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Patho: GI > GI > Flashcards

GI Flashcards

1
Q

Most abundant plasma protein

A

Albumin

Synthesized exclusively by the liver

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2
Q

Specific liver function enzyme

A

ALT, an aminotransferase

AST: not specific to liver, present in extrahepatic tissues

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3
Q

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

A

Alkaline phosphate

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4
Q

Gallstone formation is due to

A

Abnormalities in physicochemical characteristics of various components of bile.

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5
Q

Most gallstones are composed of

A

cholesterol: high fat and protein intake

They are radiolucent: not seen in xrays

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6
Q

Gallstones are most often in patients with what dz?

A

Cirrhosis and hemolytic anemia

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7
Q

Procedure of choice for acute cholecystitis

A

Lap cholecystectomy

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8
Q

Procedure done during lap cholecystitis to clean duct

A

Cholenagiography with ERCP

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9
Q

Cardio and resp changes in laparoscopic surgery

A

increased intraabdominal pressure

Decrease in VR, CO increase in SVR and MAP

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10
Q

WHich medication is controversial during surgery of acute cholecystitis

A

Opioids, they cause spasm of Oddic sphincter

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11
Q

Presence of what causes halothane induced hepatitis

A

immunoglobulin G antibodies

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12
Q

Most common volatile anesthetic agent to cause hepatitis

A

Halothane

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13
Q

Which volatile anesthetic does not produce TFA?

A

Sevoflurane

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14
Q

Most common cause of Chronic Hepatitis is produced by

A

Alcohol and Hep C

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15
Q

Remaining gallstones are composed of

A

Calcium bilirubinate; these are radioopaque

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

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16
Q

Inflammation of gallbladder

A

Cholecystitis

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17
Q

Cholithiasis increased in

A

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

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18
Q

Choliathiasis is

A

Gallstones in gallbldder

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19
Q

Acute cholecystytis

A

Obstruction of common bile duct or cystic duct by gallstones

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20
Q

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

A

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

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21
Q

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

A

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

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22
Q

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

A

Spasm of sphincter of Oddi

TX: Glucagon, Nitroglycerin, and Naloxone

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23
Q

Where are gallstones present in choledocholithiasis

A

Common Bile duct

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24
Q

Acute hepatitis may progress to

A

Chronic hep, cirrhosis, end stage liver failure and carcinoma

25
Q

Symptoms of acute hepatitis

A

May have minimum symptoms, at least malaise and jaundice

26
Q

Viral hepatitis viruses are

A

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

27
Q

Most common cause of viral hep

A

HEP A, not B

28
Q

Which viruses have high risk of development of cirrhosis and carcinoma

A

B, C

29
Q

Which Hepatitis occurs with another

A

B and D

30
Q

What is the antidote for drug induced hepatitis in acetaminophen OD

A

Oral N- Acetylcysteine

31
Q

Hepatitis caused by acetaminophen OD is cause mainly by

A

NAPQI, toxic metabolite and decreased stores of glutathione

32
Q

Tx for autoimmune hepatitis

Dx

A

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

33
Q

Chronic hepatitis most commonly caused by

A

Alcohol then Hep C

34
Q

Most common hereditary hyperbilirubinemia

A

Gilbert Syndrome

35
Q

Gilbert Syndrome is caused by

A

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

36
Q

In Gilbert Syndrome how much is bilirubin

A

Does not exceed 5

Normal is 0-1

37
Q

Crigler Najjar syndrome

A

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

38
Q

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

A

Phonobarbital therapy decreases jaundice by stimulating activity of glucuronosyl transferase

39
Q

Dubin Johnson syndrome

A

Increase COnjugated hyperbilirubinemia
Not cholestatic
Benign

40
Q

Postoperative intrahepatic cholestasis

A

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

41
Q

Which labs are increase in postop intrahepatic cholestaisis

A

NONE

42
Q

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

A

Cholesotasis infancy, End Stage CIRRHOSIS in adulthood

43
Q

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

A

Pruritus

Tx: Liver transplant

44
Q

Hepatitis sypmtoms

A

Minimal.. malaise and jaundice

45
Q

Halothane hepatitis caues

A

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

46
Q

Which volatile anesthetic does not produce TFA

A

Sevoflurane

47
Q

DM is caused by

A

Insulin resistance and low insulin production

48
Q

DM 1a and DM 1b

A

Type 1 DM

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

49
Q

Which dz may mimic ureterolithiasis

A

Choledocholithiasis

50
Q

Symptoms of cirrhosis

A

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

51
Q

Ascites is caused by

A

Hypoalbinemia, water and sodium retention

52
Q

Which coagulation factors are VIt K dependent

A

2,7, 9, 10

53
Q

Coagulopathy also afected

A

Protein C, S, ANtithrombin 3, Protein Z

54
Q

Acute Liver failure is severe failure with

A

Impaired synthetic capacity and encephalopathy

55
Q

Dx tool for Acute liver failure

A

Child PUgh Score, higher the score worst outcome

56
Q

Pharmakinetics in liver dz

Vd, Cl, Protein binding,

A

Vd: increased
Cl- decreased
Protein binding, decreased

57
Q

Organ allocation for End Stage Liver Dz is called

A

MELD score (40 is highest score)

58
Q

Liver Dz decreases or increases SVR

A

Decreases

Patho: GI (3 decks)

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