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Q-37- lactose def in brush border: is osmotic diarhea( gap osmotic>100mosm) , native american, asian, black is common. due to colon anaerobic degrade undigested lactose into lactiac acid and H2 gas leading to exposive diarrhea and abd distention
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qs-38-a malabsorption and pancrease calcification involve to alcohol
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39.C
Biliary pain is most frequently caused by obstruction of the common bile duct or the cystic duct by a gallstone. However, the presence of gallstones is a frequent incidental finding and does not always necessitate treatment, in the absence of identifiable disease. Furthermore, biliary pain may be associated with functional disorders of the biliary tract, so called acalculous biliary pain, and can even be found in patients post-cholecystectomy (removal of the gallbladder), possibly as a consequence of dysfunction of the biliary tree and the Sphincter of Oddi.
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for 39 just want to add in q pt gets pain typically after food its becoz after food CCK is released which causes constraction of spinctor of oddi .
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40--EE
Pt has respiratory acidosis - low Ph and high Pco2 with normal bicarb
For respiratory acidosis compensation will be by meta alklosis ;kidneys will try to produce Hco3 and secrete them into circulation .
This process occurs in the itercalated cells of colecting tubules-
H2O + CO2 == HCO3 + H [in presence of carbonic unhydrase]
Hco3 will be secreted in the blood and H will be excreted in as urine NH4Cl
Thus net effect is loss of acid and gain of HCO3
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43--
Dd thiazide blocs Na-Cl reabsorption in early DCT
S/E= hyponatremia; hypokalemia;meta alkalosis
hyperglycemia; hyperlipidemia; hyperurecemia; hypercalcemia [hyper GLUC]
A- spironolactone K sparing diuretic action on cortical tubules
b-loop diuretics on aascending limb of loop of henle
e-mannitol
c and f -nonspecific