GI Flashcards
LEGEND: MC= Most Common MCC= Most Common Cause (155 cards)
1
Q
Typical histological appearance of Celiac Sprue
A
flat jejunal mucosa with no vili
2
Q
Stable retroperitoneal hematoma is most likely due to what structure?
A
pancreas (except the tail).
3
Q
Retroperiotineal Structures?
A
Suprarenal gland Abdominal aorta/IVC Duodenum (part 2,3,4) Pancreas (not tail) Ureters Colon (Asc/Desc) Kidneys Rectum
4
Q
Which galactose metabolism is more severe and what is the enzyme associated with it?
A
Classic galactosemia; Galactose1phosphate uridyl transferase (GALT)
vomiting lethargy failure to thrive with feeding.
5
Q
Deficiency in Galactokinase will give rise to what symptoms?
what enzyme is upregulated in this deficiency?
A
cataracts ; Aldose Reductase
6
Q
Bilious vomiting first 24 hours of life =?
A
intestinal obstruction below second part of duodenum.
due to:
intestinal stenosis
atresia
7
Q
Intraabdominal infections are usually caused by which 2 organisms? -classify them
A
E.Coli- Gram negative
B. Fragilis- Gram negative bacillus
also enterococci, streptococci
8
Q
Best treatment for long term PUD therapy?
A
Antibiotics for h.pylori infection
(Metronidizole, tetracycline, amoxicillan, clarithromycin)
+ PPi/bizmuth for 14 days
9
Q
How does sucralfate act?
A
binds to base of mucosal ulcers protecting against gastric acid. Allows for healing.
10
Q
What drug has prokinetic and antiemetic proprties and is used to treat GI motility disorders like gastroparesis and and prevent nausea/ vomiting? what kind of drug is this?
A
Metoclipramide (dopamine anatagonist)
11
Q
What is MIsoprostol and how is it used?
A
Prostaglandin E1 aalog used to prevent NSAID induced ulcer disease.
12
Q
What binds oxaloacetate in the first step of the TCA (krebs) cycle to form citrate?
A
Pantothenic acid (co-enzyme A is active form)
13
Q
RAS is activated by what to lead to Map kinase activation and eventually gene activation?
A
inactive GDP
RAS = ACTIVE with GTP => Raf=> Map Kinase => transcr. factor activation
14
Q
Most common malignant hepatic lesion?
A
metastasis from another primary site
15
Q
What is diffuse hepatic fibrosis with replacement of normal lobular architecture by fibrous-lined parenchymal nodules a sign of?
A
cirrhosis
16
Q
Hindgut encompasses what 4 parts of the GI Tract? whats its blood supply?
A
distal 1/3 of transverse colon, descending colon, sigmoid,, colon, and rectum.
IMA
17
Q
does the Inferior mesenteric vein course with the IMA?
A
no
18
Q
IgA protease is produced by which bacteria? where does it act on IgA?
A
Meningitidis species
Hinge Region
19
Q
How does IgA protease aid bacterial invasion?
A
cleases IgA protease at hinge region and cannot bind and inhibit the action of pili or fimbriae to mucosal adherenc and penetration
20
Q
which bacteria use inhibiion of phago-lysozomal fusion to evade host?
A
M. tuberculosis
M. leprae
Legionella
Ehrlichia
21
Q
which evasion mechanism impairs opsonization and phagocytosis? which bugs do this?
A
capsule formation S. pneumoniae N. meningitidis H. flu Cryptococcus neoformans
22
Q
Which hepatitis has a anticteric (subclinical) infection?
A
Hepatitis A
23
Q
What test would you use to determine whether an elevated Alk Phos is of hepatic or bony origin?
A
y-glutamyl transpeptidase is predominat in hepatocytes andbiliary epithelia
24
Q
Why do anti-HepC antibodies not give the host an effective immune response?
A
remarkable variety in the antigenic structure of hepC virus ENVELOPE proteins
25
5 proteins that can bbind DNA
```
transcription factors
steroids
thyroid proteins
Vitamin D receptors
retinoic acid receptors
MYC proteins (transc. factors)
```
26
Describe Conn's syndrome + 3 symptoms
aldosterone secreting tumor (adenoma) leading to
PRIMARY HYPERadlosteronism
-hypokalemia, met. alkalosis, decr. plasma renin activity
27
what is an opiate antidiarrheal like meperidine? what receptors does it bind to?
