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NBME 22 Answers

nbme22/Block 3/Question#31

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(282),

What do you use to treat Hepatic Encephalopathy? Lactulose. What does that do, it acidifies NH3 in the GI tract into NH4+ and promotes loss of the nitrogenous products that cause encephalopathy. This is how you remember this process.

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submitted by dr.xx(45),

The most important waste product is ammonia (NH3). This small molecule crosses the blood–brain barrier and is absorbed and metabolised by the astrocytes, a population of cells in the brain that constitutes 30% of the cerebral cortex. Astrocytes use ammonia when synthesising glutamine from glutamate. The increased levels of glutamine lead to an increase in osmotic pressure in the astrocytes, which become swollen. There is increased activity of the inhibitory γ-aminobutyric acid (GABA) system, and the energy supply to other brain cells is decreased. This can be thought of as an example of brain edema of the "cytotoxic" type.


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submitted by d_holles(38),

Can portal HTN contribute to hepatic encephalopathy?