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Exam 2 - GI and Liver > Clinical - GI and Liver > Flashcards

Flashcards in Clinical - GI and Liver Deck (43):

How would cholangiocarcinoma present?

pain that looks a lot like acute cholecystitis (inflamed gallbladder) or acute cholelithiasis


Pathologic finding associated w/ primary sclerosing cholangitis



AST normal values

8-20 U/L


ALT normal values

8-20 U/L


LDH normal values

45-90 U/L


Name (3) measures for looking at liver synthetic fxn

-Albumin (3.5-5.5 g/dL)
-Prothrombin time (12-14 sec)
-Platelets (150,000 - 400,000)


Total bilirubin (conj + undone) normal values

0.1 - 1.1 mg/dL


Direct (conjugated) bilirubin

0.0 - 0.3 mg/dL


Alkaline Phosphatase normal values

20-70 U/L


GGT: what is it and what are normal values?

GGT = Gamma-glutamyl-transpeptidase. Enzyme that's in hepatocytes and biliary epithelial cells.

Normal GGT = 0 - 30 U/L


normal GGT with high Alk Phos is suggestive of? Why?

w/ normal GGT, it is unlikely liver origin that is the cause of the high Alk Phos (think of bone diseases or metastases).

However, high GGT + high Alk Phos = suggests liver origin


Hemoglobin normal values for M and F

M: 13.5 - 17.5 g/dL

F: 12 - 16 g/dL


Hematocrit normal values for M and F

M: 39 - 49%

F: 35 - 45%


Creatinine normal values

0.6 - 1.2 mg/dL


Which vitamin is Thiamine? Thiamine plays a MAJOR role in production of what?

Thiamine = B1
Plays a major role in production of Acetyl-CoA (energy metabolism and such)


Wernicke-Korsakoff syndrome

Thiamine (B1) deficiency linked to alcoholism, causes neurological sx: confusion, memory problems, psychosis


Which vitamin is Riboflavin?

Riboflavin = B2


Which vitamin is Niacin? What is one unique property of Niacin?

Niacin = B3
Unusual for a vitamin, b/c Niacin can be made in small amounts in human body from Tryptophan. Low amounts of Trp in corn explain Niacin deficiencies in places where corn is dietary staple.



Caused by Niacin (B3) deficiency:
Sx = 3 D's: Diarrhea, Dermatits, and Dementia


Which amino acid can be used as a precursor for niacin synthesis by the human body?

Tryptophan (Trp, W)
[endogenous synthesis of niacin is insufficient for health, but can help reduce amt needed from exogenous sources]


Which vitamin is Biotin? What reaction does it catalyze?

Biotin = B7. ONLY used for carboxylation reactions. Include gluconeogenesis (co-enzyme to pyruvate carboxylase) and fatty acid synthesis (acetyl-CoA carboxylase)


Multiple carboxylase deficiency: cause and sx

deficiency in either Biotinidase and/or Holocarboxylase synthase. These enzymes assist in making Biotin useable as a co-enzyme in carboxylation reactions.
Sx = alopecia, brittle fingernails, skin rashes, neuro deficits, and tingling of extremities.


Which vitamin is Pantothenic acid? What are the (2) characteristic sx of pantothenic acid deficiency?

Pantothenic acid = B5

Deficiency sx: Numbness and painful burning/tingling of extremities


Which vitamin is Pyridoxine? What is the co-enzyme form that all states must be converted into?

Pyridoxine = B6, which can be found in several states.
Co-enzyme form = Pyridoxal Phosphate


All ____ enzymes use pyridoxal phosphate as a co-enzyme

transaminase enzymes


Name (5) disorders that use pyridoxal phosphate as a co-enzyme and, thus, may respond to vitamin supplements

-Pyridoxine-dependent epilepsy
-Ornithineaia with gyrate atrophy
-X-linked sideroblastic anemia


X-linked sideroblastic anemia: what's the defect and what is the enzyme affected? Tx?

