PATH 370 Quiz #5 UPDATED ACTUAL Questions and
CORRECT Answers
type 2 diabetes mellitus most common form of DM
insulin resistance and beta cell dysfunction lead to a relative lack of insulin --
hypoinsulinemia
- suspect decreased number of insulin receptors of abnormal translocation of
glucose transporters
- as disease progresses, insulin production may be impaired
risk factors:
female sex
obesity
aging
sedentary lifestyle
nonketotic hyperglycemia hyperosmolar coma can develop, more common in
older adults
hyperosmolar coma (HHNK) occurs because endogenous insulin suppresses
ketone formation and thus prevents ketoacidosis
dehydration develops with high osmolality and hemoconcentration of
erythrocytes, proteins, and creatine
,hormonal regulation after a meal 1. glucose in ingested food causes a brief rise in insulin release (first phase)
2. continued glucose causes the second phase: insulin production
3. ingestion of nutrients stimulates the release of glucose-dependent
insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) from cells in
the gut
the effect on blood glucose is known as the incretin effect
General manifestations of hepatocellular failure Acute liver failure
jaundice, decreased clotting factors, hypoalbuminemia , decreased vitamins D
and K (osteomalacia -- vitamin D; poor blood-clotting factor production --
vitamin K)
hormonal regulation GIP and GLP-1 stimulate the production of insulin
GLP-1 inhibits glucagon
glucose oxidized in the cell (glycolysis) and used primarily for glycogenesis
(production of glycogen in liver and muscle)
glycolysis ----- > glycogenesis (glucagon)
portal hypertension sluggish blood flow resulting in increased pressure in portal circulation
congested venous drainage of the GI tract
clinical manifestations:
anorexia
varices (esophageal, gastric, hemorrhoidal)
ascites
, gastroesophageal varices Abnormal veins in the lower part of the tube running from the throat to the
stomach.
complex venous network surrounds the proximal part of the stomach and
esophagus
collateral venous pathways surround the proximal part of the stomach and
esophagus and dilates in response to elevated portal pressure
clinical features:
affects about half of cirrhotic patients
variceal bleeding is a life threatening condition
- mortality = 50%
- two distinct phases of a variceal hemorrhage
1. coincident with and shortly after bleeding
2. period of 6-8 weeks following initial bleeding
* greatest risk of rebleed occurs in the first 72 hours (lethal)
clinical manifestations:
hematemesis, melena, bright red rectal bleeding, anemia, shock
treatment:
fluid resuscitation
- normal saline via large-bore IV lines
correcting the coagulopathy and stopping further bleeding with blood
components and clotting factors replaced
- parenteral vitamin K, fresh frozen plasma, platelets, recumbent factor VIIa
vasopressin, nitroglycerin
- lowers portal pressure
emergency EGD
- endoscopic sclerosis
endoscopic ligation of esophageal varices
- suctioning and ligation of varix
Chrohn's disease (regional enteritis or granulomatous affects all layers of the intestinal wall of the proximal portion of the colon or
colitis) terminal ileum
suggestive findings are ulcerations, strictures, fibrosis, and fistulas
clinical manifestations:
intermittent bolus of fever
diarrhea, if bloody, not as severe as ulcerative colitis
constant chronic RLQ pain (may have mass or tenderness)
chronic active hepatitis progressive liver destruction inflammatory disease of liver
lasts > 6 months
diagnosis:
abnormal liver enzymes
serologic studies (blood tests that look for antibodies in your blood.)
CORRECT Answers
type 2 diabetes mellitus most common form of DM
insulin resistance and beta cell dysfunction lead to a relative lack of insulin --
hypoinsulinemia
- suspect decreased number of insulin receptors of abnormal translocation of
glucose transporters
- as disease progresses, insulin production may be impaired
risk factors:
female sex
obesity
aging
sedentary lifestyle
nonketotic hyperglycemia hyperosmolar coma can develop, more common in
older adults
hyperosmolar coma (HHNK) occurs because endogenous insulin suppresses
ketone formation and thus prevents ketoacidosis
dehydration develops with high osmolality and hemoconcentration of
erythrocytes, proteins, and creatine
,hormonal regulation after a meal 1. glucose in ingested food causes a brief rise in insulin release (first phase)
2. continued glucose causes the second phase: insulin production
3. ingestion of nutrients stimulates the release of glucose-dependent
insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) from cells in
the gut
the effect on blood glucose is known as the incretin effect
General manifestations of hepatocellular failure Acute liver failure
jaundice, decreased clotting factors, hypoalbuminemia , decreased vitamins D
and K (osteomalacia -- vitamin D; poor blood-clotting factor production --
vitamin K)
hormonal regulation GIP and GLP-1 stimulate the production of insulin
GLP-1 inhibits glucagon
glucose oxidized in the cell (glycolysis) and used primarily for glycogenesis
(production of glycogen in liver and muscle)
glycolysis ----- > glycogenesis (glucagon)
portal hypertension sluggish blood flow resulting in increased pressure in portal circulation
congested venous drainage of the GI tract
clinical manifestations:
anorexia
varices (esophageal, gastric, hemorrhoidal)
ascites
, gastroesophageal varices Abnormal veins in the lower part of the tube running from the throat to the
stomach.
complex venous network surrounds the proximal part of the stomach and
esophagus
collateral venous pathways surround the proximal part of the stomach and
esophagus and dilates in response to elevated portal pressure
clinical features:
affects about half of cirrhotic patients
variceal bleeding is a life threatening condition
- mortality = 50%
- two distinct phases of a variceal hemorrhage
1. coincident with and shortly after bleeding
2. period of 6-8 weeks following initial bleeding
* greatest risk of rebleed occurs in the first 72 hours (lethal)
clinical manifestations:
hematemesis, melena, bright red rectal bleeding, anemia, shock
treatment:
fluid resuscitation
- normal saline via large-bore IV lines
correcting the coagulopathy and stopping further bleeding with blood
components and clotting factors replaced
- parenteral vitamin K, fresh frozen plasma, platelets, recumbent factor VIIa
vasopressin, nitroglycerin
- lowers portal pressure
emergency EGD
- endoscopic sclerosis
endoscopic ligation of esophageal varices
- suctioning and ligation of varix
Chrohn's disease (regional enteritis or granulomatous affects all layers of the intestinal wall of the proximal portion of the colon or
colitis) terminal ileum
suggestive findings are ulcerations, strictures, fibrosis, and fistulas
clinical manifestations:
intermittent bolus of fever
diarrhea, if bloody, not as severe as ulcerative colitis
constant chronic RLQ pain (may have mass or tenderness)
chronic active hepatitis progressive liver destruction inflammatory disease of liver
lasts > 6 months
diagnosis:
abnormal liver enzymes
serologic studies (blood tests that look for antibodies in your blood.)
