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Gastrointestinal > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What are the major functions of the liver (7)

A

1) Carbohydrate metabolism
2) Fat metabolism and synthesis
3) Protein metabolism
4) Hormone metabolism
5) Storage
6) Coagulation
7) Detoxification

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2
Q

The liver stores what (3)

A

1) Vitamins A, B12, E, D, K
2) Copper, iron
3) Glycogen

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3
Q

The liver produces which coagulation factors

A

2, 7, 9, 10

Protein C and S

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4
Q

Where are Kupffer cells located?

A

Liver (discontinuous capillary)

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5
Q

Bile is secreted in response to what signals (2)

A

CCK, vagal impulses

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6
Q

Bile acids are mainly composed of which type of acids (2)

A

Cholic and chenodeoxycholic acids

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7
Q

Most common pathology of the biliary tract

A

Cholelithiasis

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8
Q

For patients with small or medium stones who are not suitable to surgery, which treatment should be given?

A

Ursodeoxycholic acid (prevents bile reabsorption)

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9
Q

Which analgesia should be used in biliary colic? Which analgesia should NOT be used?

A

Buprenophine is preferred, morphine is contraindicated as it tightens the sphincter of Oddi

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10
Q

For relief of biliary spasms, which drugs could be used (2)

A
  • Atropine

- GTN

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11
Q

Most bile salts entering the Gi tract are passed in the faeces. True/false?

A

False

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12
Q

Side effects of bile acid sequestrants (2)

A
  • Deficiency in fat soluble vitamins

- GI side effects

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13
Q

Phase 1 drug metabolism does what

A

Conjugation

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14
Q

CYP450 family mediates which phase of drug metabolism reactions?

A

Phase 1

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15
Q

Hepatic encephalitic is a result of elevated what?

A

Ammonia (NH3)

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16
Q

Drug which can be used to treat hepatic encelopathy? (2)

A

Lactulose (acidic breakdown product), antibiotics (suppress flora producing NH3)

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17
Q

The main function of plasma proteins is to maintain which pressure

A

Oncotic or colloid osmotic pressure

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18
Q

Ceruloplasmin is which type of globulin?

A

Alpha globulin

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19
Q

Visual impairment can be caused by a deificency in which vitamin

A

Vitamin A (binds to retinol)

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20
Q

Transferrin is an example of which type of globulin?

A

Beta globulin

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21
Q

What’s the most abundant plasma protein?

A

Albumin

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22
Q

Iron is transported as which type of iron?

A

Ferric (Fe 3+)

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23
Q

How much vitamin A is stored within the liver?

A

A ~10 month supply

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24
Q

How much vitamin D is stored within the liver?

A

~3 weeks worth

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25
Q

HMG-CoA catalyses the irreversible formation of what

A

Mevalonic acid

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26
Q

Synthesis of 1 molecule of cholesterol requires how much ATP

A

36 molecules

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27
Q

What does synthesizing cholesterol require (3)

A

1) Carbon source (e.g. acetyl-CoA)
2) Source of reduction power (e.g. NADPH)
3) Energy (ATP)

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28
Q

Vitamin D is involved in the role of regulating which supplement?

A

Calcium and phosphorous

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29
Q

Most abundant form of vitamin D in the blood is

A

D3

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30
Q

Cholesterol resins work how

A

They bind bile salts in intestine and prevent reabsorption

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31
Q

XDR resistant organisms are what

A

Non-susceptible to at least 1 agent in all but 2 or fewer antimicrobial categories

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32
Q

PDR resistant organisms are what

A

Non-susceptible to all agents in all categories

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33
Q

MDR resistant organisms are what

A

Non-susceptible to at least 1 agent in 3 or more antimicrobial categories

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34
Q

Mechanisms of gene exchange between bacteria (3)

A

Conjugation, transposition, transformation

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35
Q

Examples of horizontal transmission vectors (3)

A

Transformation, transduction, conjugation

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36
Q

HAI are present in which proportion of ITU patients?

A

1:3

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37
Q

Most antibiotics are used in the community or hospital?

A

Community

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38
Q

Are most antibiotics supplied to humans or animals?

A

It’s 50:50

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39
Q

Prudent prescribing of antimicrobials includes prescribing as absolute few antibiotics as possible. True or false?

A

False

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40
Q

Largest causes of liver cirrhosis (4)

A

1) Obesity/diabetes (NAFLD)
2) Booze
3) HCV/ HBV
4) Drugs (least common)

41
Q

Liver cirrhosis will result in (4)

A

1) Reduced metabolic capacity
2) Portal hypertension
3) Ascites
4) Shunting of blood to avoid first-pass metabolism

42
Q

Alcohol has what order kinetics?

A

Zero order

43
Q

The decreased blood albumin content in liver cirrhosis leads the kidneys to secreting more renin, true or false?

A

True

44
Q

What effect does liver cirrhosis have on aldosterone production?

A

Increases (aldosteroneism)

45
Q

NSAIDs should be given in patients with liver failure as a first-line therapy. True/false?

A

False - NSAIDs can be given, but as a last resort. They will reduce renal prostaglandin synthesis which perfuses the kidneys, leading to risk of hepato-renal syndrome

46
Q

NSAIDs are safe to prescribe in alcoholics. Why is this statement false? (2)

A

Alcoholics are at increased risk of bleeds (e.g. from peptic ulcers), alcoholics may need prostaglandin production to maintain kidney perfusion

47
Q

In cirrhotic liver disease, drugs which are metabolised late or early are preferred?

