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Patho II > GI Tract 2 > Flashcards

GI Tract 2 Flashcards

1
Q

Bile salts orient themselves around droplets of lipid and keep the lipid droplets dispersed called _______

A

Emulsification

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2
Q

Bile is produced continuously by _____ and is stored in the ____ for subsequent release

A

Hepatocytes; gallbladder

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3
Q

Why does ileal resection lead to steatorrhea?

A

Bile salts are excreted in feces instead of recirculated to the liver -> depleted bile acid pool -> deficiency of fat soluble vitamins (ADEK)

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4
Q

How does hypersecretion of gastrin cause malabsorption?

A

⬆️ gastrin ⬆️ H ⬇️ pH -> inactivation of pancreatic lipase

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5
Q

How does bacterial overgrowth lead to malabsorption?

A

May lead to deconjugation of bile acids & “early” absorption in upper small intestine. Bile acids not present throughout small intestine to aid in lipid absorption

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6
Q

⬇️ number of intestinal cells leading to malabsorption. Bacterium may cause

A

Tropical sprue

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7
Q

Celiac disease, gluten allergy, destroyed microvilli (bald intestine). Results when decreased absorption even when food is well digested

A

Non tropical sprue

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8
Q

Abdominal/LUQ pain, shoulder pain (d/t irritation of diaphragm), hypotension

A

Indications for splenectomy?

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9
Q

Most frequent hematologic indication for splenectomy. Excess platelet removal and destruction by spleen

A

Idiopathic thrombocytopenic purpura (ITP)

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10
Q

Capillary blocked by platelet deposits. Fever, hemolytic anemia, renal failure, low platelets (used up in clumps in body).

A

Thrombotic thrombocytopenic purpura (TTP)

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11
Q

Tx for TTP

A

Plasmapheresis, steroids, FFP, aspirin,

Splenectomy for refractory patients

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12
Q

Spleen removes one or more cell lines of blood (RBC, WBC, platelets). MC d/t portal venous HTN

A

Hypersplenism

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13
Q

What do patients need after splenectomy?

A

Vaccinate for pneumococcus, hemophilus

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14
Q

Severe epigastric pain to back; increases post-prandial. N/V (dehydration).
Grey-Turner sign, Cullen sign
ARDS (d/t elastase)

A

Acute pancreatitis

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15
Q

Lab findings indicating acute pancreatitis

A

⬆️⬆️ amylase, lipase, hypocalcemia, hyperglycemia

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16
Q

Management of acute pancreatitis

A 
NPO & NG suction
IV hydration
Pain meds
Remove stones
ERCP
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17
Q

Tumor of neuroendocrine cells of GIT that secrete serotonin (5-HT)

A

Carcinoid tumors

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18
Q

Carcinoid tumors increase levels of bradykinin, prostaglandins, kallikrein, & histamine resulting in:

A 
Skin flushing
Watery diarrhea/abd pain
Bronchospasm
Valvular lesions
Large swings in BP
SVT
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19
Q

How do you diagnose carcinoid tumors

A

High levels of 5-HIAA in urine

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20
Q

Tx for carcinoid tumors

A

Octreotide (somatostatin analogue)

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21
Q

Abdominal angina implies ischemia in 2 of what 3 mesenteric vessels?

A

Celiac axis, SMA, or IMA

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22
Q

Post-prandial pain, sitophobia, & weight loss

A

Abdominal angina

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23
Q

High K, lactic acidosis, leukocytes is, “thumbprinting” on barium enema. Angiogram helpful

A

Ischemia of SMA

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24
Q

Painless bleeding, bloody diarrhea (pain), acute left sided abdominal finding. Most commonly in “watershed” areas- splenic flex use and rectosigmoid.
Small vessels so angiogram not helpful

A

Ischemia of IMA (ischemic colitis)

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25
Q

What is considered a late sign for GI bleed?

A

Hypotension and tachycardia seen when blood loss approaches 25% of blood volume

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26
Q

RLQ pain, anorexia, N/V, fever

A

Appendicitis

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27
Q

Acute abdominal pain, tenderness, & fever, absent bowel sounds, tachycardia, hypotension, & dehydration

A

Peritonitis

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28
Q

Bile production is ______ ml/day

A

1200

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29
Q

When BG is high _____ occurs, when BG is low _____ occurs

A

Glycogenesis; glycogenolysis

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30
Q

The liver oxidizes fatty acids to produce _____

A

ATP

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31
Q

The liver is responsible for formation of ALL clotting factors except _____

A

III; IV, vWF, VIII

32
Q

Kill 99% of bacteria from gut

A

Kupffer cells

33
Q

______ develops d/t induction fo P450 by various drugs

A

Tolerance

34
Q

______ reactions slow down in old age

A

Phase II

35
Q

Hepatic triad

A

Bile duct, hepatic vein, & hepatic artery

36
Q

Portal vein ______ ml/min + hepatic artery ______ ml/min = hepatic vein ______ ml/min

A

1300; 500; 1800

37
Q

Blood supply to the liver is _____ % of CO

A

25-30%

38
Q

Liver receives blood from ______ (25%) and from _____ (75%). The oxygen supply is __:__

A

Hepatic artery; hepatic portal vein; 50:50

39
Q

Interlobular vessels in the liver open into _____

A

Hepatic sinusoids

40
Q

Normal portal vein pressure =

A

9 mmHg

41
Q

Cirrhosis ____ resistance to blood flow, therefore ___ portal blood flow

A

Increases; decreases

42
Q

What is the arterial buffer response to cirrhosis?