Diphenoxylate; mu-opiate receptors=> slow motility
28
What drug is used for secretory diarrhea?
Ocreotide
29
Which cofactor is necessary for synthesis of delta-aminolevulinic acid? what disease is this d-aminolevulinic acid elevated in?
pyridoxal phosphate
| lead poisoning
30
What mechanisms and triggers are in the cephalic phase of digestion
vagal and cholinergic mechanisms
| thought of, smell, sight of food
31
a delta agent infection refers to what? what is else necessary for this infection?
Hep D infection
| co-infection with hepatitis B
32
where are parietal cells found in gastric glands? what do they secrete?
Superficial layer
intrinsic factor
HCL
33
where are chief cells found in gastric glands? what do they secrete?
DEEP layers
pepsinogen
34
Most common benign vascular tumors in adults?
Cherry Hemangiomas
35
What type of diverticulum is Meckels?
what does this mean?
True diverticulum
3 layers (mucosa, submucosa, muscularis)
36
Presentation and findings in Meckel's diverticulum patient
Failure to obliterate the omphalomesenteric duct;
Ectopic acid secreting gastric tissue cells=> Rectal bleeding, intestinal obstruction but usually asymptomatic
37
What enzyme initiates pancreatic damage in acute necrotizing pancreatitis?
activation of trypsinogen to trypsin which activates zymogens (protease, elastase, phospholipase)
38
what enzyme of pancreatitis is activated for pancreatic autodigestion?
tyrpsin activates
| PROTEASES
39
Vascular damage and hemorrhage of pancreatitis is accomplished by which enzyme?
Elastase (which is activated by trypsin)
40
Fat necrosis seen in pancreatitis is done by which enzymes?
lipase/phospholipase
41
what is the systemic circulation shunt for paraumbilical veins? clinical manifestation?
Sup/Inf epigastric veins
| Esophageal varices
42
left gastric vein utilizes which portosystemic shunt?
esophageal veins
| esophageal varices
43
superior rectal veins drain to what systemic shunt if portal system is blocked?
middle & inferior rectal veins
44
gall bladder disease risk factors?
female, fat, forties
45
What is responsible for contraction of gallbladder?
| Where is it produced?
CCK
| I-cells of Duodenum
46
chemotactic agents?
```
IL-8
N-formylated peptides
Leukotriene B4
5-HETE
C5a
```
47
Where does Iron Absorption occur?
duodenum/proximal jejunum.
48
what might a gastrojujunostomy cause?
Iron deficiency anemia;
also B12 malabsorpotion, folate, VitD (fat solubles) and calcium in other gastric bypass SXs
49
what part of mRNA is NOT TRANSCRIBED?
PolyA tail
50
how does HepB increase risk for HCC
virus integrates its DNA into the host genome => Chronic liver cell injury (more likely to have mutations), encodes HBx which binds p53 (cannot suppress)
51
ETEC produces which to toxins?
Heat Labile (LT/ cholera-like) = adenylate cyclase=incr cAMP
Heat Stable Enterotoxin =Guanylate cyclase =incr. cGMP
52
When does Extrahepatic biliary atresia usually present
3rd-4th week of life with Jaundice
53
lab findings of biliary atresia
increased direct biliruubin
increased alk phos,
increased y-glutamyl transferase
54
liver biopsy of biliary atresia
marked intrahepatic ductule proliferation
portal tract edema and fibrosis
Parenchymal cholestasis
55
Gilbert syndrome presentation?
| deficient enzyme?
mild unconjugated hyperbilirubinemia
| UDP-glucuronyl transferases
56
What is the marker for hgh infectivity in chronic Hep B
HBeAg
57
What is present in window phase of Hepatitis B infection?
Anti-HBc IgM
58
Effects of Alcohol on catabolism? (Ratio & which process of glucose is affected)
NADH/NAD+ ratio is increased
Gluconeogenesis is inhibited
59
Cocaine does what to glucose levels?
hyperglycemia due to adrenergic activation
60
C-labeled urea test is used to detect what?
Urease produced by H.pylori infection
61
Most common benign liver tumor? microscopic description?
Cavernous hemangioma
| Carvernous blood filled vascular spaces with single epithelial layer
62
hyperestrinism can cause? 4
gynecomastia
spider angiomata
testicular atrophy
decreased body hair
63
Impaired B-oxidation is usually due to which enzyme? timing of and description of symptoms that are seen?
