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Surgical Nursing > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What it the typical presentation of Hyperthyroidism?

A

Feline older than 8 years
excessive production of thyroxine
unilateral or bilateral adenomatous hyperplasia

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2
Q

What are the clinical signs associated with hyperthyroidism?

A 
Irritable 
Anorexic 
weight loss
Polyphagia 
PU/PD
Vomiting/ diarrhoea
Goitre
heart disease 
-hyperthrophic cardiomyopathy
-tachycardia
Kidney disease 
-chronic renal insufficiency 
-can be masked by hyperthyroidism
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3
Q

What are the three options of treatment for Hyperthyroidism?

A

Medical management
Surgical removal
Radiotherapy

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4
Q

How is a thyroidectomy carried out?

A

Stabilise with medical management first
Removal of one or both of the thyroid glands
preservation of the parathyroid tissue

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5
Q

What post-operative care should be considered in the hyperthyroid cat?

A 
Fluid therapy analgesia 
Monitor kidney problems(can arise once metabolism lowered after removal of the thyroid) 
Monitor hypocalcemia
laryngeal paralysis
Horners syndrome 
Recurrent hyperthyroidism 
hypothyroidism
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6
Q

What is hypocalcemia and how should it be monitored in the hyperthyroid cat after surgery?

A

Look at the calcium levels in the blood lower than normal

monitor 2-7 days after surgery check ionized calcium levels

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7
Q

What are the clinical signs of Hypocalcemia?

A

Muscle twitching
Facial pruitis
Seizsures

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8
Q

What is the treatment of hypocalcemia?

A

10% calcium gluconate 0.25-1.5ml/kg slow iv over 10-20 minutes
maintained on a calcium drip 10ml/10% calcium gluconate in 250mls of hartmanns solution at 60ml/kg over 24 hours
oral vitamin D and calcium
taper medication over 4-10 weeks, monitor ionized calcium

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9
Q

Describe the anatomy of the parathyroid glands?

A

Above the thyroid glands two glands either side
secrete parathyroid hormone
increases calcium concentration in the blood and decreases phosphorus

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10
Q

What are the typical presentation of parathyroid tumours?

A

Older dog
Adenoma or adenomatous hyperplasia
causes increased secretion of parathyroid hormone and loss of normal inhibition- primary hyperparathyroidism
increased calcium levels hypercalcemia

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11
Q

How do you diagnose a parathyroid tumour?

A

Hypercalcemia
PU/PD
parathyroid mass on u/s
rule out lymphoma and anal sac adenocarcinoma

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12
Q

How do you treat parathyroid tumours?

A

Pre-treat, diuresis IVFT saline +/- diuretic
Surgical removal of the mass
parathyroidectomy
Partial thyroidectomy

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13
Q

What are the post-operative care considerations for the parathyroidectomy patient?

A

Monitor ionized calcium levels (once or twice daily 2-7 days)
Monitor renal parameters
routine fluid therapy and analgesia

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14
Q

How should you treat a post-parathyroidectomy patient that has hypocalcemia?

A

10% calcium gluconate 0.25-1.5 mg/kg slow iv over 10-20 minutes
Continue on calcium spiked drip 10ml of 10% calcium gluconate in 250mls hartmanns 60ml/kg over 24 hours
Oral vitamin D and calcium
Taper oral calcium over 2-4 months, then vitamin D assuming calcium stable

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15
Q

What is the pancreatic endocrine function?

A

Beta cells produce insulin
regulates the glucose metabolism
Insulin decreases blood glucose levels and causes storage of glucose

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16
Q

What is an insulinoma?

A

Carcinoma or adenoma of the pancreas cells
Secretes insulin
aggressive biological behaviour (metastasis)
Causes hypoglycemia

17
Q

What are the clinical signs of an insulinoma?

A 
Lethargy
Improves after feeding 
Ataxia 
Seizures 
Muscle weakness 
Mild initial onset gradual worsening of symptoms
18
Q

How is an insulinoma diagnosed?

A

Mass on u/s
Low blood glucose levels
Fasting blood glucose less than 2.2mmol/l
improvement in signs following feeding or administration of glucose
increase serum insulin
CT

19
Q

How do you treat and insulinoma?

A 
Sugar solution, glucose iv 0.25g/kg
Medical management
-frequent meals
-glucocortocid steroids
-diazoxide
20
Q

How is the surgery to remove the insulinoma carried out?

A

Removal of nodule via partial pancreatectomy
5% dextrose infusion to prevent hypoglycemia
monitor glucose peri-operative

21
Q

post-operative care insulinoma

A 
Monitor glucose 
transient hypeglycemia
persistent hypoglycemia 
pancreatits (ANALGESIA)
785 days will metastasise aggressive tumour
22
Q

What is the function of the adrenal glands?

A 
Adrenal cortex
-Cortisol production 
-Aldosterone 
-sex hormones 
Adrenal medulla 
-catecholamines (noradrenaline, adrenaline)
23
Q

What types of adrenal tumours can you get?

A 
Adenoma/ adenocarcinoma 
fuctional vs non-fuctional 
tumours of the adreanl cortex 
-cushings
-conns syndrome (hyperaldosteronism)
Tumours of the adrenal medulla
Phaeochromocytoma
24
Q

What do adreoncotical tumours do?

A 
Most common 
Secrete cortisol 
Create cushings 
-PU/PD, pot bellied, lethargy, muscle weakness, alopecia, polyphagia 
-low dose dexmethasone test
25
Q

What do phaeochromocytoma cause and what are the clinical signs associated with them?

A 
Release of catecholamines 
typical signs 
-generalised weakness 
-collapse
-panting
-tachycardia
-muscle wasting
-intermittent hypertension
26
Q

How are phaeochromocytoma diagnosed?

A

U/s mass on adrenal glands

CT

27
Q

How are adrenocortical tumours medically treated?

A

Trilostane before surgery

28
Q

How are phaechromocytoma treated medically?

A

Phenooxybenzamine 2-3 weeks before surgery (reduces effects of adrenaline)
Propranolol (beta adrenergic antagonist) can help with persistent tachycardia

29
Q

What are the surgical considerations for adrenocoritcal tumours?

A

May have delayed healing

pulmonary thromboembolism

30
Q

What are the surgical considerations for phaechromocytoma?

A 
Surgical manipulation can cause a surge in catecholamine release 
-hypertension
-tachycardia
-arrythmias
-cardia arrest 
Close anaesthetis monitoring 
Propranolol for tachycardia
Lidocaine for arrythmias
31
Q

What surgical approached can you take to remove an adrenal tumour?

A

Midline
Flank
Laproscopic

32
Q

What is a risk of adrenal tumour removal?

A

Haemorrahage

Blood type before surgery

33
Q

What post-operative care should you consider after adrenal tumour removal?

A

Fluids and analgesia
Monitor arrythmias
Monitor hypoadrenocortisim
Dogs require steroid supplementation during and after surgery (dexmethasone pre-op, prednisalone post-op)
Supplementation mineralcorticoids
Monitor electrolytes (decreased sodium and increased potassium)
Fludrocortisone

34
Q

What adrenal tumours are more common in cats and what clinical conditions do they cause?

A 
Adrenocortical 
conns syndrome hyperaldosetronism
increased sodium and water retention 
hypertension 
Hypokalaemia 
episodic muscle weakness 
collapse

Surgical Nursing (24 decks)

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