A

Increase hepatic artery blood flow in response to decreased portal flow to maintain supply

43
Q

Hepatic blood flow depends on:

A

Driving pressure (MAP - hepatic venous pressure)
Intrahepatic vascular resistance
Metabolic demand

44
Q

All volatile anesthetics ___ hepatic blood flow

A

Decrease

45
Q

______ is removed form blood by liver, conjugated with glucuronate and excreted in bile (not urine)

A

Free bilirubin

46
Q

In the intestine, bacteria convert _____ bilirubin to _____ (soluble). Some is reabsorbed into blood and excreted as urobilin into urine or stercobilin in feces

A

Conjugated; urobilinogen

47
Q

In hemolytic anemia _____ increases

A

Unconjugated bilirubin

48
Q

In obstructive jaundice ______ increases

A

Conjugated bilirubin

49
Q

In the liver, bilirubin is conjugated with _____ by enzyme ______

A

Glucuronic acid; UDP glucuronyl transferase

50
Q

Raises with biliary tract obstruction

A

Alkaline phosphatase

51
Q

Best indicator of hepatocellular dysfunction

A

PT prolongation (not making prothrombin)

52
Q

_____ is sign of worst prognosis in liver failure

A

Hypoglycemia (failure of glucose production)

53
Q

Jaundice is seen when bilirubin > ? (Normal ?)

A

1.5 mg/dL; 0.5 mg/dL (free bilirubin)

54
Q

What test can differentiate b/w conjugated and uncojugated hyperbilirubinemia?

A

Van den Bergh test

55
Q

Jaundice of the newborn is d/t increased ______ bilirubin. This is d/t a deficiency of _____ in the immature liver

A

Unconjugated; glucuronyl transferase

56
Q

Transmitted primarily by fecal-oral route.
Short incubation (3 wks), no carrier
Asymptomatic
RNA virus

A

Hep A

57
Q

Transmitted primarily by parenteral, sexual, & maternal-fetal routes.
Long incubation period (3 mo)
Carriers
DNA virus

A

Hep B

58
Q 
Skin poppers (60%). Resembles HBV in course and severity.
Carriers, Chronic Cirrhosis, Carcinoma
A

Hep C

59
Q

A defective virus. Need HBV (co-infection)

A

Hep D

60
Q

Transmitted enterically & causes water-born epidemics.
Resembles HAV.
Increased mortality rate in pregnant women (Expectant mothers, Enteric)

A

Hep E. (Vowel A&E hit your bowels)

61
Q

Both ____ & ____ predispose a patient to hepatocellular Ca

A

HBV & HCV

62
Q

IgM antibody to HAV; best test to detect active hepatitis A

A

IgM HAVAb

63
Q

Antigen found on surface of HBV, indicates active state.
Appears before the symptoms, persists 3-4 months, disappears when virus clear.
If persistent > 6 mos -> carrier state

A

HBsAg

64
Q

Antibody to ABsAg, appears a few weeks after disappearance of the antigen and indicates recovery & vaccination (immunity)

A

HBsAB

65
Q

Antigen a/w core of HBV

A

HBcAg

66
Q

Antibody to HBcAg; only marker during window period. Appears 4 weeks after the appearance of HBsAg, is present during acute illness and can remain elevated for years

A

HBcAb

67
Q

A second different antigenic determinant in the HBV core. Important indicator of infectivity (transmissibility) BEware

A

HBeAg

68
Q

Antibody to ‘e’ antigen; indicates low transmissibility

A

HBeAb

69
Q

Which drugs cause acute hepatitis

A

INH & methyldopa

70
Q

Which drugs cause cholestasis

A

Chlorpromazine, Erythromycin, & Estrogen

71
Q

Which drugs cause fatty liver

A

Steroids, alcohol (MCC), tetracycline

72
Q

Which VA causes liver disease

A

Halothane

73
Q

Tx for acetaminophen overdose

A

N-Acetylcysteine

74
Q

Rare, often fatal childhood hepatoencephalopathy.

Fatty liver, hypoglycemia “ominous sign”, coma, a/w viral infection (VZV, influenza B) & salicylates

A

Reye’s syndrome

75
Q

Characterized by thrombocytopenia, leukopenia, magaloblastic anemia (d/t deficiency of folate & thiamine)
MAC ⬆️ in sober and ⬇️ in intoxicated pts

A

Chronic alcoholism

76
Q

Delirium Tremens occurs after _____ hrs cessation of drinking

A

24-96

Patho II (11 decks)

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