Acteyl coA dehydrogenase (first enzyme in process?
fasting from 16-24 hrs.... failure to produce ketone bodies, hypoglycemia ( gluconeogenesis is impaired)
64
Calcification of gallbladder diffusely is known as what condition? and is associated with risk of which disease?
porcelain gallbladder
| up to 33% gallbladder carcinoma
65
Chronic liver disease with autoimmune destruction of the intrahepatic bile ducts and cholestasis describes which disease?
Primary biliary cirrhosis
66
What symptoms are seen with Primary biliary cirrhosis?
Pruritus, fatigue, pale stools, xanthelesma
jaundice, steatorrhea, portal hypertension and osteopenia if it prgresses
67
When is air in biliary tree seen? (pneumobilia)
Gallstone ileus (large gallstone erodes intestinal lumen)
68
Conditions associated with Primary Biliary Cirrhosis
```
Sjogrens syndrome
Raynauds
scleroderma
autoimmune thyroid
hyperthyroidism
celiac disease
```
69
Diffuse esophageal spasms mimics what disease clinically? Describe DES?
periodic non-peristaltic contractions of esophagus, dysphagia & chest pain
Angina Pectoris
70
Difference between an Ulcer and a Erosion?
ULCER- Deeper = into submucosa
EROSION- shallow= into but not through the Muscularis Mucosa
71
1g of protein = ?calories
1g of carbs=?calories
1g of fat=?calories
```
protein= 4calories/g protein
carbs= 4calories/g carb
fat= 9calories/g of fat
```
72
What side effect can be seen in opiod analgesic treatment?
contraction of sphincter of oddi=> incr. common bile duct pressure=> gallbladder pressure=> biliary colic & RUQ pain
73
Common complication associated with Uclerative Colitis?
Toxic megacolon? moreso in UC than Chron's
74
How do you diagnose toxic megacolon?
plain XRAY Film
75
What accumulates in Cori's Disease? what is the enzyme? symptoms
small chain dextrin-like matrerial within hepatocytes.
Debranching enzyme
hypoglycemia, hypertriglyceridemia, ketoacidosis, hepatomegaly.
76
Fixing damaged DNA process: 5 steps
Glycosylase cleaves the altered base leaving AP Site
Endonuclease cleaves 5' end
lyase cleaves 3' sugar phosphate
DNA polymerase and
Ligase fill the single nucleotide gaps
77
What classification of virus is HepB?
| What is its mechanism of replication?
Double stranded circular DNA enveloped virus
Reverse Transcriptase (RNA-dependent DNA-polymerase activity)
78
Three enzymes that stimulate gastric acid secretion (HCL)?
acetylcholine (vagal stimulation)
Histamine
Gastrin
79
What can block gastric acid secretion?
Proton pump inhibitors block the final common pathway of HCL secretion from pareietal cells (the parietal cell apical membrane H+/K+-ATPase proton pump)
PGE2
secretin
VIP
80
what bug is Gram - OXIDASE + comma shaped rods that grow on alkaline medium.
Vibrio Cholerae
| NOT CAMPYLOPACTER JEJUNI
81
MOA of Vibrio Cholerae?
similar to which bug?
Cholera toxin increases cAMP in intestinal mucosa, inreased efflux of sodium & chloride (water follows = no blood or leukocytes seen)
Heat LABILE toxin of ETEC
82
Erythrocytes and Leukocytes in diarrhea is diagnostic of which bugs?
EIEC and Shigella
83
Pus with diarrhea is characteristic of which pathogen?
Salmonella Species (enteritidis)
84
AZT full name
Zidovudine
nrti= thyymidine analog without 3'-OH group making 3'-5' phosphodiester bon formation impossible.
85
How is HepAV transmitted
fecal oral route
overcrowding/ poor sanitation = contaminated food/water/raw&steamed shellfish
Think of dirty ass seafood markets.
86
when would (perianal/bladder/vaginal/retroperitoneal) fistulae + nonbloody diarrhea/fever & Malaise be seen?
what locations are involved?
Crohn's disease
any portion of GI Tract from mouth to anus
87
how does hepatitis cause cell damage
Viral HBsAg on cell surface stimulate CD*+ Tcells to destroy infected hepatocytes
88
Secretins function and what produces it?
increases bicarb and secretion of alkaline pancreatic juices. INHIBITS gastric acid secretion + pyloric sphincter contraction
S cell of Small Intestine
89
Acute viral hepatitis necrosis + ?
