Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N935 Advanced Pathophysiology II > Endocrine > Flashcards

Endocrine Flashcards

1
Q

islets of langerhans

A
  • make up 1-2% of pancreas weight
  • hormones are produced and do not enter ducts but are secreted into the capillary blood vessel
  • venous blood from islet drains into the hepatic portal vein and then into general circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

four cells in the islets of langerhans

A
  • delta
  • pancreatic polypeptide (PP)
  • alpha
  • beta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

beta cells

A
  • compromise 60-70% of islet mass

- secrete insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

alpha cells

A
  • compromise 25% islet mass

- secrete glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

delta cells

A

secrete somatostatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

three major hormone classifications

A
  • peptides/proteins –> insulin and glucagon
  • amino acid –> dopa and epi
  • steroids –> lipid soluble, derived from cholesterol (like estrogen or progesterone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

insulin

A
  • synthesized in beta cells
  • released via exocytosis to the capillary then enters portal circulation
  • half life = 5-8 min
  • major hormone degradation sites are liver and kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

insulin function

A
  • key hormone controlling glucose removal from the plasma
  • facilitates transport of glucose by stimulating uptake into the liver, muscle, and adipose tissue
  • brain = one of the few tissues that does not require insulin or glucose for transport into cells
  • liver = insulin promotes efficient storage of excess glucose in the form of glycogen (glycogenesis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pancreatitis

A
  • inflammation of the pancreas which is commonly caused by gallstones and alcohol
  • can also be caused by trauma such as ERCP, obstruction and certain medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pancreatitis clinical presentation

A
  • abdominal pain
  • N/V
  • febrile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pancreatitis anesthetic considerations

A
  • early hydration
  • pain meds
  • electrolytes
  • patient NPO until pain and inflammation has resolved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pancreatitis labs

A
  • elevated WBC count
  • possible ARF
  • liver dysfunction
  • electrolyte abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

pancreatitis complications

A
  • pancreatic necrosis = cell death secondary to inflammation

- pancreatic pseudocyst = contains only fluid and is the most common complication of chronic pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

pancreatic cancer

A
  • fourth most common cause of cancer deaths in the US

- risk factors = obesity, smoking, chronic pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pancreatic cancer s/s

A
  • abdominal pain
  • weight loss
  • pain = retroperitoneal invasion
  • jaundice = biliary obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pancreatic cancer treatment

A
  • surgical resection is the only effective treatment
  • patient with tumor in head of pancreas develop painless jaundice and are usually candidates for surgical resection
  • most common techniques = pancreatectomy or whipple
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cystic fibrosis

A
  • autosomal recessive
  • mutation of chromosome 7
  • defective chloride ion transport in epithelial cells in lungs, pancreas, liver, GI and reproductive organs
  • decreased chloride –> decreased transport of sodium and water –> viscous secretions that are luminal obstruction and scarring to exocrine glands
  • primary M&M = chronic pulmonary infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CF anesthetic implications

A
  • elective surgery delayed until optimal pulmonary function obtained
  • volatiles decrease airway pressure by decreasing bronchial smooth muscle and decreasing hyperactive airways
  • AVOID anticholinergics to maintain secretions in less viscous state
  • intubated –> need to suction
  • DEEP - to minimize coughing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

T1DM

A
  • T cell mediated destruction of beta cells in pancreas

- 80-90% of beta cell function lost before hyperglycemia occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T1DM patient presentation

A
  • hyperglycemia
  • fatigue
  • weight loss
  • polyuria
  • blurred vision
  • intravascular volume depletion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T1DM diagnosis

A

BG >200

HgA1C > 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what form of DM is DKA most associated with?

A

T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T2DM

A
  • insulin resistance and beta cell insufficiency
  • insulin resistance leads to circulating free fatty acids, cytokines, insulin antagonist and target tissue defects at insulin receptors
  • impaired glucose associated with increase in body weight, decrease in insulin secretion sand reduction in peripheral insulin action
  • increased insulin levels = densitization of target tissue, causing decreased response to insulin
24
Q

Symptoms of T2DM

A
  • polyuria
  • polydipsia
  • weight loss
  • fasting glucose >126
  • 2 hour plasma glucose level >200 during oral glucose test
25
Q

what are factors that can lead to insulin resistance?

A
  • abd obesity
  • excess calorie consumption
  • lack of exercise
  • genetic susceptibility
26
Q

what are reasons preop hyperglycemia is undesirable?

