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SPR25: Health Assessment > Endocrine > Flashcards

Endocrine Flashcards

Test 4

1
Q

The ______ is the primary source of glucose production. How is it created?

A

Liver

Glycogenolysis
Gluconeogenesis

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2
Q

What happens to glucose & insulin 2-4 hours after eating?

A

endogenous production of glucouse increases

endogenous insulin production decreases

This is to maintain normal BG levels

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3
Q

What hormones help regulate glucose levels?

A

Glucagon
Epi
Growth hormone
Cortisol

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4
Q

What are the roles of Glucagon?

A

Stimulates Glycogenolysis & Gluconeogenesis

Inhibits glycolysis

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5
Q

What is the most common endocrine disease?

A

DM

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6
Q

What causes DM?

A

inadequate supply of insulin and/or tissue resistance to insulin

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7
Q

Describe Type 1b DM?

A

Rare

Non-immune

Absolute insulin deficiency

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8
Q

Describe DM 1a

A

Autoimmune

-80-90% Destruction of pancreatic B-cells
-long period (9-13yrs) of B-cell antigen production before onset

-min/absent insulin production
-dx before 40yo

symptoms: fatigue, wt loss, polyuria, polydipsia, blurry vision, hypovolemia, ketoacidosis

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9
Q

Describe DM 2

A

90% of DM cases

Increasingly seen in younger pts now
-Under-Dx; normally present 4-7 yrs beforehand

Desensitized to insulin –> increased insulin secretion –> decreased pancreas function –> insulin levels inadequate

characterized by insulin resistance in skeletal muscle, adipose, & liver

Acquired & contributing factors: Obesity, sedentary life

Dx: A1c & fasting blood glucose

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10
Q

What are the 3 main abnormalities seen in DM2?

A
  1. impaired insulin secretion
  2. increased hepatic glucose release
  3. insufficient glucose uptake in peripheral tissues
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11
Q

What causes insulin resistance in DM2?

A

Abnormal insulin molecules
-Circulating insulin antagonists
-insulin receptor defects

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12
Q

What is the A1C Dx criteria?

A

<5.7% = Normal

5.7 - 6.5% = Pre DM

> 6.5 = DM

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13
Q

What is the Tx for DM2?

A

Diet
Exercise
wt loss

PO anti-DM meds:
-Metformin (biguanide - preferred)
-Sulfonylureas (not effective long term)

Insulin: Must have w/ DM1
-Rapid: Lispro, Aspart @ meals
-Short
-Interm: NPH, Lente
-Long: Glargine, Ultralente

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14
Q

What is the most dangerous complication of insulin? What exacerbates this? Tx?

A

Hypoglycemia

Exacerbated by: ETOH, metformin, sulfomylureas, ACE-I, MAOIs, BB

Tx: glucose

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15
Q

Describe DKA

A

Diabetic Ketoacidosis

Seen in DM1
-Trigger by illness/infection

Dx criteria:
glucose > 300
pH <7.3
HCO3- <18
serum osmo <320
++ urine ketones

Tx: IVF
-Insulin: Loading: 0.1u/kg + infusion: 0.1u/kg/hr
-bicard (correct acidosis)
-K+, phos, mag, sodium (electrolytes)

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16
Q

Describe HHS

A

Hyperglycemis Hyperosmolar Syndrome

occurs in DM2

Characterized by: severe hyperglycemia, hyperosmolarity (can lead to coma), dehydration
-Symptoms: polyuria, hypovolemia, hypotension, tachycardia

Slight acidosis

Tx: IVF, insulin bolus + infusion, electrolytes

Increased mortality

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17
Q

What are DM complications?

A

Microvascular: impaired blood flow

NEPHROpathy: –> ESRD
-Symptoms: HTN, proteinuria, periphery edema, decreased GFR
-tx: HD, PD, transplant

Peripheral neuropathy: Starts in toes/feet
-ulcers develop from unnoticed mechanical injuries/trauma –> infections

Retinopathy: dt microvascular damage
-includes color loss –> blindness
-BP/sugar control slows progression

Autonomic Neuropathy:
-CVS: abnormal CV dynamics, loss of HR variability, ortho hypotension, dysrhythmias
-GI: decreased GI secretions/motility, gastroparesis
—-Symptoms: N/V, decreased appetite, bloating, apigastric pain
—–Tx: control BG, small meals, prokinetics

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18
Q

When GFR <_____ your kidney can no longer clear _____

A

15-20

K+ (potassium)

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19
Q

What considerations should we have with DM?

