in newborns.
Liver disease may not cause any symptoms at 189. initial or the symptoms
may be vague, like weakness and loss of energy. In acute liver disease, symptoms
related to problems handling bilirubin, including jaundice, dark urine, and light stools,
along with loss of 190. hunger, nausea, vomiting, and diarrhoea are the most
common. Chronic liver disease symptoms may include jaundice, dark urine,
abdominal swelling, unexplained weight loss or gain, and abdominal pain, although
these symptoms may not be present until the disease has reached an advanced stage.
13. For gaps 191-200 use ONE word only:
Cirrhosis is a condition in which the liver slowly deteriorates and
malfunctions due 191. ...... chronic injury. Scar tissue replaces healthy liver tissue,
partially blocking the flow of blood 192. ...... the liver. Scarring also impairs the
livers ability to control infections, remove bacteria and toxins from the blood,
process nutrients, hormones, and drugs, make proteins that regulate blood clotting,
and produce bile to help absorb fats, including cholesterol and fat-soluble vitamins.

A healthy liver 193. ...... able to regenerate most of its 194. ...... cells when
they become damaged. With end-stage cirrhosis, the liver can 195. ...... longer
effectively replace damaged cells. A healthy liver is necessary for survival.
Treatment for cirrhosis depends on the cause of the disease and whether
complications 196. ...... present. The goals of treatment are 197. ...... slow the
progression of scar tissue in the liver and prevent or treat the complications of the
disease. Hospitalisation may be necessary for cirrhosis with complications.
The liver is an important organ in the body. It performs many critical
functions, two of which are producing substances required 198. ...... the body, for
example, clotting proteins that are necessary in order 199. ...... blood to clot, and
removing toxic substances that can be harmful to the body, for example, drugs. The
liver also has an important role in regulating the supply to the body of glucose (sugar)
and lipids (fat) that the body uses as fuel. In order to perform these critical functions,
the liver cells must 200. ...... working normally, and they must have an intimate
relationship with the blood since the substances that are added or removed by the liver
are transported to and from the liver by the blood.
14. For gaps 201-210 choose the best variant A, B or C:
The relationship of the liver to the blood is unique. 201. ...... most organs in
the body, only a small amount of blood is supplied to the liver by arteries. Most of the
livers supply of blood comes from the intestinal veins as the blood 202. ...... to the
heart. The main vein that returns blood from the intestines is called the portal vein. As
the portal vein passes through the liver, it 203. ...... into increasingly smaller and
smaller veins. The tiniest veins (called sinusoids because of their unique structure) are
in close contact with the liver cells. In fact, the liver cells line up along the length of
the sinusoids. This close 204. ...... between the liver cells and blood from the portal
vein allows the liver cells to 205. ...... and add substances to the blood. Once the blood
has passed through the sinusoids, it is collected in increasingly larger and larger veins
that ultimately form a single vein, the hepatic vein that returns the blood to the heart.
In cirrhosis, the relationship between blood and liver cells is destroyed. Even
though the liver cells that survive or are newly-formed may be able to 206. ...... and
remove substances from the blood, they do not have the normal, intimate relationship
with the blood, and this interferes with the liver cells ability to add or remove
substances from the blood. In addition, the scarring within the cirrhotic liver 207. ......
the flow of blood through the liver and to the liver cells. As a result of the obstruction
to the flow of blood through the liver, blood backs-up in the portal vein, and the
pressure in the portal vein 208. ...... , a condition called portal hypertension.
Because of the obstruction to flow and high pressures in the portal vein,
blood in the portal vein 209. ...... other veins in which to return to the heart, veins with
lower pressures that bypass the liver. Unfortunately, the liver is unable to add or
7

The Digestive System

remove substances from blood that bypasses it. It is a 210. ...... of reduced numbers of
liver cells, loss of the normal contact between blood passing through the liver and the
liver cells, and blood bypassing the liver that leads to many of the manifestations of
cirrhosis.
201.
202.
203.
204.
205.
206.
207.
208.
209.
210.

