Deck 1 Flashcards
Endocrine function of pancreas
Alpha: glucagon
Beta: insulin
Delta: somatostatin
PP: pancreatic polypeptide
What is trypsin’s function and how is it activated
Produced by pancreas as trypsinogen
Proteolytic enzyme
Activated by enterokinase enzyme in duodenum
How does pancreatitis lead to hyperglycaemia
destruction of beta cells of langerhans
no insulin
Acid-base balance formula
Henderson-Hasselbach equation
pH= pKa + log ([HCO3]/[PCO2*0.03])
pKa = acid dissociation constant
Anion gap
= (Na + K) - (HCO3 +Cl)
Difference between plasma cations and anions
Normal range of anion gap
4 - 12
What does an increased in anion gap mean
External acid:
- ketones
- poisoning (salicylate)
- lactate
- Kidney failure
(Bicarb consumed by unmeasured acid, leaving a big anion gap)
What is a buffer
Weak acid + conjugate base
or
Weak base + conjugate acid
Resists change in pH
What are buffers in blood
Bicarbonate
Haemoglobin
Causes of metabolic acidosis
Normal anion gap (loss of bircarb)
- diarrhoea
- ileostomy
- tubular damage
Increased anion gap (gain of acid)
- ketones (starvation or diabetes)
- lactate (sepsis)
- poisoning (salicylate)
Causes of metabolic alkalosis
- vomiting
- renal loss of H+
- low chloride state
Causes of resp acidosis
- pneumonia
- ARDS
- Neuro: guillian barre
Causes of resp alkalosis
- hyperventilation
- anxiety
- altitude
Mx of high K
- calcium glucanate 10 mls of 10%
- insulin (10u actrapid) + 50mls 50% dextrose
- Salbutamol nebs
- Resonium
Normal urine output for a child and adult
Adult: 0.5 ml/kg/hr
Child: 1ml/kg/hr
Causes of acute limb ischaemia
Atherosclerosis -> thrombosis
Embolic (secondary to AF)
Rutherford classification of acute limb ischaemia
I: not immediately threatened
IIa: salvageable if prompt rx
IIb: salvageable if immediate rx
III: amputation
Definitive mx of acute limb ischaemia
Embolic: embolectomy
Thrombotic: thrombolysis or bypass graft
What makes a pneumonia HAP and not CAP
HAP: develops after 48hrs post admissi
Early onset vs late onset HAP bacterial causes
Early onset (less than 5 days in hospital): Strep pneumonia
Late onset (>5d)
- MRSA
- pseudomonas