1.6.15 - Endocrine Cases Flashcards
addisons disease
adrenal insufficiency
tests is suspect adrenal insufficiency
basal plasma cortisol
ACTH level
low cortisol and high ACTH
addisons
normal or low cortisol - adrenal fatigue - subclinical addisons
ACTH stimulation test
cosyntropin IV and measure preinjection
30 and 60 minute cortisol
don’t rise - addisons
5 S’s
for adrenal insufficiency
-salt, sugar, steroids, support, search
arterial supply to adrenal gland
superior, middle, inferior suprarenal arteries
venous drainage of adrenal glands
suprarenal veins
lymphatic drainage of adrenals
para-aortic nodes
driven by motion of resp diaphragm**
to thoracic inlet back to heart
autonomics for adrenal
T8-T10
SD for adrenals
flexed segment - T/L junction
OPP for adrenals
lympatics - resp diaphragm
sympathetics T6-L2
PS - OA, AA, C2, temporal, occiput
cranial
ventral abdominal release
fascial restriction of adrenal
champmans
anterior chapmans for adrenals
2-2.5 inches above and 1 inch lateral to umbilicus
posterior chapmans for adrenals
intertransverse space between T11 and T12 bilaterally
sympathetics to adrenals
T6-L2
labs for hypothyroid
TSH, T4, and T3
TSH increase
T4 decrease
primary hypothyroid
TSH decrease
T4 decrease
central hypothyroid
TSH elevated
T4 normal
subclinical hypothyroid
arterial to thyroid
superior and inferior thyroid arteries
levothyroxine
T4
tx of hypoT
repeat TSH
every 6 weeks until thyroid function stabilized
venous drainage thyroid
superior, middle, inferior thyroid veins
thyroid lymph drainage
prelaryngeal, pretracheal, paratracheal nodes
motion of respiratory diaphragm**
to thoracic inlet to heart
symapthetics to thyroid
T1
contributions from superior, middle, and inferior cervical ganglia - 1st rib
sympathetics are vasomotor
OPP for thyroid
lymphatics
sympathetics - T1 - flexed - compensatory extensions T3-4
cervical spine
cranial - hypothalamic pituitary axis
elevated 1st rib
thyroid dysfunction
inferior cervical ganglion
anterior chapmans reflex thyroid
ICS between 2 and 3 rib close to sternum bilaterally
posterior chapmans reflex thyroid
over transverse T2
sympathetics to thyroid
vasomotor
metabolic syndrome
constellation of altered function
-abdominal obesity, dyslipidemia, HTN, insulin resistance
path of thyroid, adrenal, pancreas, liver, kidney
aterial to pancreas
superior and inferior pancreaticoduodenal arteries
venous from pancreas
superior and inferior pancreaticoduodenal veins
-portal system
lymph pancreas
pancreaticosplenic and preaortic nodes
sympathetics to adrenals
vasomotor
also - stimulation causes E and NE secretion
sympathetics to pancreas
T6-9
vasomotor
PS to pancras
vagus
-secretomotor
PS stimulation of pancreas
insulin, bicarb, somatostatin, glucagon release
liver function
metabolize, detoxify, inactivate substances
store - carbs, lipids, vit, min
activate hormones - T4 to T3
synthesize albumin, glucose, cholesterol, phospholipids
arterial to liver
hepatic artery
venous liver
portal system
-hepatic vein
lymph liver
nodes above and below diaphragm
liver sympathetics
T6-9
stimulate breakdown of glycogen to glucose
PS to liver
vagus
-decrease glycogen breakdown
arterial to kidney
renal arteries
kidney venous
renal veins
lymph kidney
renal vein to drain toward lateral aortic nodes
sympathetics for kidney
T10-L1
vasomotor
flexed segment at TL junction
kidney SD
sympathetics to kidney effects
vasoconstriction
Na reabsorption prox tub
renin secretion
increased fluid retention and increased BP
OPP for kidney
lymph
autonomics
myofacial/osseous restrictions in area
chapmans