A.
A.
A.
A.
A.
A.
A.
A.
A.
A.

like
returns
multiplies
attachment
remove
create
barricades
increases
searches
combination

B.
B.
B.
B.
B.
B.
B.
B.
B.
B.

unlike
proceeds
develops
union
eradicate
produce
obstructs
enlarges
investigates
mixture

C.
C.
C.
C.
C.
C.
C.
C.
C.
C.

as
advances
breaks up
relationship
confiscate
manufacture
impede
raises
seeks
amalgamation

15. Fill in gaps 211-220 with the missing preposition or adverb:

A second reason 211. ...... the problems caused by cirrhosis is the disturbed
relationship between the liver cells and the channels 212. ...... which bile flows. Bile is
a fluid produced 213. ...... liver cells that has two important functions: to aid in
digestion and to remove and eliminate toxic substances 214. ...... the body.
The bile that is produced by liver cells is secreted 215. ...... very tiny
channels that run between the liver cells that line the sinusoids, called canaliculi. The
canaliculi empty into small ducts which then join together 216. ...... form larger and
larger ducts. Ultimately, all of the ducts combine into one duct that enters the small
intestine. 217. ...... this way, bile gets to the intestine where it can help with the
digestion 218. ...... food.
At the same time, toxic substances contained in the bile enter the intestine
and then are eliminated in the stool. In cirrhosis, the canaliculi are abnormal and the
relationship 219. ...... liver cells and canaliculi is destroyed. As a result, the liver is not
able to eliminate toxic substances normally, and they can accumulate in the body.
220. ...... a minor extent, digestion in the intestine also is reduced.
16. Use the words in the box to fill in gaps 221-235:
accumulate
function
remove

accumulation
malnutrition
retain

bacterium
overnight
supplement

consume
plan
swelling

effect
prevent
treatment

As cirrhosis of the liver becomes severe, signals are sent to the kidneys to
221. ...... salt and water in the body. The excess salt and water first accumulates in the
tissue beneath the skin of the ankles and legs because of the 222. ...... of gravity when
standing or sitting. This 223. ...... of fluid is called oedema or pitting oedema. The
224. ...... often is worse at the end of a day after standing or sitting and may lessen
225. ...... as a result of the loss of the effects of gravity when lying down. As cirrhosis
worsens and more salt and water are retained, fluid also may 226. ...... in the
abdominal cavity between the abdominal wall and the abdominal organs. This
accumulation of fluid (called ascites) causes swelling of the abdomen, abdominal
discomfort, and increased weight.
Because 227. ...... is common in people with cirrhosis, a healthy diet is
important in all stages of the disease. Health care providers recommend a meal 228.
...... that is well balanced. If ascites develops, a sodium-restricted diet is
recommended. A person with cirrhosis should not eat raw shellfish, which can contain
a 229. ...... that causes serious infection. To improve nutrition, the doctor may add a
liquid 230. ...... taken by mouth or through a nasogastric tube, a tiny tube inserted
through the nose and throat that reaches into the stomach.
People with cirrhosis are encouraged not to 231. ...... any alcohol or illicit
substances, as both will cause more liver damage. Because many vitamins and
medications, prescription and over-the-counter, can affect liver 232. ...... , a doctor
should be consulted before taking them.
233. ...... for cirrhosis also addresses specific complications. For oedema and
ascites, the doctor will recommend diuretics medications that 234. ...... fluid from
the body. Large amounts of ascitic fluid may be removed from the abdomen and
checked for bacterial peritonitis. Oral antibiotics may be prescribed to 235. ......
infection. Severe infection with ascites will require intravenous antibiotics.
17. Match the terms on the left with those on the right to form collocations that
fit in gaps 236-245:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

blood
clean
future
gastrointestinal
hepatic
oesophageal
portal
protein
various
viral

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

bleeding
encephalopathy
episodes
flow
hepatitis
hypertension
intake
symptoms
varices
wastes
8

