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The BIG Test > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Where is the pituitary gland located?

A

Sella turcica of the sphenoid bone

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2
Q

The posterior pituitary (neurohypophysis) releases ADH and oxytocin in response to what?

A

Neural impulses arising from the hypothalamus

*ADH is synthesized in the supraoptic and paraventricular nuclei of the hypothalamus

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3
Q

Is the posterior pituitary inside or outside the BBB?

List the 4 structures not protected by the BBB.

A

Outside

  1. Posterior pituitary
  2. Pineal gland (secretes melatonin)
  3. Median eminence of the hypothalamus (connection to pituitary)
  4. Area postrema (senses toxins, N/V)
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4
Q

What may trigger the release of ADH?

A 
Serum osmolality 
Pain 
Stress
Hypoxia
Anxiety
Hyperthermia
PPV
Beta stimulants
Histamine
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5
Q

What is the principle mechanism of anterior pituitary hormonal control?
Is the anterior pituitary connected to the hypothalamus?

A

Negative feedback

The hypothalamus is connected to the anterior pituitary (and the posterior pituitary) by blood vessels (hypothalamic-hypophyseal portal system)

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6
Q

List the 6 hormones released by the anterior pituitary.

A
  1. ACTH
  2. TSH
  3. GH
  4. Prolactin
  5. LH
  6. FSH
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7
Q

What inhibits the release of ACTH?

A

Serum cortisol inhibits by negative feedback the release of CRF from the hypothalamus + ACTH from the anterior pituitary

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8
Q

Diabetes Insipidus
Nephrogenic vs. Central
What would you give to differentiate?

A

Central - failure to release ADH
Nephrogenic - renal tubules fail to respond to ADH

*Administer DDAVP - if the urine becomes concentrated = central

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9
Q

What are the 2 cardinal features of DI?

A
  1. Hypernatremia - hyperosmolality > 300 mOsm/kg

2. Polyuria - large amount of dilute urine (2-15 L/day) - < 200 mOsm/kg

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10
Q

Cause of DI?

Cause of SIADH?

A

DI - pituitary procedures, transphenoidal hypophysectomy

SIADH - intracranial disease (tumors), carcinoma of the lung, myxedema, porphyria

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11
Q

Which is released in greater quantities…thyroxine (T4) or triiodothyronine (T3)?

A

T4 (97%)
Most of the T4 is then converted to T3 in the tissues

*T3 is 4x more potent than T4

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12
Q

What is the best initial test of thyroid function?

A

TSH

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13
Q

The parathyroid gland regulates what 2 electrolytes?

A
  1. Ca - increases

2. Phosphate - decreases

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14
Q

What is the role of calcitonin?

A

Released from thyroid gland
Weak role in calcium homeostasis
Decreases plasma concentration of Ca
Decreases activity of osteoclasts (bone breakdown)
Increases activity of osteoblasts (bone deposition)
*Opposite effects of PTH

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15
Q

What is the classic triad of Grave’s disease?

A

Goiter +

  1. Hyperthyroidism
  2. Exophthalmos
  3. Dermopathy
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16
Q

When in the perioperative period is thyroid storm most likely to occur?

A

First 6-18 hours post-op
Tx: cold fluids, digitalis, sodium iodide, cortisol, propranolol, PTU

*May look like MH

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17
Q

Hypothyroidism causes _____ in the infant or child and _______ in the adult.

A

Cretinism *Large tongue

Myxedema *Cold intolerance

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18
Q

Does hypothyroidism alter MAC?

A

NO, however recovery from anesthesia may be delayed due to hypothermia, respiratory depression, and slowed drug biotransformation

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19
Q

What is the bone disorder caused by hyperparathyroidism?

A

Osteitis fibrosa cystica
Ca leaks OUT of the bone
Broken, brittle bone disease
(The patient with hyperparathyroidism has hypercalcemia)

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20
Q

What gland is both endocrine and excretory?

A

Pancreas

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21
Q

Pancreatic duct + common bile duct =

A

Sphincter of Oddi

Empties into the duodenum

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22
Q

What 2 hormones are secreted by the islets of Langerhans?

A
  1. Insulin *beta cells

2. Glucagon *alpha cells

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23
Q

What hormone does the pancreatic islet delta cells produce?

A

Somatostatin

Inhibits GI motility and secretions (HCL)

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24
Q

What 2 tissues do NOT need insulin to utilize glucose?

A
  1. CNS

2. RBCs

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25
Q

What is the expected pattern during and after resection of an insulinoma?

A

Hypoglycemia during resection

Hyperglycemia after resection

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26
Q

What are the 3 ketones produced in the patient with DM?

