GI

Question 1

Most abundant plasma protein

Answer 1

Albumin

Synthesized exclusively by the liver

Question 2

Specific liver function enzyme

Answer 2

ALT, an aminotransferase

AST: not specific to liver, present in extrahepatic tissues

Question 3

What lab can indicate damage to hepatocyte membranes in bile-salt induced cholestatic disorders

Answer 3

Alkaline phosphate

Question 4

Gallstone formation is due to

Answer 4

Abnormalities in physicochemical characteristics of various components of bile.

Question 5

Most gallstones are composed of

Answer 5

cholesterol: high fat and protein intake

They are radiolucent: not seen in xrays

Question 6

Gallstones are most often in patients with what dz?

Answer 6

Cirrhosis and hemolytic anemia

Question 7

Procedure of choice for acute cholecystitis

Answer 7

Lap cholecystectomy

Question 8

Procedure done during lap cholecystitis to clean duct

Answer 8

Cholenagiography with ERCP

Question 9

Cardio and resp changes in laparoscopic surgery

Answer 9

increased intraabdominal pressure

Decrease in VR, CO increase in SVR and MAP

Question 10

WHich medication is controversial during surgery of acute cholecystitis

Answer 10

Opioids, they cause spasm of Oddic sphincter

Question 11

Presence of what causes halothane induced hepatitis

Answer 11

immunoglobulin G antibodies

Question 12

Most common volatile anesthetic agent to cause hepatitis

Answer 12

Halothane

Question 13

Which volatile anesthetic does not produce TFA?

Answer 13

Sevoflurane

Question 14

Most common cause of Chronic Hepatitis is produced by

Answer 14

Alcohol and Hep C

Question 15

Remaining gallstones are composed of

Answer 15

Calcium bilirubinate; these are radioopaque

Most of the other are composed of cholesterol, high fat and protein intake; radiotranslucent

Question 16

Inflammation of gallbladder

Answer 16

Cholecystitis

Question 17

Cholithiasis increased in

Answer 17

women, pregnant, increased age, rapid weight loss and OBESITY

Question 18

Choliathiasis is

Answer 18

Gallstones in gallbldder

Question 19

Acute cholecystytis

Answer 19

Obstruction of common bile duct or cystic duct by gallstones

Question 20

Which pts can not have lap cholescystectomy and what procedure must they undergo

Answer 20

Septic shock, peritonitis, pancreatitis or coagulopathy. Must undergo OPEN cholecystectomy

Question 21

Inflammation of abdominal cavity by pneumoperitoneum causes in Venous return, CO SVR and MAP

Answer 21

Intrabdominal pressure: increases
CO and VR: decrease
SVR increase
MAP: increase

Question 22

What may cause opioids if administered during an open cholecystitis and TX?

Answer 22

Spasm of sphincter of Oddi

TX: Glucagon, Nitroglycerin, and Naloxone

Question 23

Where are gallstones present in choledocholithiasis

Answer 23

Common Bile duct

Question 24

Acute hepatitis may progress to

Answer 24

Chronic hep, cirrhosis, end stage liver failure and carcinoma

Question 25

Symptoms of acute hepatitis

Answer 25

May have minimum symptoms, at least malaise and jaundice

Question 26

Viral hepatitis viruses are

Answer 26

A, B, C, D, Herpes simplex virus, cytomegalovirus, Epstein Barr virus

Question 27

Most common cause of viral hep

Answer 27

HEP A, not B

Question 28

Which viruses have high risk of development of cirrhosis and carcinoma

Answer 28

B, C

Question 29

Which Hepatitis occurs with another

Answer 29

B and D

Question 30

What is the antidote for drug induced hepatitis in acetaminophen OD

Answer 30

Oral N- Acetylcysteine

Question 31

Hepatitis caused by acetaminophen OD is cause mainly by

Answer 31

NAPQI, toxic metabolite and decreased stores of glutathione

Question 32

Tx for autoimmune hepatitis | Dx

Answer 32

No tx: corticosteroids and immunosuppressive drugs Liver transplant if progression to end stage liver dz Dx made by serologic and genetic testing

Question 33

Chronic hepatitis most commonly caused by

Answer 33

Alcohol then Hep C

Question 34

Most common hereditary hyperbilirubinemia

Answer 34

Gilbert Syndrome

Question 35

Gilbert Syndrome is caused by

Answer 35

Mutation in glucuronosyl transferase enzyme (this enzyme is responsible of conjugating bilirubin for disposal

Question 36

In Gilbert Syndrome how much is bilirubin

Answer 36

Does not exceed 5 | Normal is 0-1

Question 37

Crigler Najjar syndrome

Answer 37

Rara unconjugated hyperbilirbenemia Glucuronosyl transferase is reduced to less than 10% Peds develop kernicterus

Question 38

In pts with Crigleer Najjar syndrome, what can be the tzx

Answer 38

Phonobarbital therapy decreases jaundice by stimulating activity of glucuronosyl transferase

Question 39

Dubin Johnson syndrome

Answer 39

Increase COnjugated hyperbilirubinemia Not cholestatic Benign

Question 40

Postoperative intrahepatic cholestasis

Answer 40

Occurs during prolonged hours of surgery, prolonged hypoxemia, hypovolemia and need for blood transfusion

Question 41

Which labs are increase in postop intrahepatic cholestaisis

Answer 41

NONE

Question 42

In Progressive familial Intrahepatic cholestasis, which dz is in infancy and which is in adult

Answer 42

Cholesotasis infancy, End Stage CIRRHOSIS in adulthood

Question 43

What sign is seen in progressive Familian intrahepatic cholestasis and what is the tx

Answer 43

Pruritus | Tx: Liver transplant

Question 44

Hepatitis sypmtoms

Answer 44

Minimal.. malaise and jaundice

Question 45

Halothane hepatitis caues

Answer 45

Immune mediated hepatotoxic reaction: Presence of circulating immunoglobin G antibodies. Antibodies attack the surface of hepatocytes proteins that have been covalently modified by TFA, metabolite of halothane and form neoantigens

Question 46

Which volatile anesthetic does not produce TFA

Answer 46

Sevoflurane

Question 47

DM is caused by

Answer 47

Insulin resistance and low insulin production

Question 48

DM 1a and DM 1b

Answer 48

Type 1 DM | 1a, autoimmune, beta cell destruction results in absence or small amounts of insulin

Question 49

Which dz may mimic ureterolithiasis

Answer 49

Choledocholithiasis

Question 50

Symptoms of cirrhosis

Answer 50

Spider angiomata, gynecomastia, testicular atrophy and ascites, portal HTN, hepatic encephalopathy, Hepatopulmonary syndrome, hepatorenal syndrome and portopulmonary HTN(most deadly), coagulopathy

Question 51

Ascites is caused by

Answer 51

Hypoalbinemia, water and sodium retention

Question 52

Which coagulation factors are VIt K dependent

Answer 52

2,7, 9, 10

Question 53

Coagulopathy also afected

Answer 53

Protein C, S, ANtithrombin 3, Protein Z

Question 54

Acute Liver failure is severe failure with

Answer 54

Impaired synthetic capacity and encephalopathy

Question 55

Dx tool for Acute liver failure

Answer 55

Child PUgh Score, higher the score worst outcome

Question 56

Pharmakinetics in liver dz | Vd, Cl, Protein binding,

Answer 56

Vd: increased Cl- decreased Protein binding, decreased

Question 57

Organ allocation for End Stage Liver Dz is called

Answer 57

MELD score (40 is highest score)

Question 58

Liver Dz decreases or increases SVR

Answer 58

Decreases