GI ADVANCED PATHOPHYSIOLOGY EXAM 2023-2024 ACTUAL EXAM 200 QUESTIONS AND CORRECT DETAILED ANSWERS (100% VERIFIED ANSWERS) |ALREADY GRADED A+

GI ADVANCED PATHOPHYSIOLOGY EXAM 2023-2024

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? - ANSWERincreased 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? - ANSWER1. decreased potassium, sodium, and oxygen (O2).

2. increased Co2.

3. alkalosis, infection, hemorrhage, increased protein intake, renal failure,

constipation

4. sedatives

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

1. feminization (excess estrogens)

2. poor metabolism of drugs

3. 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? - ANSWERLiver 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? - ANSWEREGD- 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? - ANSWERperitonitis 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.

3. bronchospasms (45-65% w asthma have GERD).

4. 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)