VIral Hepatitis
Hepatocyte injury =?
Hepatocyte death =?
final result
Hepatocyte Necrosis + Apoptosis ( acidophilic bodies/councilman bodies/apoptotic bodies)
diffuse swelling & ballooning degeneration
Lobular architectual disruption and confluent hepatocyte necrosis = bridging necrosis
monouclear inflammation develops in the sinusoids/portal tracts
90
Gastrin does what 2 things?
facilitates HCL secretion
| proliferation/hyperplasia of parietal cells
91
Which 2 bugs have toxins that inhibit the 60s ribosomal subunit in human cells blocking protein synthesis preventing binding of tRNA?
Shigella dysenteriea
| EHEC shiga like toxin
92
Most diverticula are which type? and whats another name for these and why?
False
| Pulsion, herniation through the wall => painless rectal bleeding
93
Dimercaperol is the chlating agent used for which poisoning?
Arsenic
94
CaNa2EDTA is the chelating agent used for which poisoning (2)? MOA
lead
Mercury
Complexes with mono-/di-/trivalent ions
95
Deferoxamine is the chelating agent used for which poisoning? MOA
Iron poisoning
| Binds to iron in bloodstream=> urinary excretion
96
Cyanide poisoning antidote?
| Cyanomethemoglobin is the poisonous agent or or blocking agent?
Amyl Nitrite forms cyanomethemoglobin blocking binding to ETC enzymes
97
Pb (lead) toxicity symptoms? at least 3
microscopic finidings?
```
abdominal colic
constipation
headache
lead line
peripheral neuropathy
```
microcytic hypochromic anemia + basophilic stippling
98
Risk factors for HCC?
```
HCV
HBV
alcoholic cirrhosis
aflatoxis
hemochromatosis
(elevated AFP) with cirrhosis
```
99
How does HBV cause cancer (HCC)?
Viral DNA integration into host genome=> Hbx activates synthesis of insulin-like growth factor II and receptors for insulin-like growth factor I.
100
prolonged Cholestatis can cause what deficiencies?
Intestinal malabsorption and nutritional deficiencies of fat soluble (ADEK) vitamins
+VitD def=> osteomalacia
101
Causes of cholestatis? (intra v extrahepatic)
Intrahepatic= Drug induced, PrimaryBiliary Cirhossis, Primary Sclerosing Cholangitis
Extrahepatic= Choledocholithiasis, Malignancy, Primary Sclerosing Cholangitis (its both)
102
Significance of Adenomatous polyps? how does aspirin effect these?
contain dysplastic mucosa which are premalignant
decrease there formation and stop progression to colon adenocarcinoma
103
Cox-2 overexpression is seen in what disease?
Colon Adenocarcinoma
104
How is REYES syndrome cause liver damage? (Macro v Micro?) mechanism?
inborn METABOLIC error that makes them sensitive to toxic effects of salicylates
Microvesicular steatosis of hepatocytes
105
Which type of adenomatous polyp is more likely to undergo malignant transformation?
Villous > Tubular
| to become adenocarcinoma
106
Name 4 non-neoplastic polyps
Hyperplastic
Hamartoumous
Inflammatory
Lympoid
107
Which strain of E.COLI cannot ferment sorbitol and does not produce a glucuronidase?
EHEC O157:H7
108
Location of Chrons v UC?
Crohn- Anwhere (perianal fistula/strictures common
UC- Colorectal intestine, RECTUM ALWAYS
109
Wall involvement of Chrons v UC
Chron- Entire wall inflammation, Noncaseating granulomas, skip lesions
UC- Mucosa + Submucosa only, continuous
110
Clincal pres of Chron v UC
more abdominal pain
v.
bloody diarrhea (both have abd. &diarrheal invoment)
111
Lynch Syndrome mutations?
| mutation type?
MSH2 MLH 1 (mutS mutL human homologs)
Mismatch repair types
112
Whipple disease findings? bug?
distended macrophages in lamina propria of SI. M0 conain PAS positive Tropheryma whippelii bacilli (rod shaped)
113
Microscopic findings of clear/foamy cytoplasm of enterocytes is characteristic of?
abetalipoproteinemia
114
Infection with HCV usually leads to what outcome?
stable chronic hepatitis > chronic hepatitis progressing to cirrhosis (close 2nd))
115
Difference between EIEC & EHEC
EIEC- bloody diarrhea (similar to shigellosis) + FEVER
EHEC- shiga-like toxin = bloody diarrhea (NO FEVER)
116
Most common cause of Hyatid cysts in humans?