A
  1. Acetoacetic acid
  2. Beta-hydroxybutyric acid
  3. Acetone

W/o insulin, glucose can’t get into the cells - carbs are not available, so fatty acids become available - these fatty acids are oxidized in the liver to ketones

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27
Q

What is the most common cause of death during treatment of ketoacidosis?

A

K swings

*Type 1 DM

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28
Q

The diabetic with autonomic neuropathy is at increased risk for perioperative morbidity and mortality. What are 6 anesthetic concerns?

A
  1. Orthostatic hypotension
  2. Silent MI
  3. Gastroparesis
  4. Atlanta-occipital joint immobility
  5. Renal insufficiency
  6. HTN

*The HR response to antimuscarinics and beta blockers is blunted

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29
Q

Hyperosmolar Hyperglycemic Nonketotic Diabetic Coma

A

Deficient insulin response to glucose stimulation
Severe dehydration
BS may reach 1,000 mg/dL
Needs to be slowly corrected or else cerebral edema

*Type 2 DM

30
Q

What hormone is secreted by the zona glomerulosa of the adrenal cortex?

A

Aldosterone

*Acts on the DT and CD to increase Na reabsorption and increase K secretion

31
Q

What hormone is secreted by the zona fasiculata of the adrenal cortex?

A

Cortisol
*ACTH controls the secretion of cortisol (anterior pituitary)

Causes increase in glucose, sodium retention, potassium excretion

32
Q

The adrenal medulla secretes what 3 catecholamines?

A
  1. NE
  2. Epi
  3. Dopamine
    * Under the control of the SNS - Ach release from the preganglionic cholinergic fibers
    * Chromaffin cells
33
Q

What is the final metabolic product of catecholamine metabolism?

A

Vanillylmandelic acid

34
Q

Cushing’s Syndrome

aka hyperadrenocorticism

A

Excessive cortisol
Most cases d/t over-production of ACTH by the anterior pituitary
S/S: HYPERtension, HYPERglycemia, HYPOkalemia, skin pigmentation, weakness, moon face, buffalo hump

35
Q

What is the most common cause of secondary adrenal insufficiency?

A

Iatrogenic administration of exogenous glucocorticoids

*Depresses ACTH release from the anterior pituitary, adrenal cortex atrophies

36
Q

Addison’s Disease
aka primary adrenal insufficiency
aka hypoadrenocorticism

A

Autoimmune destruction of the adrenal cortex - impaired secretion of aldosterone and cortisol
S/S: HYPOtension*, HYPOnatremia, HYPOglycemia, HYPERkalemia, hemoconcentration (water follows Na secretion), skin pigmentation, weight loss, weakness (opposite of Cushing’s)

37
Q

What disease is associated with hypersecretion of aldosterone by the adrenal cortex?

A

Conn’s syndrome

aka primary hyperaldosteronism

38
Q

What drug releases catecholamines from the adrenal medulla and inhibits catecholamine uptake into chromaffin granules?

A

Droperidol

*Avoid with a pheo - What else should be avoided?
Histamine-releasing drugs (Histamine triggers the release of catecholamines)
Ketamine

39
Q

Where are Kupffer cells found? What are their function?

A

Macrophages that line the sinusoids of the liver

40
Q

What is the portal triad?

A
  1. Portal vein
  2. Hepatic artery
  3. Bile duct
41
Q

Can the liver act as a reservoir of blood?

A

YES, the liver is a major reservoir for blood, storing up to 500 mL of blood

42
Q

When portal vein BF decreases, hepatic arterial BF increases. What is this phenomenon called?

A

Arterial buffer response

Maintains hepatic O2 supply and BF

43
Q

What % of hepatic BF is provided by the portal vein? Hepatic artery?

A

Portal vein - 70% (10 mmHg)
Hepatic artery - 30% (90-100 mmHg)
*Each provide 50% of total oxygen

44
Q

What 2 vessels converge to form the hepatic portal vein?

A
  1. Splenic vein
  2. Superior mesenteric vein

*Hepatic artery arises from celiac artery

45
Q

What are 3 likely hematologic abnormalities seen in chronic alcoholics?

A
  1. Thrombocytopenia
  2. Leukopenia
  3. Anemia - megaloblastic
46
Q

When do manifestations of severe alcohol withdrawal syndrome usually appear?

A

24-96 hours (1-4 days) after cessation of drinking

Tx: Librium (long-acting benzo)

47
Q

The patient has hepatic cirrhosis. What is the significance of this for the anesthetist?

A

Portal vein has decreased flow
Hepatic arterial flow is usually maintained
Avoid situations that decreased hepatic artery flow and oxygen delivery - optimize BP
Isoflurane maintains hepatic blood flow the most!

48
Q

What is the most common major complication of cirrhosis?