A
  • dehydration occurs due to osmotic diuretic effect of glucose
  • accumulation of lactate
  • impaired immune response which increases incidence of post-op infections
  • exacerbation of brain, CV, and renal ischemic changes
27
Q

systemic effects of hyperglycemia

A
  • risk of heart disease
  • fatigue and lack of energy
  • pancreas malfunction
  • risk of infection
  • high blood pressure
  • gastroparesis
  • risk of cataracts and glaucoma
28
Q

three life threatening complications of DM

A
  • DKA
  • HHS
  • hypoglycemia
29
Q

DKA

A
  • most common cause is infection

- decreased insulin leads to catabolism of free fatty acids into ketones which results in DKA

30
Q

DKA treatment

A
  • correction of hypovolemia, hyperglycemia, and total body potassium deficit
  • close anion gap!!
  • when glucose moves into the cell, so does potassium so you MUST monitor labs frequently
31
Q

hypoglycemia

A
  • brain depends on glucose as source of energy, which makes it very susceptible to hypoglycemia
  • if not treated, mental status change, anxiety, lightheaded and coma may occur
32
Q

systemic manifestations of hypoglycemia

A
  • diaphoresis
  • tachycardia
  • nervousness
33
Q

metabolic syndrome

A
  • have clinical characteristics that are frequently seen in patients that are at risk for T2DM
  • combo of insulin resistance with hypertension, hyperlipidemia, procoagulant state, and obesity
34
Q

clinical manifestations associated with metabolic syndrome

A
  • visceral obesity
  • insulin resistance
  • high triglycerides
  • HTN
  • low HDL cholesterol
35
Q

in order to have metabolic syndrome you need to have at least three of the following…

A
  • fasting glucose >110
  • abdominal waist >40 inches (men) and > 35 in (women)
  • triglyceride level > 150
  • HDL < 40 (men) and < 50 (women)
  • blood pressure > 130/85
36
Q

hyperosmolar hyperglycemic state (HHS)

A
  • hyperglycemia without the presence of ketone bodies
  • more common in T2DM due to the fact that insulin is present enough to prevent breakdown of fats into ketone bodies
  • osmotic diuresis as well which results in extreme dehydration and altered level of consciousness
37
Q

DKA vs HHS s/s

A
  • DKA = polyuria, dyspnea, N/V

- HHS = polyuria, polydipsia, confusion, lethargy

38
Q

four major classes of oral antidiabetic meds

A
  • sulfonylureas
  • biguanides (metformin)
  • glitazones
  • glucosidase inhibitors
39
Q

sulfonylureas

A
  • long half life, so d/c 24-48 hours before surgery
  • initial treatment for T2DM
  • MOA = stimulate insulin secretion from pancreatic beta cells
  • second generation = glyburide and glipizide, which are more potent and have hypoglycemia as side effect
40
Q

sulfonylureas harmful cardiac side effects

A

-may potentially inhibit myocardial protection by decreasing ATP channels in myocardium which leads to a larger myocardial infarction

41
Q

Biguanides (metformin)

A
  • decrease hepatic gluconeogenesis and enhance glucose utilization across cell membranes
  • most serious SE = lactic acidosis; this can occur if too much metformin accumulates due to acute or chronic dehydration
42
Q

how much insulin does an adult secrete per day

A

50 units

43
Q

insulin

A
  • most important anabolic hormone
  • facilitates glucose and potassium into the adipose and muscle cells, therefore increasing glycogen, protein and fatty acid synthesis
  • decreases glycogenolysis and gluconeogenesis, lipolysis and catabolism
44
Q

intermediate acting insulin

A
  • NPH
  • lente
  • lispro protamine
45
Q

short acting insulin

A

regular

46
Q

rapid acting insulin

A
  • lispro

- aspart

47
Q

long acting insulin

A
  • glargine (lantus)

- ultralente

48
Q

anesthetic management goals for DM

A
  • aggressive preop glucose control associated with less infection, improved wound healing and decrease in morbidity and mortality
  • maintain glycemic control
  • avoid further deterioration of pre-existing end organ damage
  • optimize electrolyte abnormalities prior to surgery
  • cervical spine mobility assessed preop
  • difficult intubation in up to 30% of T1DM
49
Q

insulinoma

A
  • benign pancreatic tumors that occur in women twice as much as men
  • tumor on pancreas that secretes LOTS of insulin
  • diagnosis made by whipple’s triad
50
Q

whipple’s triad

A
  • hypoglycemia with fasting
  • glucose of less than 50 with symptoms
  • relief of symptoms with glucose administration
51
Q

treatment insulinoma

A
  • surgical removal is definitive treatment

- preoperatively patient is treated with diazoxide (inhibits insulin release from beta cells)

52
Q

intraoperative management of insulinoma

A
  • first hypoglycemia may occur then hyperglycemia after tumor removal
  • important to monitor blood glucose levels because GA can mask s/s of hypoglycemia
53
Q

S/S diabetic neuropathy

A
  • HTN
  • painless myocardial ischemia
  • reduced HR to atropine or propranolol (diabetic autonomic neuropathy)
  • resting tachycardia
  • lack of sweating
  • may limit ability of patient to compensate and predispose patient to CV instability (ex post induction hypotension and sudden cardiac death)
54
Q

intraoperative blood glucose management

A
  • goal = avoid hypoglycemia while keeping blood glucose below 180 mg/dL
  • stress of surgery causes hyperglycemia through increase in counter regulatory hormones and inflammatory mediators
55
Q

what is hyperglycemia in the perioperative period associated with?

A
  • infection
  • poor wound healing
  • increased mortality
  • worse neurologic outcomes

N935 Advanced Pathophysiology II (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions