Gastrointestinal / Hepatic Systems / Nutrition

Question 1

What are the respiratory quotients for lipogenesis, gluconeogenesis, and ketogenesis?

Answer 1

lipogenesis (from glucose): 1.0

gluconeogenesis (from alanine): 0.8

ketogenesis (from fat): 0.7

Question 2

What vessels provide blood flow to the liver?

Answer 2

portal vein: 75% of flow, 50% of O₂

hepatic artery: 25% of flow, 50% of O₂

Question 3

How do NSAIDs promote stomach ulceration?

Answer 3

decreased prostaglandin synthesis

• > decreased mucus secretion
• > increased corosive effects of HCl and pepsin

Question 4

What does an ABG look like in a patient with acute, unremitting diarrhea?

Answer 4

a non-gap metabolic acidosis w/ hyperchloremia and hypokalemia

Question 5

Which type of anesthetic is associated with quicker return of bowel function post-op?

Answer 5

thoracic epidural

Question 6

Which classes of medications reduce LES tone?

Answer 6

anti-cholinergics

opioids

thiopental

volatiles

Question 7

What are the ASA NPO guidelies?

Answer 7

clear liquids: 2 hours

breast milk: 4 hours

light meal, formula, non-human milk: 6 hours

heavy meal: 8 hours

Question 8

How does propranolol decrease portal pressure?

Answer 8

blockade of ß2 receptor in the hepatic artery causing vasoconstriction

Question 9

How is portal hypertension defined?

Answer 9

pressure gradient between the portal vein and IVC

>5: portal hypertension

>12: symptomatic

Question 10

What should be used for volume resuscitation after large volume paracentesis?

Answer 10

5g of albumin per 1L of ascites removed

Question 11

What are the components of the Child-Pugh score?

Answer 11

INR

bilirubin

albumin

ascites

encephalopathy

Question 12

What are the components of the MELD score?

Answer 12

INR

bilirubin

creatinine

Question 13

Is hepatorenal syndrome a pre-, post-, or intrinsic renal condition?

Answer 13

pre-renal that doesn’t respond to treatment

(likely vasoconstriction of renal arteries and vasodilatation of the splanchnic circulation)

Question 14

How should muscle relaxants (except cisatracurium) be dosed in patients with hepatic failure?

Answer 14

Increased initial dose (larger volume of distribution)

Decreased maintenance dose (decreased metabolism)

Question 15

How is hepatic blood flow affected by general anesthesia? Neuraxial anesthesia?

Answer 15

decreased for both

Question 16

Why is hypocalcemia associated with increased morbidity and mortality in acute pancreatitis?

Answer 16

it’s a sign of calcium precipitating with fats degraded by the pancreatic enzymes

Question 17

Which is associated with less morbidity and mortality, enteral nutrition or TPN?

Answer 17

there is no difference

Question 18

Which is associated with a better immune response, enteral nutrition or TPN?

Answer 18

enteral nutrition

Question 19

What are the transmission rates for HIV, HCV, and HBV following needle stick (roughly)?

Answer 19

HBV ~ 20%

HCV ~ 2%

HIV ~ 0.2%

Question 20

After HCV infection, how many patient go on to develop chronic infection? Cirrhosis?

Answer 20

85% develop chronic infection

of those, 20% develop cirrhosis

Question 21

How does propofol lead to pancreatitis?

Answer 21

It elevated triglycerides, which are broken down by pancreatic lipase to free fatty acids, which cause a proinflammatory state, leading to pancreatits (usually takes about a week)

Question 22

Which opioid has causes the least sphincter of Oddi contraction?

Answer 22

meperidine

Question 23

What drug counteracts the sphincter of Oddi contraction caused by opioids?

Answer 23

glucagon

Question 24

How many ATPs are made per molecule of glucose via aerobic metabolism?

Answer 24

38

Question 25

Why do cirrhotic patients often have an elevated SvO2?

Answer 25

high cardiac output and peripheral A-V shunting

Question 26

Which electrolyte deficiency associated with TPN is most likely to cause respiratory failure?

Answer 26

hypophosphatemia

Question 27

What are the risk factors for acalculous cholecystitis? Why is it a surgical emergency?

Answer 27

• trauma, surgery, and TPN
• rupture can occur within 48h