A

Late (i.e. phase 2 reactions) as simply, phase 1 drugs are more affected by liver disease

48
Q

Which agent is essential for paracetamol metabolism?

A

Glutathione

49
Q

Paracetamol is metabolised by which P450 isoform?

A

2E1

50
Q

Which drug is most commonly implicated in acute liver injury?

A

Ibuprofen

51
Q

Which “Rule” is used to determine if a medication is at high risk of liver injury?

A

Hy’s Rule - does it elevate ALT/AST >5x URN AND does it elevate bilirubin >3mg/dL?

52
Q

In liver disease, what’s the preferred elimination route for drugs given to patients?

A

Renal

53
Q

Which “zone” of the liver on histology is most vulnerable to injury from blood flow?

A

Zone 3, AKA Pericentral zone

54
Q

4 most common causes of acute liver disease (4)

A

1) Viral
2) Alcoholic
3) Drugs (especially if young patient)
4) Bile duct obstruction

55
Q

Causes of pre-hepatic jaundice (2)

A
  • Haemolysis of any cause

- Haemolytic anaemias

56
Q

Hepatic jaundice causes (5)

A
  • Acute liver failure
  • Alcoholic hepatitis
  • Cirrhosis (decompensated)
  • Bile duct loss (atresia, PBC, PSC)
  • Pregnancy
57
Q

Post-hepatic jaundice causes (5)

A
  • Congenital biliary atresia
  • Gallstones of cystic bile duct
  • Strictures of cystic bile duct (e.g. PSC)
  • Infection
  • Tumours (especially head of pancreas)
58
Q

Mallory bodies appear in which stage of liver disease?

A

Alcoholic hepatitis

59
Q

Most common causes of NASH (3)

A

1) DM
2) Obesity
3) Hyperlipidaemia

60
Q

How long does chronic liver disease have to last before being “chronic”?

A

> 6months

61
Q

Budd-Chiari is a disease of which organ?

A

Liver

62
Q

Primary biliary cholangitis and primary sclerosing cholangitis are which type of disease

A

Autoimmune

63
Q

PBC is more/less common in women?

A

More common

64
Q

PBC is a cause of itch with/without a rash?

A

Without

65
Q

Treatment of PBC is primarily with

A

Ursodeoxycholic acid

66
Q

Which type of autoimmune hepatitis is more likely to have extrahepatic manifestations?

A

Type 1

67
Q

Marked piecemeal nercrosis and lobular involvement with numerous plasma cells is likely to suggest what

A

Autoimmune hepatitis

68
Q

Early onset autoimmune hepatitis is associated with which HLA type?

A

HLA-DR3

69
Q

Late onset autoimmune hepatitis is associated with which HLA type?

A

HLA-DR4

70
Q

Treatment of autoimmune hepatitis drugs (2)

A

Corticosteroids, immunosuppresants.

71
Q

Primary Sclerosing Cholangitis is more common in which population?

A

Scandanavia

72
Q

PSC buzzword

A

Onion-skinning necrosis

73
Q

PSC is diagnosed through which investigation

A

ERCP

74
Q

Haemochromatosis shows which genetic inheritance pattern

A

Mono-genetic, autosomal recessive

75
Q

Wilson’s Disease has which genetic inheritance pattern?

A

Autosomal recessive

76
Q

Kaiser Fleisher rings are a sign of what

A

Wilson’s Disease

77
Q

Alpha 1 antitrypsin deficiency CPC

A

Lung emphysema

78
Q

Budd-Chiari syndrome is what

A

Thrombosis of the hepatic veins

79
Q

Treatment of choice for Budd-Chiari

A

TIPS

80
Q

Hepatitis A is spread only via which route

A

Faecal-orally

81
Q

Is there a carrier state of hepatitis A?

A

No

82
Q

Hepatitis B is spread how

A

Sexually, blood products, vertically

83
Q

Can people be carriers of hepatitis B?

A

Yes

84
Q

Hepatitis B is generally symptomatic. True or false?

A

False

85
Q

Hepatitis C is spread via which route

A

Sexually

86
Q

Councilman bodies with piecemeal necrosis on liver biopsy suggests what

A

Hepatitis C

87
Q

Primary biliary cirrhosis is associated with autoantibodies against which organelle

A

Mitochondria

88
Q

Haemochromatosis predisposes to carcinoma. True or false?

A

True

89
Q

Haemochromatosis is confirmed via which stain

A

Perl’s Prussian Blue

90
Q

Wilson’s Disease patients have a low/high serum ceruloplasmin?

A

Low

91
Q

Risk factors for gallstones (5)

A
  • Fair
  • Fat
  • Female
  • 40
  • Fertile
92
Q

Rokitansky-Aschoff sinuses can be a result of what

A

Chronic cystitis (cystic duct)

93
Q

Carcinoma of the bile duct is called

A

Cholangiocarcinoma

94
Q

Cholangiocarcinoma is associated with which conditions (2)

A

UC, PSC

95
Q

Cholangiocarcinoma is a cause of which type of jaundice

A

Hepatic

96
Q

Klatskin tumour is a tumour where

A

Bifurcation of hepatic ducts

97
Q

Which blood marker is indicative of pancreatitis?

A

Amylase (elevated)

98
Q

Acute pancreatitis causes mnemonic

A

I GET SMASHED

99
Q

Most common carcinoma of the pancreas?

A

Adenocarcinoma

Gastrointestinal (7 decks)

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