ENDO Flashcards
CUSHING’S Ano mataas at mababa sa cushings
⬆️ salt, sex, sugar ⬇️Ca, K, Immunity
CUSHING’S Aside from steroids and tumor as causes ano pa isang cause
LUNG CA
CUSHING’S Sx (CUSH)
- Cushion (truncal obesity, moon face, buffalo hump, Gynecomastia
- Unusual hair growth (hirsutism)
- Skin acne, purple striae, butterfly mark
- High BP+ osteoporosis + muscle weakness
CUSHING’S meds
- Mitotane
- Metyrapone
- Ketoconazole
- Levoketoconazole
- Spirinolactone
CUSHING’S Dx
1. What type of urine test
2. done at night
3. Pag binigay to tas mataas parin postive sa cushing
4. Tatlong dx na sa blood naman extraction
24H URINE CORTISOL TEST
SALIVA CORTISOL TEST
DEXAMETHASONE SUPPRESSION TEST
SERUM NA, SERUM K, FBS
CUSHING’S list K rich foods (C BROAS)
CANTALOUPE/MELON
BANANA/BROCOLLI
RAISIN
ORANGE (highest)
APPLE/AVOCADO/ASPARAGUS
STRAWBERRY/SPINACH
CUSHING’S rx for?
INFECTION
CUSHING’S * Type of isolation * Restrict __ * Diet: * Compli: * 2 surgical tx
- REVERSE ISOLATION
- NA
- ⬇️CHO & FATS ⬆️K & CHON
- DM 2 & INFECTION
- HYPOPHYSECTOMY & BILATERAL ADRENALECTOMY
CUSHING’S 3 important assessments
WEIGH DAILY
EDEMA ASSESSMENT
WOF HYPOKALEMIA SX
AKA PRIMARY ADRENAL INSUFFICIENCY
ADDISON’S DSE
ADDISON’S HALL MARK
BRONZE SKIN
ADDISON’S ano mataas at mababa in this dse
⬇️salt sex sugar ⬆️Ca K + bronze skin
ADDISON’S Sx (ADDS)
- Added tan & K
- Dec weight
- Dec hair, BP, energy
- Sodium Loss/ salt craving
ADDISON’S diet
- ⬆️CHO CHON ⬇️ K
- Inc Na on hot weather
ADDISON’S Iwa watch out
HYPERK
ADDISONIAN/ ADRENAL CRISIS/ ACUTE ADRENAL FAILURE
ADISSONIAN CRISIS bawal magbigay ng steroids if?
drop in BP 89/40 less (shock)
ADISSONIAN CRISIS sx
- Severe headache, low back pain, abd pain, leg pain
- Extreme weakness and HypoNa
ADISSONIAN CRISIS mngt
- IV fluid (shock)
- Fludrocortisone
- Hydrocortisone (po, maintenance)
- avoid infection
ADDISON’S med
ADD-sone + Kayexelate and Insulin
* Fludrocortisone (mineralocorticoid)
* Dexa, Hydrocortisone, Prednisone (glucocorticoids)
STEROIDS anong 7S tatandaan
- stress & surgery- inc the dose
- Slowly taper off
- Sugar inc
- Sepsis/ low WBC
- sight rx (cataract)
- Skinny (muscles & osteoporosis)
- Swollen (water gain)
what disorder ung ⬆️ADH but mababa sa osmolality and Na
SIADH
SIADH URINE SPECIFIC GRAVITY RESULT?
