Alters ammonia metabolism by colonic bacteria

Excellent! Lactulose is metabolized into lactic acid in the colon. This leads to acidification of ammonia, a biomolecule which has been implicated in hepatic encephalopathy. Ammonium becomes entrapped in the GI tract and is removed in feces. Acidification of the colon also results in reduced production of ammonia by colonic bacteria. 

Investigations

You review Andrew's blood results. 

Bilirubin: 41 mmol/L (<17) 

Albumin: 32 g/L (35-45) 

Alkaline phosphatase: 145 IU/L (30-100) 

Alanine transaminase: 8300 IU/L (<40) 

Gamma-glutamyl transferase: 1031 IU/L (<70) 

Creatinine: 405 micromol/L (60-100) 

Paracetamol: Not detected 

INR: 7.2 (0.8-1.1) 

You proceed to place Andrew on the liver transplant list. A few hours later, a liver becomes available and Andrew is taken to the operating theater. 

What is the most accurate statement based on the investigations? 

Cholestasis is the most likely diagnosis
There is a risk for a thromboembolic event
Paracetamol has been metabolized
The patient presentation is not due to paracetamol overdose

Map: Andrew Hall (1102)
Node: 20963
Score:

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OpenLabyrinth
OpenLabyrinth is an open source educational pathway system

Review your pathway

  • B
  • PPIs are weak bases that become activated by colonic bacteria
  • D
  • C
  • Ignore the emotional expression.
  • E
  • A
  • Respond bluntly: “That is common in diabetes.”
  • PPIs are weak acids activated by protonation in parietal cells
  • Blame the patient for non-adherence
  • PPIs are weak bases converted by CYP450 enzymes to the active form in parietal cells
  • Validate the emotion
  • Sequesters bile acids
  • PPIs are weak acids converted by CYP450 enzymes to the active form in parietal cells
  • Reschedule without offering alternative solutions
  • Antagonizes beta receptors
  • Tell the patient to change devices without giving proper guidance.
  • Reschedule with alternative (e.g., WhatsApp call) if needed
  • Insist on continuing with poor video quality
  • Reschedule without offering alternative solutions
  • Switch to audio + chat mode and promise a PDF summary afterward
  • PPIs are weak bases activated by protonation in parietal cells
  • Activates vasopressin receptors
  • Activates somatostatin receptors
  • Reschedule with alternative (e.g., WhatsApp call) if needed
  • Insist on continuing with poor video quality
  • Tell the patient to change devices without giving proper guidance.
  • Ramipril
  • Alters ammonia metabolism by colonic bacteria

Reminder

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