The Digestive System

Doctors may prescribe a beta-blocker or nitrate for 236. ...... . Beta-blockers
can lower the pressure in the varices and reduce the risk of bleeding. 237. ...... requires
an immediate upper endoscopy to look for 238. ...... . People who have had varices in
the past may need to take medicine to prevent 239. ...... . 240. ...... is treated by
cleansing the bowel with lactulose a laxative given orally or in enemas. Antibiotics
are added to the treatment if necessary. Patients may be asked to reduce dietary 241.
...... . Hepatic encephalopathy may improve as other complications of cirrhosis are
controlled.
Some people with cirrhosis who develop hepatorenal failure must undergo
regular haemodialysis treatment, which uses a machine to 242. ...... from the blood.
Medications are also given to improve 243. ...... through the kidneys. Other treatments
address the specific causes of cirrhosis. Treatment for cirrhosis caused by hepatitis
depends on the specific type of hepatitis. For example, interferon and other antiviral
drugs are prescribed for 244. ...... , and autoimmune hepatitis requires corticosteroids
and other drugs that suppress the immune system. Medications are given to treat 245.
...... of cirrhosis, such as itching and abdominal pain.
18. For gaps 246-260 make a new word from the one given in brackets, which
fits in the gap:
The pancreas is a pinkish white 246. ...... (GLAND) organ found in 247. ......
(VERTEBRA) near the stomach and small intestine. The pancreas is the second
largest gland that is connected to the digestive tract, after the liver. It has both
endocrine and exocrine functions. Exocrine glands are glands that secrete their 248.
...... (PRODUCE) into ducts (duct glands). Endocrine glands are glands that secrete
their product directly into the blood rather than through a duct. The pancreas
exocrine function involves the 249. ...... (SECRETE) of bicarbonate and digestive
enzymes into the small intestine. Its endocrine function involves the 250. ......
(REGULATE) of blood sugar levels by secreting the hormones insulin, glucagon, and
somatostatin directly into the blood. The endocrine portion of this organ consists of
about 1 million islets of Langerhans, amounting to only 1-3 percent of the organ
weight. The majority of cells is exocrine and secretes one to three litres of digestive
fluid per day.
The exocrine portion is the major part of the gland. It consists of pancreatic
acinar cells that secrete digestive enzymes into tiny ducts 251. ...... (WEAVE)
between the cells. 252. ...... (PANCREAS) enzymes include anylase, trypsin,
peptidase, and lipase. Pancreatic secretions are controlled by the hormones secretin
and cholecystokinin.
The pancreas is an important organ for digestion and the control of 253. ......
(CIRCULATE) levels of glucose. This organ is an excellent example of an intricate,
well-tuned organ that functions in harmony with other parts of the body, providing a

service to the body while receiving the nutrients and 254. ...... (REMOVE) of wastes
necessary for its survival. For example, in terms of its function in the digestive
system, it is one of several parts of the body that work together, involving 255. ......
(COOPERATE) giving and receiving, including the stomach, intestines, liver,
pancreas, heart, brain, and so forth.
Cystic fibrosis is an inherited disease of the mucus glands that affects many
body systems. The disorders most common signs and symptoms include 256. ......
(PROGRESS) damage to the respiratory system and chronic digestive system
problems.
Mucus is a 257. ...... (SLIP) substance that lubricates and protects the 258.
...... (LINE) of the airways, digestive system, reproductive system, and other organs
and tissues. In people with cystic fibrosis, the body produces mucus that is 259. ......
(NORMAL) thick and sticky. This abnormal mucus can obstruct the airways, leading
to severe problems with breathing and 260. ...... (BACTERIUM) infections in the
lungs. These infections cause chronic coughing, wheezing, and inflammation. Over
time, mucus build-up and infections result in permanent lung damage, including the
formation of scar tissue (fibrosis) and cysts in the lungs.
19. The words in italics 261-280 have been swapped around. Use them in their
correct position:
Most people with 261. fatal fibrosis also have digestive problems because
262. large, sticky mucus interferes with the function of the pancreas. The pancreas
produces insulin, a hormone that helps to control blood sugar levels. It also makes
enzymes that 263. lead digest food. In people with cystic fibrosis, mucus 264.
releases the ducts of the pancreas, preventing these enzymes from reaching the
intestines to aid digestion. Problems with digestion can lead to diarrhoea,
malnutrition, 265. permanent growth, and weight loss.
Cystic fibrosis used to be considered a 266. cystic disease of childhood.
With improved treatments and better ways to manage the disease, many people with
cystic fibrosis now 267. digest well into adulthood. Adults with cystic fibrosis
experience 268. unable problems affecting the respiratory, digestive, and
reproductive systems. For example, most men with cystic fibrosis are 269. digestive
to father children because the tubes that carry sperm are 270. thick by mucus and do
not develop properly. Infertility is also possible, though less common, in women with
cystic fibrosis.
Pancreatitis is inflammation of the pancreas. The pancreas is a 271. blocked
gland behind the stomach and close to the duodenum the 272. poor part of the
small intestine. The pancreas secretes digestive juices, or enzymes, into the duodenum
through a tube called the pancreatic duct. Pancreatic enzymes 273. reach with bile to
9