Concentrated
SIADH ⬇️Na early sx
HEADACHE
SIADH seizure early sx
HEAD AND CONFUSION (WATER INTOXICATION/CEREBRAL EDEMA)
SIADH Mngt
- 800-1k ml/ day of fluids lang per day
- Give salt
- Loop diuretics w 3% saline (hypertonic)
- Seizure precautions & IO
SIADH meds
Aquaretics/ Vasopressin 2 receptor antagonists (-vaptan)
++Urea & Demeclocycline (ADH antagonist) for chronic
Most accurate measure for fluid balance
DAILY WEIGHTS
what disorder ung ⬇️ADH but mataas sa osmolality and Na
DI
DI specific gravity
Diluted
DI compli
Hypovolemic shock
DI mga bawal
Caffeined beverages, alcohol, parsley, celery
Late sx of hypovolemic shock
ANURIA <100ml/day
Too much release of ⬆️Ca but⬇️Phosphorus
HYPERPARATHYROIDISM
HYPERPARATHYROIDISM SX
STONES=KIDNEY
MOANS= FRACTURE & BONE PAIN
GROAND= CONSTIPATION
muscle weakness, arrythmia, hypoactive DTR, altered LOC (blood bone beats)
HYPERPARATHYROIDISM Diet
Lean meats- Rich in Phosphorus
HYPERPARATHYROIDISM tx
- Morphine/demerol for bone pain
- Amiodarone for arrhythmia
- Calcitonin
- IV phosphate
- Furesomide
- Magsul
- Parathyroidectomy
⬇️Ca but ⬆️Phosphorus
HYPOPARATHYROIDISM
HYPOPARATHYROIDISM HALLMARKS and other sx
TwiTChing Spasm
* TROUSSEAU’S AND CHOVSTEK’S SX + diarrhea
* Arrythmia din
* SPASMS
* Seizure
HYPOPARATHYROIDISM Anong mineral pede caused nito
Hypomagnesemia (Ca and Mg kakampi) (Opposite sina Na and K)
HYPOPARATHYROIDISM med
- Ca gluconate, Ca carbonate, Ca lactate
- Vit D (calcitriol)
- Phenobarbital for seizure
- Teriparatide to dec phosphate inc Ca
HYPOPARATHYROIDISM Mngt
Tracheo set at bedside
Breathe w paper bag
NO lean meats (rich in Phosphate), NO dairy products like milk and egg yolks bc may phosphate parin. ✅green leafy, anchovies, tuna
Parathyroid diseases dx
- Serum Ca & Phosphate
- Lengthened QT interval
- Prolonged ST segment
- X ray (⬇️bone density)
⬆️T3 &T4 ⬇️TSH everything is high, fast, wet
Hyperthyroidism
HYPERTHYROIDISM is aka?
GRAVE’S DSE
HYPERTHYROIDISM HALLMARK and mngt
EXOPTHALMOS
- Tape eyes/ eye patch
- Dark sun glass
- Eyedrops/artificial tears
- Eye exercise
HYPERTHYROIDISM other sx
Hyperphagia (⬆️metabolism)
HEAT INTOLERANCE (MOIST SKIN)
DIARRHEA
W GOITER
HYPERTHYROIDISM IIWASAN KASI NAKAKATRRIGER MAG THYROID STORM
- DIM LIGHTS/ STIMULANTS
- SODIUM (EYE SWELLING)—HOB elevated
- SMOKING, STRESS, SEPSIS, SICKNESS/INFECTION
- DO NOT TOUCH THE NECK
THYROID STORM sx
HAT
- HYPERTHERMIA
- AGITATION
- TACHYCARDIA
HYPERTHYROIDISM MEDS
ANTI THYROID/ PLM
PROPYLTHIOURACIL (bby safe) & PROPANOLOL
LUGOL’s SOL/POTASSIUM IODIDE- straw, 1h apart w other meds
TAPAZOLE/METHIMAZOLE (1ST LINE, NOT BBY SAFE)
HYPERTHYROIDISM Diet
⬆️cal, protein, carbs
No spicy, caffeine, fiber
Thyroidectomy Complications and mngt
- STRIDOR- ET and tracheo at bedside
- Thyroid storm
- Accidental removal of parathyroid (TETANY)- ✅Ca gluconate