In which organ AND how does it manifest?
Echinococcus Granulosus from foreign countries (new zealand, austrailia, medditerannean)
LIVER GRANULOMA. (also lung, muscle, bone)
117
What disease causes an obstruction of the Hepatic Vein? how does this normally drain?
What is seen on liver biopsy?
Budd-Chiari Syndrome
drains liver/portal circ. to systemic circ
Centrilobular congestion & Fibrosis
118
A patient receiving total parental nutrition can develop what? treat how? Pathenogenesis (2)?
Gallstones; exogenous CCK
1) Biliary Stasis due to Decreased CCK release (absent enteral stimulation)
2) in ileal resection- supersaturation of bile with Cholesterol (enterohepatic bile acid circulation disturbances)
119
Hemachromatosis description ?
| Including Mechanism/Mutation/Proteins/Location
Auto-Recessive
Abnormally high gastrointestinal iron absorption due to mutation of HFE [@chrom6= basolateral epithelial surface protein that detects amounts of circulating IRON] => Unregulated uptake of iron/TRANSFERRIN complex into small intestine crypts
p.s. HFE protein binds to Transferrin receptor for regulation
120
Clinical Manifestations of Hemachromatosis (6)
```
Skin hyperpigmentation
Diabetes (due to pancreatic islet cell destruction)
Abdominal pain
HCC
Liver Cirrhosis w/ hepatomegaly
Cardiac Dysfxn/ enlargement
Arthopathy
Impotenence
```
121
Gallbladder hypomotility can cause what?
Biliary SLUDGE
122
What types of stones are associated with crohn's disease and why?
OXALATE STONES IN KIDNEY (not particularly calcium- see below.)
Bile normally absorbed in ileum is not absorbed therefore bile is excreted leading to decreased lipid absorption as well. These lipids now stay in lumen of GI and bind CALCIUM (which normally binds OXALATE for fecal excretion). Now the Oxalate is absorbed and can precipitate as stones in Kidney.
123
6 organs/systems Crohns disease can effect + How?
Intestines- fistulas, abcesses, perianal dx, incr. adenocarcinoma
Liver-cholangiocarcinoma
Malabsorption- Oxalate renal stones, hypoproteinemia, b12/folate deficiencies, gallstones
Skin-erethyma nodosum
Joints-anthritis , ankylosing spodylitits
Eyes- Iritis, uveitis, episcleritis
124
F=?
AUC oral curve/ AUC IV curve ...... AUC= Area under the curve.
125
```
BLOTS:
North
West
South
Southwetern
```
N-mRNA
W- Proteins
S- DNA
SW- DNA--bound protein
126
Protease Inhibitor
MOA
side effects
inhibit cleavage of polypeptide precursor into mature viral proteins
hyperglycemia
lipodystrophy-buffalo hump
inhibition of p-450
127
Pathogenetic toxins of C.DIff.
Clinical manifestations
Rx
Enterotoxin A- watery Diarrhea
Cytotoxin B- colonic epithelial cell necrosis & fibrin deposition.
Toxic megacolon, white/yellow psuedomembranes
PCR detection treated with Metronidazole
128
DOC for Giardia Lambia? which others are treated similarly
Metronidazole
H.pylori
amembiasis
trichomoniasis
129
indications for:
Cipro/fluoroquinolones in diarrhea
Mebendazole
Albendazole
Blood + mucousy diarrhea (EIEC + Shigella)inflammatory travelers diarrhea.
Exept C. Jejuni=?____mycin
Anti-helminthic works on microtubules for roundworms (ancylostomata, Asccaris, Enterobius)
tapeworm (cestodes)- echinococcus Granulosus = no diarrhea = liver cysts instead
c.jej = erythro
130
Most Common Location of Colon Adenocarcinoma?
Rectosigmoid colon
| 2nd= Right Sided-Ascending colon ( more likely to bleed= Iron Def. Anemia)
131
Common Coenzymes for Mitochondrial processes?
pyruvate dehydrogenase
aKG Dehydrogenase
branched-chain ketoacidDehydrogenase
```
Thiamine
LIPOIC ACID
CoA
FAD
NAD+
```
132
Defiency of Methylonate mutase can be due to deficiency in which cofactor?
methylmalonic aciduria = vitamin B12 dependent process
133
Homocytinuria is characterized by which enzyme deficiency and which primary symptom?
what cofactors are necessary?
