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NBME 22 Answers

nbme22/Block 3/Question#31 (25.0 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(978),
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htaW do you use ot taetr eatipHc aohycpapthnelE? caL.outsle htWa eosd taht o,d ti icsaiedfi NH3 ni the IG tarct noit N4H+ adn oetmrspo lsos fo teh siotnuenorg cosuptdr htat asecu ayntphhpcaelo.e Tihs is woh you mbrmreee sith csse.orp

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. +3  
nevergoingtopost  Lactulose is the correct treatment for hepatic encephalopathy, but it actually acidifies the GI tract (colonic metabolism of lactose → lactate). This favors the NH3 form and decreases NH4+. NH3 is then additionally pulled from the blood into the gut. +  

submitted by dolphinpanda(3),

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

submitted by dr.xx(143),
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The osmt tiptaonmr waets ocuptdr si nmaoima N().H3 sTih amsll mucolele sssoerc teh ibdorabnl–o reaibrr and is sdebaorb dan eaemtdobisl by eth ytceossatr, a aitupoplno of sclle ni eht aribn ttah tneouttssci 03% fo eht raclebre .eocrtx syAcotrtes eus aommain nhew nyssehiigtns aegulinmt romf gteaa.mtul eTh esdaciren eselvl of itemgunal alde ot na acersnie in tsmiooc sesurrpe in the ssty,cteoar hwcih oeebmc wlne.los Terhe si naderceis ittiaycv of het rinhiyobti tbγron-imayuic aidc GB)AA( smyt,es adn het reynge supply to eothr ibnra cesll is eserddec.a sThi anc be tguhhto of sa na aplexem fo nairb emead fo het "t"cycoitxo yp.te


submitted by d_holles(173),
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aCn taporl NTH beructotni to etcahpi leypnahcpeah?to

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