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NBME 22 Answers

nbme22/Block 3/Question#31 (22.1 difficulty score)
A 35-year-old man is admitted to the hospital ...
Absorption of nitrogenous products from the gastrointestinal tract🔍

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submitted by yotsubato(778),
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tWah do oyu eus to etrta Hceaipt ?hctoEaphalpyen lstcueaLo. Waht eods ttah od, it diecsfiia HN3 in het GI catrt noti 4HN+ nda tspoeomr slso fo hte ogtsiorennu udrtocsp atth uaesc hahol.tnpepeayc sTih is how oyu eebrrmem tihs erps.sco

carmustine  FA 2019 pg 385 "Triggers --> increased NH3 production & absorption (due to GI bleed, constipation, infection)." +4  
drzed  To add, you can also use rifaximin which will act as a antibiotic decreasing the production of NH3 from gut flora. Same concept. +2  

Increased bleeding in the GI tract also delivers hemoglobin and other proteins to the tract which are broken down to nitrogenous products and then absorbed

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submitted by dr.xx(125),
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ehT sotm oainrtmpt tawse cpdruot si inmmaoa N().H3 sihT amlsl eolecmul cssoesr eth ibrl–oonabd reibrra adn si sobrbead nda lemotiesabd yb eth osrtcsa,ety a piuanooltp fo clels ni hte bnrai ttah ecitutostns 30% of eth lcererba ox.tcre rcestoytAs sue amnamio wehn sgihynisestn itgnuamle omrf uaeg.mlatt Teh dciaserne selelv fo ngtiaemul ldae to an sneecria ni oosctim rsrpusee ni hte osesttyca,r hhciw moecbe leons.wl Terhe is eiecasrdn yiaicttv of hte bhtoniiiry tmcnryγiouaib- acdi ()BAAG me,syst adn het yrnege yslppu ot hrote raibn ecsll is dcesraede. ihsT anc eb gththou fo as an mplxaee of brani edame of hte o"titccyx"o ypt.e


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submitted by d_holles(137),
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nCa ptaolr TNH irtutocnbe to tceaiph lcytpopeaeahhn?

djtallahassee  Sorry for the late add. Portal system does contribute to hepatic enceph ESPECIALLY when there is a TIPS or shunt that bypasses the liver. However before, it won't directly contribute to more NH3+ +2