- Accidental removal of larynx (HOARSENESS)
- Laryngeal spasm (SOB) tracheo at bedside
- Bleeding (freq swallowing, feeling of fullness, bloods sa nape, upper chest, pillow, incision site)- neutral head and neck alignment
Thyroidectomy
1. Position
2. Neck position
3. Preop meds to prevent thyroid storm
Semi fowlers
Neutral
Anti thyroid, propanolol, Glucocorticoids
THYROID DISORDERS DX
- RADIOACTIVE IODINE UPTAKE
- TSH
- Serum T4
- Thyroid scan
HYPERTHYROIDISM kelan lang tataas TSH nito
If 2nd-3tiary hyperthyroidism
before and after gagawin sa RADIOACTIVE IU
Before:
* PT (no pregnant)
* Remove jewelries and dentures
* pt should be awake (❎anes or sedation)
* 5-7 days HOLD anti thyroid meds
* NPO 2-4 h
After:
* NPO 1-2 h
* private room w private bathroom
* Flush 3x
* Sariling food utensils
* No crowds
* Linen radioactive
⬇️T3 & T4 ⬆️TSH; everything is low, slow, dry
HYPOTHYROIDISM
HYPOTHYROIDISM aka and mc cause
HashimOtos
Pituitary tumor
HYPOTHYROIDISM classic sx
- cOld intolerance
- chOlesterol⬆️= MI
- cOnstipation
- Cretinism
- Alopecia
- Amenorrhea
Late sx
- Non pitting edema
- Brittle hair/nails
- ⬇️libido & lethargy
- Hoarseness
HYPOTHYROIDISM Kelan lang bababa TSH
If 2nd/3rtiary hypothyroid bc hypothalamus prob na here
HYPOTHYROIDISM med and considerations
(-thy) LEVOTHYROXINE. Pneumonic: LEVO no
* LOW SLOW ONSET
* EARLY MORNING EMPTY STOMACH 1x daily
* VERY ⬆️HR & BP and insomnia (SE)
* Oh bby is fine
* NO DOUBLING DOSES, STOP ABRUPT — MYXEDEMA COMA
Myxedema Coma sx?
All are ⬇️ lalo na Na, CBG, Temp so check RR & temp q 1h. Prio is resp failure so tracheo at ET at bedside
HYPOTHYROIDISM COMPLI and diet
HYPOVOLEMIC SHOCK BC ⬇️Na
Low Cal
Tumor of adrenal gland that pump out high amounts of CATCHOLAMINES that may lead to HPN crisis
PHEOCHROMOCYTOMA
PHEOCHROMOCYTOMA doc
PHENTOLAMINE & BETA BLOCKERS
PHEOCHROMOCYTOMA mngt
No changing positions rapidly (put pressure to tumor so squirt catecho)
Hypersecretion of aldosterone from adrenal gland so LEAVES K but ATTRACTS Na and water
HYPERALDOSTERONISM
HYPERALDOSTERONISM Hypernatremia sx and Hypokalemia sx and other sx
Hypernatremia
- Inc muscle tone
- Polydispsia
- Swollen dry tongue
Hypokalemia
- U waves, ST depression
- Dec DTRs
- Consti and hypoactive bowels
HPN, polyuria and low urine gravity/ diluted
HYPERALDOSTERONISM tx
- Spironolactone
- Adrenalectomy
- Na restriction
- K supplements/ foods
DI sx
- 3P’s
- Hypotachytachy
- Glycosuria
- Wt loss, caxechia (T1), neuropathys
- Heart attack & stroke
DM 2 initial sx
- Acanthosis Nigricans (Hyperpigmentation)
- PCOS
- ASYMPTOMATIC
Tx sa DM 1 and 2
DM 1- insulin
DM 2- OHA
Hypoglycemia papakain sa conscious? Unconscious?
- Simple sugars: Hard candy/ 4 tsp sugar/4 sugarcubes/ 1/2 c juice/soda/ crackers/ LOW fat milk
- or Complex CHO/CHON (meal to)
- 15:15 FOC (15 g of sugar in 15 mins check.
