CHOUD-BSC GI phys

Question 1

What are the 4 steps of bilirubin transfer

Answer 1

hepatocellular uptake, intracellular binding, conjugation, biliary excretion

Question 2

Mutations in the multidrug resistance associated protein 2 result in what syndrome

Answer 2

dubin johnson

Question 3

what can lead to unconjugated hyperbilirubinemia

Answer 3

excessive production of bilirubin, reduced hepatic uptake

impaired conjugation

Question 4

what can lead to conjugated hyperbilirubinemia

Answer 4

decreased hepatocellular excretion

impaired bile flow (intra and extra hepatic)

Question 5

What are some disorders that lead to pre-hepatic jaundice

Answer 5

malaria, sickle cell anemia, thalassemia, G6PD deficiency, autoimmune, drugs or toxins

Question 6

What are some causes of hepatic jaundice

Answer 6

hepatitis ABC yellow fever
bacterial sepsis, TB, alcohol, birth control, carcinoma, lymphoma, pre-operative hypo perfusion/shock, chronic active hepatitis

Question 7

What are cuases of intra hepatic obstruction that lead to post hepatic jaundice

Answer 7

biliary atresia, primary biliary cirrhosis, malignant infiltration of ducts

Question 8

What are causes of extra hepatic obstuction that lead to post hepatic jaundice

Answer 8

gallstones in bile ducts
cancer
strictures of bile ducts
pressure on common bile duct from enlarged lymph nodes
cholangitis
pancreatitis

Question 9

What is physiologic neonatal jaundice

Answer 9

massive fetal hemoglobin lysis shortly after birth because low UDPGT levels and the intestinal flora of a newborn is underdeveloped
unconjugated bilirubin levels rise about 2-5 days

Question 10

What is breast milk jaundice

Answer 10

jaudive in breast-feeding newborns at end of first week, there are chemicals in breast milk that inhibit UDPGT

Question 11

Describe physical findings in pre-hepatic jaundice

Answer 11

no bilirubin in urine, stool and urine are a darker color

spenomegaly with hemolytic disorders

Question 12

Describe physical findings in hepatocellular (hepatic jaundice)

Answer 12

dark urine, low grade fever, RUQ discomfort

hepatomegaly

Question 13

Describe physical findings in post-hepatic jaundice

Answer 13

RUQ pain, dark urine, pale stool
intermittent signs and symptoms caused by stones or carcinoma
occult blood in stool–>cancer of ampulla
hepatomegaly and palpable gall bladder

Question 14

What is the usualy total serum bilirbuin number

Answer 14

<1mg/dL

Question 15

What type of bilirubin is increased with each type of jaundice

Answer 15

pre-hepatic- unconjugated
hepatic- both types
post-hepatic both types

Question 16

If alkaline phosphatase is increased which type of jaundice can be eliminated

Answer 16

pre-hepatic

Question 17

when urine bilirubin and urobilinogen are both increased what type of jaundice can be suspected

Answer 17

hepatic jaundice

Question 18

when urine bilirubin is increased and there is no urobilinogen which jaundice can be suspected

Answer 18

post hepatic

Question 19

can a single test differentiate between various classifications of jaundice

Answer 19

no need a combination

Question 20

Which type of jaundice is there splenomegaly

Answer 20

pre and intra hepatic

Question 21

ALT and ASP levels are increased in which types of jaundice

Answer 21

hepatic and post-hepatic

Question 22

antimalarial drugs can show light on what disease

Answer 22

G6PD deficiency

Question 23

what are the symptoms of hemolysis

Answer 23

malaise, weakness, abdominal or lumbar pain

Question 24

To determine G6PD what labs do you order

Answer 24

actual enzyme activity of G6PD
CBC with reticulocyte count to determine levels of anemia and bone marrow function
urinary urobilinogen
bilirubin levels to see if there is high unconj bilirubin

Question 25

What is the Tx for G6PD

Answer 25

discontinuation of precipitating agent
O2 therapy
bedrest
blood transfusion

Question 26

What can trigger G6PD deficiency

Answer 26

fava beans, antimalarials, antibiotics

Question 27

elevated levels of amylase and lipase suggest what in someone with alcoholism

Answer 27

pancreatitis

Question 28

What will a abdominal radiograph look like in a person with gallstones and secondary pancreatitis

Answer 28

gallstones and a “sentinel loop” which is a segment of air in the LUQ of small intestine

Question 29

What type of imaging is used for gallstones

Answer 29

ERCP

Question 30

What does phototherapy do in an infant

Answer 30

converts trans bilirubin to cis which is more water soluble

Question 31

what type of light is used in phototherapy

Answer 31

blue light