The Digestive System

274. live food. The pancreas also 275. blocks the hormones insulin and glucagon into
the bloodstream. These hormones help the body regulate the glucose it takes from
food for energy. Normally, 276. medical enzymes secreted by the pancreas do not
become active until they 277. join the small intestine. But when the pancreas is 278.
first, the enzymes inside it attack and damage the tissues that produce them.
Pancreatitis can be acute or chronic. Either form is serious and can 279. help to
complications. In severe cases, bleeding, infection, and 280. inflamed tissue damage
may occur.
20. For gaps 281-300 make a new word from the one given in brackets, which
fits in the gap:
Acute 281. ...... (PANCREAS) usually begins with gradual or sudden pain in
the upper abdomen that sometimes extends through the back. The pain may be mild at
first and feel worse after eating. But the pain is often severe and may become constant
and last for several days. A person with acute pancreatitis usually looks and feels very
ill and needs immediate medical attention. Other symptoms may include: a 282. ......
(SWELL) and tender abdomen, nausea and 283. ...... (VOMIT), fever and a rapid
pulse. Treatment for acute pancreatitis requires a few days stay in the hospital for
284. ...... (VEIN) (IV) fluids, antibiotics, and medication to relieve pain. The person is
not allowed to eat or drink so the pancreas can rest. If vomiting occurs, a tube may be
placed through the nose and into the stomach to remove fluid and air. Unless 285. ......
(COMPLICATE) arise, acute pancreatitis usually resolves in a few days. In severe
cases, the person may require 286. ...... (NOSE) feeding, a special liquid given in a
long, thin tube inserted through the nose and throat and into the stomach, for several
weeks while the pancreas heals. Before leaving the hospital, the person will be
advised not to smoke, drink 287. ...... (ALCOHOL) beverages, or eat fatty meals. In
some cases, the cause of the pancreatitis is clear, but in others, more tests are needed
after the person is discharged and the pancreas is healed.
Pancreatic pseudocysts are the most common 288. ...... (CYST) lesions of the
pancreas, 289. ...... (COUNT) for 75-80% of such masses. A pancreatic pseudocyst is
most frequently located in the lesser 290. ...... (PERITONEUM) sac in the proximity
of the pancreas. The pancreatic secretions incite an intense 291. ...... (INFLAME)
response, which eventually leads to the development of a thick 292. ...... (FIBRE)
capsule surrounding the pancreatic fluid.
Pseudocysts most commonly result from an acute or chronic inflammatory
process involving the pancreas. Pancreatic trauma also can result in pseudocyst 293.
...... (FORM). In this process, the common etiologic insult that causes 294. ......
(LEAK) of pancreatic juice and pseudocyst formation is pancreatic 295. ...... (DUCT)
disruption.

Most acute fluid collections associated with acute pancreatitis resolve 296.
...... (SPONTANEOUS). Some remain for longer than 4 weeks and become encased
in a fibrous capsule. Those that persist for longer than 6 weeks may be followed 297.
...... (CONSERVE) if they are smaller than 6 cm in diameter. They still have an
excellent chance of 298. ...... (GO) complete spontaneous resolution with a low
morbidity rate. Pseudocysts that persist for more than 6 weeks and are 6 cm in
diameter or larger have a low 299. ...... (LIKELY) of complete spontaneous resolution
and are associated with 300. ...... (SIGNIFY) morbidity rates. These pseudocysts
should be drained.
Glossary
aftermath the period immediately following a usually ruinous event
ascites abnormal accumulation of serous fluid in the spaces between tissues and
organs in the cavity of the abdomen
bilirubin a reddish-yellow water insoluble pigment occurring especially in bile and
blood and causing jaundice if accumulated in excess
enema the injection of liquid into the rectum and colon by way of the anus
fretful irritable, restless
havoc wide and general destruction
ooze to pass or flow slowly through or as if through small openings or interstices
wheeze to breathe with difficulty usually with a whistling sound

10