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Patho II > GI Tract 2 > Flashcards

GI Tract 2 Flashcards

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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
What is considered a late sign for GI bleed?
Hypotension and tachycardia seen when blood loss approaches 25% of blood volume
26
RLQ pain, anorexia, N/V, fever
Appendicitis
27
Acute abdominal pain, tenderness, & fever, absent bowel sounds, tachycardia, hypotension, & dehydration
Peritonitis
28
Bile production is ______ ml/day
1200
29
When BG is high _____ occurs, when BG is low _____ occurs
Glycogenesis; glycogenolysis
30
The liver oxidizes fatty acids to produce _____
ATP
31
The liver is responsible for formation of ALL clotting factors except _____
III; IV, vWF, VIII
32
Kill 99% of bacteria from gut
Kupffer cells
33
______ develops d/t induction fo P450 by various drugs
Tolerance
34
______ reactions slow down in old age
Phase II
35
Hepatic triad
Bile duct, hepatic vein, & hepatic artery
36
Portal vein ______ ml/min + hepatic artery ______ ml/min = hepatic vein ______ ml/min
1300; 500; 1800
37
Blood supply to the liver is _____ % of CO
25-30%
38
Liver receives blood from ______ (25%) and from _____ (75%). The oxygen supply is __:__
Hepatic artery; hepatic portal vein; 50:50
39
Interlobular vessels in the liver open into _____
Hepatic sinusoids
40
Normal portal vein pressure =
9 mmHg
41
Cirrhosis ____ resistance to blood flow, therefore ___ portal blood flow
Increases; decreases
42
What is the arterial buffer response to cirrhosis?
Increase hepatic artery blood flow in response to decreased portal flow to maintain supply
43
Hepatic blood flow depends on:
Driving pressure (MAP - hepatic venous pressure) Intrahepatic vascular resistance Metabolic demand
44
All volatile anesthetics ___ hepatic blood flow
Decrease
45
______ is removed form blood by liver, conjugated with glucuronate and excreted in bile (not urine)
Free bilirubin
46
In the intestine, bacteria convert _____ bilirubin to _____ (soluble). Some is reabsorbed into blood and excreted as urobilin into urine or stercobilin in feces
Conjugated; urobilinogen
47
In hemolytic anemia _____ increases
Unconjugated bilirubin
48
In obstructive jaundice ______ increases
Conjugated bilirubin
49
In the liver, bilirubin is conjugated with _____ by enzyme ______
Glucuronic acid; UDP glucuronyl transferase
50
Raises with biliary tract obstruction
Alkaline phosphatase
51
Best indicator of hepatocellular dysfunction
PT prolongation (not making prothrombin)
52
_____ is sign of worst prognosis in liver failure
Hypoglycemia (failure of glucose production)
53
Jaundice is seen when bilirubin > ? (Normal ?)
1.5 mg/dL; 0.5 mg/dL (free bilirubin)
54
What test can differentiate b/w conjugated and uncojugated hyperbilirubinemia?
Van den Bergh test
55
Jaundice of the newborn is d/t increased ______ bilirubin. This is d/t a deficiency of _____ in the immature liver
Unconjugated; glucuronyl transferase
56
Transmitted primarily by fecal-oral route. Short incubation (3 wks), no carrier Asymptomatic RNA virus
Hep A
57
Transmitted primarily by parenteral, sexual, & maternal-fetal routes. Long incubation period (3 mo) Carriers DNA virus
Hep B
58
``` Skin poppers (60%). Resembles HBV in course and severity. Carriers, Chronic Cirrhosis, Carcinoma ```
Hep C
59
A defective virus. Need HBV (co-infection)
Hep D
60
Transmitted enterically & causes water-born epidemics. Resembles HAV. Increased mortality rate in pregnant women (Expectant mothers, Enteric)
Hep E. (Vowel A&E hit your bowels)
61
Both ____ & ____ predispose a patient to hepatocellular Ca
HBV & HCV
62
IgM antibody to HAV; best test to detect active hepatitis A
IgM HAVAb
63
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
HBsAg
64
Antibody to ABsAg, appears a few weeks after disappearance of the antigen and indicates recovery & vaccination (immunity)
HBsAB
65
Antigen a/w core of HBV
HBcAg
66
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
HBcAb
67
A second different antigenic determinant in the HBV core. Important indicator of infectivity (transmissibility) BEware
HBeAg
68
Antibody to ‘e’ antigen; indicates low transmissibility
HBeAb
69
Which drugs cause acute hepatitis
INH & methyldopa
70
Which drugs cause cholestasis
Chlorpromazine, Erythromycin, & Estrogen
71
Which drugs cause fatty liver
Steroids, alcohol (MCC), tetracycline
72
Which VA causes liver disease
Halothane
73
Tx for acetaminophen overdose
N-Acetylcysteine
74
Rare, often fatal childhood hepatoencephalopathy. | Fatty liver, hypoglycemia “ominous sign”, coma, a/w viral infection (VZV, influenza B) & salicylates
Reye’s syndrome
75
Characterized by thrombocytopenia, leukopenia, magaloblastic anemia (d/t deficiency of folate & thiamine) MAC ⬆️ in sober and ⬇️ in intoxicated pts
Chronic alcoholism
76
Delirium Tremens occurs after _____ hrs cessation of drinking
24-96

Patho II (11 decks)

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