Cystathione synthase
premature atherosclerosis
```
b6= cystathionase/synthase
b12/folate= methionine conversion
```
134
how does VIP/ VIPoma function?
what inhibits VIP and is used to treat VIPoma symptoms?
oversecretion of intestinal chloride loss into the stool (brings with it Na, K, and WATER) and INHIBITS gastric acid secretion
Somatostatin blocks this
135
total gastrectomy leads to supplementation of what in pts? (think what gastric cells secrete yo)
Water-soluble vitamins B12
136
Lactose name?
Galactosyl B1,4 glucose
137
lesser omenta coverage & ligaments?
(liver-> lesser curvature of stomach)
hepatoduodenal
hepatogastric
138
Gram Negative - Non lactose fermenter (what diagnostic test) No-H2S producing? what other classification is true of this bug?
Shigella (mackonkeys agar)
Oxidase Neg (TSI agar to determine H2S producer)
139
CEEKS = what bugs & classifications
CEEKS = gram negative, lactose Fermenters on MacConckey's agar
Citrobacter + Serratia = SLOW fermenters
Enterobacter + E.Coli + Klebsiella= FAST fermenters
140
ShYPPS= what bugs & Classications
MacConkeys Agar Lactose Fermenters
Sh + Y= shigella/yersinia
P.Aeru= OXIDASE + (ALL others Oxidase -)
P + S = Proteus/Salmonella
141
Fenoldopam
dopamine-1 receptor agonist. arteriolar dilation and natriuresis.
142
Where does Sorbitol Dehydrogenase work? (2)
where does it get sorbitol from?
Seminal vesicles
lens
from Aldose Reductase converting glucose to Sorbitol
143
Vitamin D deficiency? (Common cause of this)
serum findings?
symptoms?
Celiac disease =Vit D malabsorption
decr. serum phosporus, decr serium calcium
incr. serium parathyroid hormone (2ndary hyperparathyroidism)
Bone pain & Muscle weakness
144
Malignant transformation of an adenoma to a carcinmoma requires the mutation of which TWO genes?
Overall pathway to carcinoma
p53 & DCC
APC tumor suppressor (polyp formation) --> K-ras protooncogene (cell proliferation)--> p53 & DCC = malignant
145
Lethal fulminant hepatitis can be caused by?
| Presents how & with what symptoms?
Inhaled anesthetics (halothane)
Acute viral hepatitis;
- elevated Aminotransferase levels
- prolonged prothrombin time
- eosinophilia
146
Short acting Insulin types? Time frame for ea:
which one is used for IV DKA?
which is best for post-meal hyperglycemia?
Regular (2-4hrs) = DKA
Lispro/Aspart/Glulisine (45-75min) = Postmeal hyperglycemia
147
Secretory IgA is found where?
mucus
tears
saliva
colostrum
148
Why are non-selective B-blockers contraindicated in DM pts?
They will mask adrenergic symptoms associated with Hypoglycemia (leading to worsened hypoglycemia.
149
Adrenergic effects of hypoglycemia? When are they seen?
increased sympathetics=>
stimulate: lipolysis @ periphery & gluconeogenesis in in liver
decrease: perhipheral glucose consumption
Early in hypoglycemia
150
What is the volume of the plasma compartment? what are the characteristic of drugs that stay in plasma?
high molecular weight
high plasma protein binding
high charge
hydrophilicity
151
why would D-xylose be measured?
to differentiate between Pancreatic or Intestinal Malabsorption.
it is a monosaccharide and does not require pancreatic enzymes
152
how do TZDs affect adiponectin of DM pts?
low in DM patients
TZDs increase Adiponectin in these patietnts
153
What metabolic effect can be seen in alcoholic patients?
Metabolic Alkalosis due to vomiting from Malory weiss tear
154
difference between Mallory Weis tear
| & Boerhaave syndrome
Bor= TRANSMURAL TEAR (air/fluid leak to mediastinum/pleura)
vs mallory = mucosal tear
155
what enzyme is a glucose sensor in Pancreatic cells?
Glucokinase
*Decr. in hereditary gestational diabetes