A

Assess hydration status

Avoid nephrotoxic drugs

preserve RBF

Increased aspiration risk dt gastroparesis

Hold PO diabetics drugs to avoid hypoglycemia

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20
Q

Describe Insulinoma

A

Insulin secreting pancreatic tumor

2x women > men
-50-60 yo

Dx: Based on Whipple triad:
1. Hypoglycemia w/ fasting
2. BG <50 w/ symptoms
3. symptom relief w/ glucose

high blood insulin during 48-72h fast

Tx: Meds: Diazoxide (Preop- inhibits insulin release)
-Verapamil, phenytoin, propranolol, glucorticoids, octreotide

Sx is curative
Hypoglycemia - intraop –> hyperglycemia once tumor removed
TIGHT MONITORING ON BG & TX REQUIRED

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21
Q

Thyroid gland is composed of ____ lobes joined by an _____

A

2 lobes

isthmus

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22
Q

What is the thyroid capillary network innervated by?

A

adrenergic & cholinergic NS

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23
Q

What is in close proximity of the thyroid?

A

-R laryngeal nerve
-External motor branch of the SLN (dont know what SLN is)

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24
Q

Thyroid hormone depends on availability of exogenous _______

A

iodine

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25
Iodine binds to ________ and yields inactive __________ & ____________
thyroglobulin monoiodotyrosine diiodotyrosine
26
What is the T4/T3 ratio?
10:1
27
T/F: Thyroid hormones stimulate virtually all metabolic processes
T
28
The thyroid is regulated by _____ (3) describe each
1. Hypothalamus: secretes thyrotropin, releasing hormone (TRH) 2. pituitary: TRH --> signals **anterior** pituitary: releases, thyrotropin stimulating hormone (TSH) 3. Thyroid glands: TSH --> binds to thyroid receptors: release T3/T4 **TSH is influenced by plasma levels of T3/T4 -- negative feedback loop**
29
What is a normal TSH level?
0.4 - 5.0 millunits/L
30
What are the labs to test for thyroid functioning?(2)
TSH assay: best test of thyroid action at cellular level TRH stimulation test: use to test pituitary function and TSH secretion
31
What are the three main pathology for hyperthyroidism? symptoms?
-Graves disease -toxic goiter -Toxic adenoma symptoms: sweating, heat and tolerance, fatigue, insomnia
32
What does T3 have main effects on?
Myocardium Peripheral vascular
33
Describe Graves disease
Leading cause of hyperthyroidism Autoimmune dt **thyroid stimulating antibodies** Females> males 7:1 20-40yo Symptoms: goiter, ophthalmopathy **Dx: +TSH antibodies low TSH high T3/T4** Tx: **Methimazole or Propylthiouracil (PTU)** 1st line -iodine therapy (preop correction or thyroid storm only) -BB (relieves symptoms) Sx: subtotal thyroidectomy when meds failed Sx complications: hypothyroidism, hemorrhage, hematoma, tracheal compression, RLN damage, parathyroid damage
34
What are preop Graves' disease considerations?
Assessed levels preop **Elective cases may need to wait 6 to 8 weeks for anti-thyroid meds to take affect** Emergent cases: IV BB, glucocorticoids, PTU are needed Evaluate upper airway
35
Describe thyroid storm
Life-threatening hyperthyroid Triggered by: stress, trauma, infection, medical, illness, surgery **Labs: thyroid levels may not be much higher than regular hyper thyroidism** Tx: anti-thyroid meds Supportive care **Mortality 20%**!!!!!!
36
Describe hypothyroidism
Also called "Myxedema" Decrease T3/T4 despite normal TSH Causes: ablation of the gland by radioactive iodine or surgery -idiopathic/autoimmune Types: **Hashimoto thyroiditis** -goiter -affects middle-aged women symptoms: slow, progressive, course, cold, intolerance, weight gain, non-pitting edema, SIADH, fluid overload, plural, effusion, dyspnea, slow GI (ileus) **Tx: L-thyroxine**
37
What are hypothyroidism considerations?
Airway compromise Aspiration risk -- slower GI Cardiovascular hypodynamic Compromise respiratory function Hypothermia Electrolyte and balances **Elective cases: Thyroid therapy should be initiated 10 days prior** -Emergent: IV thyroid & steroids ASAP
38
Describe Myxedema Coma
Rare, Severe form of hypothyroidism **Medical emergency** Mortality 50% elderly women> Trigger by: infection, cold, CNS depressants **Hallmark symtpom: Hypothermia dt impaired thermoregulation** -Symptoms: delirium, hypoventilation, hypothermia, bradycardia, hypotension, delusional, hyponatremia Tx: IV L-thyroxine L-triiodothyronine -IVF w/ glucose, temp regulation, electrolyte correction, supportive care Mechanical vent sometimes required
39
What causes goiters? Tx?
Lack of iodine Ingestion of goitrogen Hormonal defect Tx: L-thyroxine Sx: only indicated if medical treatment is ineffective and goiter compromises airway or is cosmetically unacceptable
40
What are complications of thyroid surgery?
RLN injury (unilateral, bilateral, temporary, permanent) -unilateral: vocal hoarseness -- resolves in 3 - 6 months -bilateral: cause airway obstruction and warrant tracheostomy Hypothyroidism Hematoma **Keep a track set bedside!!!!!**
41
Each adrenal gland consist of a _______ (2)
Cortex Medulla
42
What does the cortex in the adrenal gland synthesis?
Glucocorticoids Mineralocorticoids (aldosterone) Androgens
43
The hypothalamus sends _______ to the anterior pituitary, which stimulates release of _________
Corticotropin releasing hormone (CRH) Corticotropin (ACTH)
44
Corticotropin (ACTH) stimulates the ________ to produce ________. What does this do?
Adrenal cortex Cortisol Cortisol helps convert NE to Epi
45
Describe Pheochromocytoma
Originates in Chromaffin cells Location: 80%: adrenal medulla 18%: organ of Zuckerkandle 2%: neck/thorax Can cause malignant HTN, CVA, MI **Secretes NE:Epi 85:15** inverse of normal Can be spontaneous or triggered by: injury, stress, meds Symptoms: HA, pallor, sweating, palpitations, HTN, orthostatic hypotension, **coronary vasoconstriction, cardiomyopathy, CHF, EKG changes** Dx: 24 hour urine collection CT, MRI Preop: Alpha blocker -**Phenoxybenzamine** -Prazosin, Doxazosin -BB (never give non selective - that works on B2) -CCB
46
Describe hypercortisolism (Cushings)
2 types: ACTH dependent: high plasma, ACTH stimulates adrenal cortex to produce excess cortisol ACTH independent: excessive cortisol production by abnormal Edino cortical tissue that is not regulated by CRH/ACTH (these levels are suppressed) -causes: adrenocortical tumors Symptoms: weight gain, moon face, ecchymoses, HTN, glucose into intolerance, muscle, wasting, depression, insomnia Dx, 24 hour urine cortisol CT, MRI, US -- determine tumor location Preop: treat BP, electrolyte, imbalances, BG Tx: Transsphenodial microadenomectomy (if resectable) -subtotal resection of anterior pituitary -pituitary radiation -adrenalectomy
47
Describe hyperaldosteronism
Primary: excess secretion of Aldo dt tumor -women>men -associated w/ pheochromocytoma, hyperparathyroid, acromegaly -renin supressed Secondary: dt elevated renin **Hallmark symptom: spontaneous HTN w/ hypokalemia** **Licorice can cause symptoms** Tx: Spironolactone K+ Antihypertensive Diuretics Tumor removal adrenalectomy
48
Describe Hypoaldosteronism
**Hallmark symptom: hyperkalemia w/o renal insufficiency** symptoms: HB, orthostatic hypotension, hyponatremia causes: congenital, ACE-I, Indomethacin-induced prostaglandin deficiency (reversible) Tx: increase sodium intake fludrocortisone daily
49
Describe adrenal insufficiency
2 types: Primary (Addisons): autoimmune adrenal gland suppression -**90% of glands must be involved** before signs appear Secondary: hypothalamic-pituitary suppression leading to a lack of CRH or ACTH production -only glucocorticoid deficiency Causes: iatrogenic: synthetic glucocorticoids, pituitary surgery, radiation **These pts lack hyper pigmentation** Dx: baseline cortisol < 20 ug/dL even after ACTH stimulation Tx: Steroids
50
There are ___ parathyroid glands located behind the ____ & _____ poles of the ______
4 Upper Lower Thyroid
51
Parathyroid hormone depends on ______. How?
Calcium decreased Ca = increased PTH release increased Ca = decreased/supressed PTH release
52
What does parathyroid hormone (PTH) do?
Maintains normal plasma Ca by promoting the movement of calcium across the GI tract, renal tubules, and bone
53
Describe hyperparathyroidism
Classified as primary, secondary, ectopic Primary: Causes: benign parathyroid adenoma 90% -carcinoma 5% -parathyroid hyperplasia 5% -symptoms: lethargy, weakness, N/V, polyuria, renal stones, PUD, cardiac disturbances -Dx: plasma Ca, 24h urinary Ca -Tx: Sx removal of abnormal portions gland Secondary: compensatory response of the parathyroid gland to counteract a separate disease process involving hypocalcemia Tx: treat underlying disease, normalize phosphate levels
54
Describe hypoparathyroidism
Causes: Iatrogenic: inadvertent removal of parathyroid gland during thyroidectomy Dx labs: decrease PTH, decrease Ca, increase phos Symptoms: Chronic: fatigue, cramps, prolonged QT, cataracts, SQ calcifications, Neuro deficits **Acute hypocalcemia after accidental parathyroid removal may cause inspiratory strider or laryngospasm** Tx: Ca replacement, Vit D
55
What is pseudohypoparathyroidism?
PTH is adequate, but the kidneys are unable to respond to it
56
The anterior pituitary gland secretes ____ hormones under the control of the ________. What are they?
6 Hypothalamus GH ACTH TSH FSH LH Prolactin
57
the posterior pituitary stores _________ (2) after being synthesized in the _________
Vasopressin Oxytocin Hypothalamus
58
Describe Acromegaly
Excessive growth hormone **seen with anterior pituitary adenoma** Dx labs: insulin-like growth factor 1 (ILGF-1) elevated **Overgrowth of soft tissues = upper airway obstructions** Hoarseness and abnormal movement of vocal cords or RLN paralysis dt overgrowth of surrounding cartilage Tx: removal of pituitary adenoma -LA somatostatin analogues (if sx not feasible)
59
What are anesthesia considerations for Acromegaly?
Distorted face anatomy -- interfere with mask placement Enlarged the tongue and epiglottis -- interferes with visualization of vocal cords Increase distance between the lips and the vocal cords Epiglottis opening may be narrowed dt vocal cord enlargement -- **Smaller ETT, VL, awake fibrotic intubation**
60
describe diabetes insipidus (DI)
Vasopressin (ADH) deficiency Causes: Central/Neurogenic: dysfunction of the posterior pituitary Nephrogenic: failure of kidneys to respond to ADH Symptoms: polydipsia, excessive/dilute urine despite increase serum osmo Tx: IV electrolytes to offset polyuria Neurogenic/Central: DDVAP Nephrogenic: low salt, low protein, thiazide diuretics, NSAIDs Considerations: monitor UO & electrolytes
61
Describe syndrome of inappropriate ADH (SIADH)
Causes: intracranial tumors, hypothyroidism, porphyria, lung cancer Dx: hyponatremia, decreased serum Osmo, increased urine Na, increased urine osmo Tx: fluid restrictions, Na tabs, Luke diuretics, Demeclocycline (ADH antagonist), hypertonic saline (severe hyponatremia)

SPR25: Health Assessment (11 decks)

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