Pathophysiology & Labs
GI 1
GI 2
GI 3
Mystery Question
100

List 7 functions of the liver and then state what these functions do for the body.

Functions of liver: Effects of liver dysfunction

1.Metabolism: carbs, proteins, lipids.

2.Excretion: bilirubin (old RBC’s)

3.Synthesis: albumin/plasma proteins, clotting factors, cholesterol, bile, clotting factors:

4.Storage: glycogen to produce glucose and Vitamins,

5.Detoxification: byproducts of certain drugs, ammonia

6.Destruction: RBC’s and bacteria

7.Immune function: Kupffer cells = are bactericidal and like macrophages of the liver.

100

This GI disease is located in the small intestine.

What is a Duodenal Ulcer?

100

Name the 2 most common causes of Peptic Ulcer Disease (PUD).

What are:

  1. Infection with Helicobacter pylori/H-pylori
  2. Medications: NSAIDS
100

Name 8 common symptoms of cirrhosis.

What are:

  1. Jaundice: increase in bilirubin. 
  2. Portal HTN: backflow of blood leading to increased portal pressure
  3. Hepatic encephalopathy: elevated levels of ammonia
  4. Ascites: accumulation of fluid in peritoneum
  5. Anemia: lack of stored iron and B12
  6. Esophageal varices: portal hypertension leading to backup and pressure on esophageal viens
  7. GI bleeding: esophageal varices, clotting cascade impairment
  8. Hypoglycemia: unable to participate in glucose metabolism: Glycogen not able to become glucose


100

List functional obstructions or paralytic ileus.

What is:

Abdominal surgery (follows surgery)

Spinal shock following spinal cord injuries

Inflammation related to severe ischemia

Pancreatitis, peritonitis, infection in the abdominal cavity

Hypokalemia

Mesenteric thrombosis

Toxemia

200

Name labs to measure 1. liver enzymes and 2. function.

What are:

Aspartate transaminase (AST)

Alanine transaminase (ALT)

Alkaline phosphatase

Albumin: protein

Prothrombin time: synthesis clotting factors

Urea levels: convert Bilirubin levels

**Remember “A PUB” 

Albumin levels: Liver’s ability to synthesize proteins (e.g. albumin)

Prothrombin time (clotting screen): Liver’s ability to synthesize clotting factors

Urea levels: Liver’s ability to convert ammonia into urea

Bilirubin levels: Liver’s ability to conjugate bilirubin

200

These diseases are an inflammation of the liver.

What are Hepatitis and Cirrhosis?

200

Define Gastroesophageal Reflux Disease (GERD). What are primary and secondary symptoms?

GERD is a weakening in the lower esophageal sphincter (LES) leading to gastric acid contents moving up into the esophagus. This can lead to esophageal ulcers, esophagitis, or strictures. 

Primary symptoms: dyspepsia (heartburn), epigastric pain, dysphagia, regurgitation

Secondary symptoms: cough, wheezing, aspiration pneumonia. 


200

This GI disease is located in the stomach.

What is a Gastric Ulcer?

200

Two common symptoms of a paralytic ileus?

What is severe steady abdominal pain and decreased bowel sounds?

300

List labs to measure pancreatic function.

What are:

Amylase: Digestion of fats & carbohydrates

Lipase: Digestion of fats & carbohydrates

Trypsin: Digestion of proteins

300

Lower abdominal pain, diarrhea, constipation, bloating and nausea.

What is IBS/Irritable Bowel Syndrome?

300

Blockage of the small intestine

What is a medical emergency?

300

This GI disease symptoms are worse when the stomach is full.

What is a Gastric Ulcer?

300

Differientate Duodonal and Gastric Ulcer patient presentations. What is different in their appearance?

  1. Duodonal ulcer: Pain worse when stomach is empty due to stomach acid entering the duodonum. Therefore, they eat small frequent meals and are well nourished. 
  2. Gastric Ulcer: Pain is worse when stomach is full due to increased production of HCL/stomach acid for digestion. Therefore, they eat less often experience weight loss. Commonly associated with stomach cancer. 
400

Name the two spincters of the stomach.

What are the

  1. lower esophageal sphincter (LES): keeps food and hydrochloric acid from moving back up the esophagus
  2. pyloric sphincter: regulates the flow of substances leaving the stomach into the small intestine
400

Differientiate Acute vs Chronic Pancreatitis.

Acute:

  • Pancreatic enzymes are stored in inactive state.
  • Inflammation and pancreatic duct blockage
  • Prolonged blockage leads to activation of enzymes causing cellular injury and autodigestion of pancreas. 
  • Common causes alcoholism and gallstones
  • S/S: right upper quadrant pain, clay colored stools, nausea/vomiting, fever, increased insulin release (hypoglycemia).

Chronic:

  • Occurs after several acute episodes leading to scar tissue formation
  • S/S: right upper quadrant pain, nausea/vomiting, hyperglycemia from lack of insulin release due to prolonged damage to pancreas
400

This GI disease symptoms are worse when the stomach is empty.

What is a Duodonal Ulcer?

400

Hand tremor with increased levels of ammonia

What is asterixis?

400

Causes of a mechanical obstruction.

What are:

Tumors, adhesions, hernias, other tangible obstructions

500

List 3 functions of the pancreas.

What is:

  1. Produces Amylase, Lipase, & Trypsin to digest fats, carbohydrates, and proteins.
  2. Release of insulin: to lower blood sugar
    1. Beta cells synthesize and secrete insulin.
  3. Release of glucagon: to raise blood sugar
500

Describe the pathophysiology with hepatic encephalopathy.

Ammonia is a waste product in the body that is usually excreted via liver. Elevated ammonia levels, due to cirrhosis, cross the blood brain barrier and create the following symptoms. 

Progressive signs and symptoms begin with 1 and progress to 6:

  1. Changes in personality
  2. Memory loss
  3. Sleep disturbances
  4. Flapping hand tremor (asterixis)
  5. Seizures
  6. Can lead to decreased level of consciousness, coma and death
500

Explain the pathophysiology with portal hypertension.

Cause: 

  • Abnormally high blood pressure in the portal venous system.
  • Organs that feed into the portal vein are now under increased pressure.
    • Stomach, intestine, spleen, pancreas
  • From here blood flow travels to the liver

Effects of Portal Hypertension

  • Melena: bloody stool
  • Caput Medusa: engorged veins in abdomen
  • Ascites: fluid shift into the peritoneal cavity
  • Esophageal Varices: 
500

What are the causes of infection with Hepatitis A, B, & C?

Hepatitis A & C: Ribonucleic Acid (RNA) Virus

Hepatitis B: Deoxyribonucleic Acid (DNA) Virus

500

Symptoms of mechanical obstruction.

What are

Severe colicky abdominal pain

Intermittent bowel sounds can be heard.

Vomiting and abdominal distention occurs quickly

Vomiting is recurrent, eventually with bile-stained content.

Restlessness, diaphoresis, tachycardia = initially

Weakness, confusion, and shock = as hypovolemia and electrolyte imbalances progress

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