Unconscious: Glucagon or D50, or sugar sublingual (at home)
bat bawal sa may DKA ang juice
Kasi may acidosis na
DM a natural insulin sa lahat hormonal effect, no hypoglycemia at night but sa GABI HYPERGLY SO ⬆️NPH at night and limit bedtime snacks
DAWN PHENOMENON
DM Man made insulin that’s common to DM 1, rebound effect, hypoglycemia at night so ⬇️ NPH and have snack bedtime
SOMOGYI EFFECT
DM age ng prone and compli
- DM 1: child— DKA
- DM 2: >30 y.o— HHNS
4 dx of DM
- Random- non fasting <200
- Fasting- NPO 8h 70-110
- GTT tolerance-NPO 8h <140
- Hgb A1c <5.6
Most sensitive tool common for GDM/Pregnant
GTT tolerance
DM Diet what to avoid
Simple sugars like soda, candy, white bread/rice, juices kasi ito is for hypogly
DM peripheral neuropathy/diabetic foot mngt
- No high heels, nylon, flip flops, etc, removal of ingrown or callous, rubbing feet hard, hot bath/ hot pads but warm is ok
- cut nails STRAIGHT
- DAILY inspection
- Lanolin lotion
- Podiatrists
- BKA/ AKA
DM retinopathy and nephropathy prevention
ANNUAL eye and kidney exam
DM when to take insulin and OHA
30 mins before breakfast
DM Diet
- CHO: 50-60 %
- fats 20-30
- CHON 10-20
- Individualized Food exchange list based
- No skipping meals
DM kelan exercise
After meals
Insulin w or without food
Without or before meals
Di mo alam if hypo/hypergly bibigay parin simple sugar?
YES
DM1 pede exercise?
NO mas delikado sila sa hypogly, TYPE 2 lng dat mag wt reduction.. dat nga mas more food sila
OHA (DM 2 only) meds and considerations
- Metformin (wt loss and lactic acidosis)
- Glipizide and Glyburide (No sa may CHF, sunburn, hepatorenal toxic)
- Thiazolidinedone/ Pioglitazone (NO sa heart and liver failure pts)
Insulin adm mga bawal
- Massage/exercise/ heat: rapid absorption so di maobserve hypogly sa peak
- Scar- delay naman
- Posterior thigh- hit sciatic nerve—paralyze
- Same site —✅rotate 1-1.5 inch apart with horse shoe pattern
- Shake —Air embolism
- Right after sa ref inject agad—lipodystrophy
Insulin adm sites/ region
- Abd
- ANTERIOR thigh
- POSTERIOR Deltoid
- Buttocks
- Hips
Insulin adm y withdraw first sa regular bago NPH
To prevent cross contamination
Kelan lang maga 90 degrees turok ng insulin
If obese
Bat NPH lang ung minimix sa iba/regular
Bc suspension at may halong protein derivatives
Insulin storage and considerations
- Ref not freezer
- Travel? Lagyan ice but not frozen
- After gamit ref uli or if nabuksan na ket san basta room temp (multiple dose naman insulin + airtight)
No. Cause of DKA
SEPSIS (infection)
DKA Sx
DKAA
* Dry and high sugar >300
* Ketone + fruity breath & Kussmaul resp, K⬆️
* Abd pain
* Acidosis
DKA Tx
DKA
* DHN first- 0.9 NSS (Isotonic) without insulin na kasabay
* Kill the sugar w IV regular bolus if >300. If <300 SQ insulin + 1/2 NS w D5W
* Add K bc naga polyuria and Na bicarbonate (acidosis)
** Added na ung K sa insulin bc insulin puts the sugar & K into the cell
child w NV and not eating still give insulin?
Yes kasi sugar is high during may illness
Which is sudden onset and sino gradual progressive bet. DKA and HHNS
- Sudden onset- DKA
- Gradual progressive- HHNS
HHNS sx
- High sugar >800
- High fluid loss (extreme DHN)
- No ketones/kussmaul/fruity breath/abd pain
- Stable K and slower onset
HHNS tx
HS
* Hydration isotonic 0.9 NS muna then maga hypOtonic
* Stabilize sugar (IV regular insulin only!)
DKA patients die from __. HHNS patients die from __
- HYPOKALEMIA
- HYPOVOLEMIA