Defect in HEME synthesis!
Enzyme: delta-amino levulinic acid synthase
Tx: Vitamin B6 (Pyridoxal phosphate) supplement


Homocysteinuria: what's the defect and what enzyme is affected? Tx?

Defect in Methionine catabolism (breakdown)
Enzyme: Cystathionine synthase
Tx: Vitamin B6 (Pyridoxal phosphate) supplement


Pyridoxine-dependent epilepsy: what job does the affected enzyme do. Tx?

Enzyme's job is to break down Lysine in the brain.
Tx: Vitamin B6 (Pyridoxal phosphate) supplement


What is Hypophosphatasia (mechanism and sx) and what is the tx?

general (non-tissue-specific) low Alkaline Phosphatase. Imp b/c it's needed for pyridoxal entry into the BRAIN.
Sx = convulsions and epilepsy
Tx: Vitamin B6 (Pyridoxal phosphate) supplement


the sideroblastic anemia caused by vitamin B6 deficiency is caused by a reduction in ___

the synthesis of heme


important complication of decompensated cirrhosis with ascites

spontaneous bacterial peritonitis
(b/c ascites is from the portal HTN; when fluid is just sitting there, can be pushed out into peritoneum and can be nutrient-rich environment for bacterial infection)


Which inflammatory bowel disease is more likely associated with fat-soluble vitamin deficiencies? Which vitamins are these?

Crohn's disease - usually involves the terminal ileum, which absorbs the fat-soluble vitamins = A, D, K, and E


Name (4) extraintestinal manifestations of BOTH inflammatory bowel diseases

BOTH Crohn's and Ulcerative Colitis (A-E-O-R)
-Arthritis = Peripheral or Spondylitis
-Eye inflammatory = Uveitis, Episcleritis
-Oral ulcerations = Apthous Stomatitis
-Rash = Pyoderma Gangrenous, Erythema Nodosum


Rovsing sign

sign of acute appendicitis, where pressure on LLQ causes pain in RLQ
(think the pain roves to the right)


mechanism of how vitamin B6 deficiency causes sideroblastic anemia

Pyridoxal phosphate (B6) is an essential co-enzyme for delta-amino-levulinic acid synthase, which catalyzes the first step in heme synthesis. So reduction in heme leaves the Fe nowhere to go. So it deposits around nuclei = sideroblasts


What type of anemia is caused by folate deficiency? By what mechanism?

Folate (B9) deficiency causes megaloblastic anemia due to the need for nucleotides in rapid proliferation of RBCs. So cells continue to grow, but division is delayed b/c replication has slowed.


Folate v. Folic acid

Folic Acid = the specific form used to fortify foodstuffs (which is readily absorbed by our GI tract b/c it's monoglutanimated)
Folate = the other polyglutaminated forms of Vitamin B9 found in natural products that are less well absorbed


Which vitamin is Cobalamin? Where is it almost exclusively found?

Vitamin B12. Found almost entirely in animal products (so vegans need fortified foods or supplements)


What is the folate trap?

When folic acid supplementation masks a Vitamin B12 deficiency


mechanism of pernicious anemia. Tx?

autoimmune destruction of parietal cells, which synthesize Intrinsic Factor needed for B12 absorption in the ileum.
Tx = B12 injections


Name (2) drugs interactions that can decrease vitamin B12 absorption

1) PPIs (Omeprazole): reduce stomach acid. Prolonged use necessary for B12 deficiency to develop

2) Tetracyclin - can interfere w/ B12 absorption. So if you're taking B12 supplements, must take them at diff times than the abx


Why would a person w/ defective induction of hepcidin be discouraged from taking Vitamin C supplements?

Hemochromatosis is caused by a defect in hepcidin induction, leading to iron overload. Vit C supplements will even further increase iron absorption, increasing the pt's risk for organ damage