GI ADVANCED PATHOPHYSIOLOGY EXAM -
ACTUAL EXAM 200 QUESTIONS AND CORRECT
DETAILED ANSWERS (100% VERIFIED ANSWERS)
|ALREADY GRADED A+
If we have a plug so bile can't get out of the liver (e.g. cholelithiasia), what happened to bilirubin? - ANSWER- increased conjugated bilirubin. --> Jaundice
(The liver converts ammonia to urea for excretion in the urine.)
What are the three causes for jaundice? - ANSWER- 1. prehapatic: increased
indirect (unconjugated) bilirubin.
2. hepatocellular: e.g. ETOH, hepatitis that increase direct bilirubin
3. cholestatis/obstructive: increase direct bilirubin
When patient has cholelithiasia, what color of stool and urine would he have? -
ANSWER- - Stool: pale, white, clay because no bilirubin in the stool.
- dark urine because elevated direct bilirubin goes to the nephrons and excrete in
the urine.
In a liver dysfunction, urea synthesis is inadequate. What happens? - ANSWER- increased blood ammonia level (NH3). --> hepatic encephalopathy
What is the normal amino acid breakdown process? - ANSWER- amino acid breakdown --> ammonia --> urea, excreted in urine. On standing, urea in urine reverts to ammonia.
What are the correct precipitating factors of hepatic encephalopathy? - ANSWER-
- decreased potassium, sodium, and oxygen (O2).
- increased Co2.
- alkalosis, infection, hemorrhage, increased protein intake, renal failure,
- sedatives
constipation
What does Lactulose (Cephulac) do? - ANSWER- Decreases pH of colon.
- decreased production of ammonia (NH3).
- reduced diffusion of NH3 from colon into blood.
- cathartic excretion of NH3.
Due to liver dysfunction, toxins and hormones are accumulated. What are the three outcomes from it? - ANSWER- * Accumulation of toxins and hormones
- feminization (excess estrogens)
- poor metabolism of drugs
- spider nevi (estrogen)
What happened to AST and ALT levels in a patient with liver dysfuction? -
ANSWER- Release of marker enzymes into body: elevated AST and ALT
Explain the portal circulation system? - ANSWER- All blood from the GI tract goes to the liver to metabolize and absorb nutrition, then goes out through the hepatic vein to vena cava. If the liver is not working then blood backs up in the portal vein which leads to portal hypertension.
What causes portal hypertension and what are its complications? - ANSWER- Liver fibrosis and degeneration causes backup of blood into portal circulation.Increased pressure (hydrostatic pressure) causes varices, ascites, anorexia, hemorrhoids.
What are the three medication treatments for esophageal varices? - ANSWER- 1.vasopressin (Pitressin) = ADH has a vasoconstriction effect. Side effect: MI (Give NTG), hyponatremia. (ADH: holds on to water) 2. Octreotide: reduce portal blood flow.
3. metoclopramide (Reglan): esophageal muscle constriction. neuromuscular
disorder side effect.
What other medical treatments are there for esophageal varices? - ANSWER- EGD- sclerosis, ligation/banding, Balloon tamponade. transjugular intrahepatic portosystemic shunting. (shunt between portal vein and hepatic vein)
What are the two major causes of ascites? - ANSWER- Ascites is accumulation of fluid in the peritoneal space.Portal hypertension (increased hydrostatic pressure) + hypoalbuminemia (decreased oncotic pressure).
What are the two major complications with hepatic ascities? - ANSWER- peritonitis and esophageal varices.
Why do you give albumin for paracentesis? - ANSWER- to prevent hypotension.
What are the two medications causing GERD? - ANSWER- tricyclics and
anticholinergics
What are the complications of GERD? - ANSWER- 1. . Barrett's esophagus (esophageal lining replaced with columnar epithelium, premalignant) 2. aspiration pneumonia.
- bronchospasms (45-65% w asthma have GERD).
- strictures of esophagus.
What are the medication options for GERD? - ANSWER- - antiacids, H2 blockers,
proton pump inhibitors (PPI). - Gaviscon: breaks down gas bubbles
- Metoclopramide (reglan): increases GI motality --> increases gastric emptying -
Bethanecol (Urecholine) = cholinergic drugs increases GI motality --> increases gastric emptying; increases lower esophageal sphincter (LES) tone.
What is a surgical option for GERD? - ANSWER- Nissen fundoplication.
What is the difference between sliding hiatal hernia and rolling hital hernia? - ANSWER- Sliding hiatal hernia is that fundus moves up through and rolling (paraesophageal) hernia is that part of stomach slips up. Both increases a chance of stomach contents getting up in the esophagus.
What are the two surgical repairs for hital hernia? - ANSWER- laparoscopic fundoplication and endoscopic fundoplication.
What are the contributing factors of gastritis? - ANSWER- ETOH, caffeine, smoking, ASA, steroids, reflux of duodenal contents, bacterial endotoxins (H.pylori, e. coli), radiation
what condition does a specific hyperacidity test for? - ANSWER- Zollinger-Ellison Syndrome
What are the medication choices for gastritis? - ANSWER- PPI, H2 blockers, Cytotec = misoprostol (acts as prostaglandin protecting the lining of the stomach) A manifestation of liver dysfunction is impaired protein synthesis. What are the three phenomenons related to that?
- clotting factor deficiency: bleeding, elevated PT (vitamin K related anemia).
2. hypoalbuminemia: edema, ascites.
- inadequate antibody production. (immunoglobulin = protein)
What is indirect bilirubin?
= unconjugated bilirubin
- elevated with increased RBC breakdown or impaired liver uptake
- bound by albumin so not found in urine
(Bilirubin, the end product of heme catabolism, is transported to the liver to be conjugated and excreted via the bile. Most of the bilirubin in blood is in transit from the tissues to the liver, in the unconjugated form, bound to albumin. Only small amounts of conjugated bilirubin are normally found in blood, and it is believed that the usual analytical methods tend to overestimate it in the low reference range. Bilirubin determinations are reported in two fractions, the "conjugated" and the "total.")
What is direct bilirubin?= conjugated bilirubin
- elevated with impaired excretion of bilirubin from liver
- water soluble, so is found in urine
How is bilirubin transported?unconjugated bilirubin --> liver --> conjugated bilirubin --> gall bladder --> bile production in the gallbladder to digest fat in the GI tract
How is bilirubin excreted?
- Bile
- some excreted in the stool (brown)
- Some reabsorbed into the blood stream
- very small amount, if any, excreted in the urine
(Bilirubin is excreted in bile and urine.
- the yellow color of bruises
- the yellow color of urine (via its reduced breakdown product, urobilin)
- the brown color of faeces (via its conversion to stercobilin)
- the yellow discoloration in jaundice.)
If the liver gets fibrotic and not working well which bilirubin level would be elevated?conjugated bilirubin (hepatitis, fibrosis, and cirrhosis) . In hepatitis, fibrosis, and cirrhosis, high amounts of unconjugated bilirubin means the liver cells are not