Answer the following question using the below reference and 2 others in AMA format.

 

Rodwell VW, Bender D, Botham KM, Kennelly PJ, P. Anthony Weil. Harper’s Illustrated Biochemistry Thirty-First Edition. McGraw Hill Professional; 2018.

 

Approximately 20 million people suffer with gall stones in the US, with 300,000 cholecystectomies, or gall bladder removal surgeries, performed each year. Gall stones are the product of high levels of cholesterol within the gall bladder, in combination with bacterially-created, insoluble precipitate from bilirubin breakdown. When cholecystectomy is performed, bile acid emission into the upper intestine is forever altered, as is cholesterol sequestration and lipid metabolism. Please explain the known effects of this surgery on these pathways 2 days post surgery. In the years after the surgery is performed, several chronic adaptations to gall bladder removal can evolve. Explain the etiology of post-cholecystectomy syndrome. What current treatments exist, if any, for this syndrome?  

 

 

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AMA references

 

Question 1:

A 65 y/o female presents to her family medicine provider for problems with coordination and balance. Tests were conducted and found that she has cerebellar ataxia and elevated levels of lactic acid. Due to her family history of Coenzyme Q Deficiency, she underwent a muscle biopsy which was positive.

Which aspects of the ETC are affected with this deficiency? What happens to ATP levels? Why is ubiquinone important in the ETC? What is the reduced form of ubiquinone?

 

Question 2: 

Trimetazidine is a drug that belongs to a class called partial fatty acid oxidation inhibitors1 (pFOX inhibitors) that can be used to treat chest pain (angina pectoris). It does this by inhibiting the beta oxidation of free fatty acids in heart muscle1. Explain how inhibition of beta oxidation of free fatty acids by trimetazidine can be used to treat chest pain and compare it to another class of drugs (i.e. beta blockers, nitrites, calcium channel blockers, etc) and the pathway they inhibit to treat chest pain. 

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