Advanced Pathophysiology – GI || All Questions Answered
Correctly.
A manifestation of liver dysfunction is impaired protein synthesis. What are the three
phenomenons related to that? correct answers 1. clotting factor deficiency: bleeding, elevated PT
(vitamin K related anemia).
2. hypoalbuminemia: edema, ascites.
3. inadequate antibody production. (immunoglobulin = protein)
What is indirect bilirubin? correct answers = unconjugated bilirubin
- elevated with increased RBC breakdown or impaired liver uptake
- bound by albumin so not found in urine
(Bilirubin, the end product of heme catabolism, is transported to the liver to be conjugated and
excreted via the bile. Most of the bilirubin in blood is in transit from the tissues to the liver, in
the unconjugated form, bound to albumin. Only small amounts of conjugated bilirubin are
normally found in blood, and it is believed that the usual analytical methods tend to overestimate
it in the low reference range. Bilirubin determinations are reported in two fractions, the
"conjugated" and the "total.")
What is direct bilirubin? correct answers = conjugated bilirubin
- elevated with impaired excretion of bilirubin from liver
- water soluble, so is found in urine
How is bilirubin transported? correct answers unconjugated bilirubin --> liver --> conjugated
bilirubin --> gall bladder --> bile production in the gallbladder to digest fat in the GI tract
How is bilirubin excreted? correct answers - Bile
- some excreted in the stool (brown)
- Some reabsorbed into the blood stream
- very small amount, if any, excreted in the urine
(Bilirubin is excreted in bile and urine.
- the yellow color of bruises
- the yellow color of urine (via its reduced breakdown product, urobilin)
- the brown color of faeces (via its conversion to stercobilin)
- the yellow discoloration in jaundice.)
If the liver gets fibrotic and not working well which bilirubin level would be elevated? correct
answers conjugated bilirubin (hepatitis, fibrosis, and cirrhosis) . In hepatitis, fibrosis, and
cirrhosis, high amounts of unconjugated bilirubin means the liver cells are not conjugating
bilirubin normally, causing it to build up in the blood (abnormal RBC breakdown).
If we have a plug so bile can't get out of the liver (e.g. cholelithiasia), what happened to
bilirubin? correct answers increased conjugated bilirubin. --> Jaundice
, (The liver converts ammonia to urea for excretion in the urine.)
What are the three causes for jaundice? correct answers 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? correct answers -
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? correct answers increased
blood ammonia level (NH3). --> hepatic encephalopathy
What is the normal amino acid breakdown process? correct answers 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? correct answers 1.
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? correct answers 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? correct answers * 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? correct answers
Release of marker enzymes into body: elevated AST and ALT
Explain the portal circulation system? correct answers 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? correct answers Liver fibrosis
and degeneration causes backup of blood into portal circulation. Increased pressure (hydrostatic
pressure) causes varices, ascites, anorexia, hemorrhoids.
Correctly.
A manifestation of liver dysfunction is impaired protein synthesis. What are the three
phenomenons related to that? correct answers 1. clotting factor deficiency: bleeding, elevated PT
(vitamin K related anemia).
2. hypoalbuminemia: edema, ascites.
3. inadequate antibody production. (immunoglobulin = protein)
What is indirect bilirubin? correct answers = unconjugated bilirubin
- elevated with increased RBC breakdown or impaired liver uptake
- bound by albumin so not found in urine
(Bilirubin, the end product of heme catabolism, is transported to the liver to be conjugated and
excreted via the bile. Most of the bilirubin in blood is in transit from the tissues to the liver, in
the unconjugated form, bound to albumin. Only small amounts of conjugated bilirubin are
normally found in blood, and it is believed that the usual analytical methods tend to overestimate
it in the low reference range. Bilirubin determinations are reported in two fractions, the
"conjugated" and the "total.")
What is direct bilirubin? correct answers = conjugated bilirubin
- elevated with impaired excretion of bilirubin from liver
- water soluble, so is found in urine
How is bilirubin transported? correct answers unconjugated bilirubin --> liver --> conjugated
bilirubin --> gall bladder --> bile production in the gallbladder to digest fat in the GI tract
How is bilirubin excreted? correct answers - Bile
- some excreted in the stool (brown)
- Some reabsorbed into the blood stream
- very small amount, if any, excreted in the urine
(Bilirubin is excreted in bile and urine.
- the yellow color of bruises
- the yellow color of urine (via its reduced breakdown product, urobilin)
- the brown color of faeces (via its conversion to stercobilin)
- the yellow discoloration in jaundice.)
If the liver gets fibrotic and not working well which bilirubin level would be elevated? correct
answers conjugated bilirubin (hepatitis, fibrosis, and cirrhosis) . In hepatitis, fibrosis, and
cirrhosis, high amounts of unconjugated bilirubin means the liver cells are not conjugating
bilirubin normally, causing it to build up in the blood (abnormal RBC breakdown).
If we have a plug so bile can't get out of the liver (e.g. cholelithiasia), what happened to
bilirubin? correct answers increased conjugated bilirubin. --> Jaundice
, (The liver converts ammonia to urea for excretion in the urine.)
What are the three causes for jaundice? correct answers 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? correct answers -
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? correct answers increased
blood ammonia level (NH3). --> hepatic encephalopathy
What is the normal amino acid breakdown process? correct answers 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? correct answers 1.
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? correct answers 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? correct answers * 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? correct answers
Release of marker enzymes into body: elevated AST and ALT
Explain the portal circulation system? correct answers 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? correct answers Liver fibrosis
and degeneration causes backup of blood into portal circulation. Increased pressure (hydrostatic
pressure) causes varices, ascites, anorexia, hemorrhoids.