A

Ascites

*Portal HTN promotes the formation of ascites

49
Q

How would you dose NDMR in a patient with cirrhotic liver disease?

A

Greater initial loading dose, but smaller maintenance doses

Increased Vd, prolonged clearance

50
Q

What is the major cause of M and M in the patient with cirrhosis?

A

Gastroesophageal varices

51
Q

What 2 lab tests are best in evaluating liver disease?

A
  1. Serum albumin (1/2 life = 20 days - chronic)

2. Prothrombin time

52
Q

Which enzyme test best assess hepatocelluar damage?

A

5-NT
GST
ALT
AST

53
Q 
What happens to the following in the patient with hepatic cirrhosis: 
SVR
CO 
BV
Portal blood flow 
Hepatic blood flow 
Plasma osmotic pressure
A 
SVR - decreased 
CO - increased 
BV - increased (d/t activation by RASS) 
Portal blood flow - decreased 
Hepatic blood flow - unchanged or decreased
Plasma osmotic pressure - decreased

*Hyperdynamic state

54
Q

Porphyria Attack
S/S
Triggers

A

Metabolic disorders that affect the biosynthesis of heme

S/S: abdominal pain, N/V, autonomic disturbances, sweating, tachycardia, HTN

Triggers: barbs, possibly benzos and Ketamine
Others: etomidate, enflurane, nifedipine, sulfa, ketorolac, pentazocine, phenytoin, hydralazine, mepivacaine, lidocaine

*Regional anesthesia may be avoided to prevent confusion

55
Q

DM Type 1 Patho

A

Autoimmune destruction of glucose transporter on islet cells
Pancreas is no longer secreting insulin
Normal insulin production is 50 units/day

56
Q

Glucose Lowering Agents

A

Increase insulin release from the pancreas -
Sulfonylureas (Chlorpropamide)
Repaglinide
DPP-4 inhibitors (Sitagliptin)
GLP-1 agonists (Exenatide) - lowers glucagon levels

Decrease hepatic glucose release and increase insulin sensitivity-
Thiazolidinediones (Rosiglitazone)

Block starch digesting enzymes -
Alpha-glucose dash inhibitors (Acarbose)

57
Q

Metformin Associated Lactic Acidosis

A

Triggers - stress and IV contrast

Hold for 8 hrs preop (24 hrs with extended release use)

58
Q

Gestational Diabetes

More harmful for mom or baby?

A

Baby - polyhydramnios, macrosomia, prematurity, RDS, rebound hypoglycemia

Tx - insulin is controversial (it doesn’t cross placenta)

59
Q

Drug-induced DI - causative agents?

Treatment for DI?

A

Lithium, amphoterocin, fluoride

ADH replacement - SE: increase in SVR
Chlorpropamide- ADH stimulator - SE: hypoglycemia

60
Q

Caution with too rapid correction of sodium. Can cause…

A

Central pontine myelinolysis

1-2 mEq/hr max

61
Q

Post-op adrenalectomy CXR due to risk of…

A

Pneumo 20%

62
Q

Clonidine Suppression Test

A

Used in the diagnosis of a pheo

0.3 mg will decrease serum catecholamine levels in essential HTN, but NOT with a pheo

63
Q

Acromegaly

A

99% from primary pituitary adenoma
Excessive GH from anterior pituitary

Careful assessment of airway

64
Q

What is the most common GI endocrine tumor?

A

Carcinoid tumor

Systemically active with metastasis
Releases —
histamine-like substances - hypotension, bronchospasm
serotonin - HTN, hypervolemia

*Preop somatostatin analog octreotide

65
Q

Innervation of Liver

A

Sympathetic: T7-10
Parasympathetic: Vagus and R phrenic

66
Q

Why are bile salts important?

A

Essential for absorption of cholesterol, fatty acids, and fat soluble vitamins

67
Q

Hepatic encephalopathy may be reversed by…

A

Flumazenil

68
Q

Pulmonary characteristics of a patient with liver failure.

A

PaO2 50-70 mmHg
Respiratory alkalosis (decreased PaCO2) - hyperventilation
HPV is impaired

69
Q

Pulmonary characteristics of a patient with liver failure.

A

PaO2 50-70 mmHg
Respiratory alkalosis (decreased PaCO2) - hyperventilation
HPV is impaired

*Do NOT hyperventilate this patient - NH4+ shifts to NH3 (ammonia — encephalopathy)

70
Q

3 Phases of Liver Transplant

A
  1. Preanhepatic - hemorrhage, hyperglycemia
  2. Anhepatic - clamping vessels to reperfusion
  3. Neohepatic - reperfusion, greatest hemodynamic instability

The BIG Test (21 decks)

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