Endocrine Flashcards
Pancreas ( anatomy, where is its location ? )
- Pancreas is posterior to liver and behind the stomach
What is the pancreas function ?
Releases
- Pancreatic juices
- Enzymes
- Insulin ( secreted by cells of the islets of Langerhans
- Neutralizes stomach acid ( because it contains sodium bicarbonate)
What is a normal glucose level
70-110 mg/dL 60-110 mg/dL is acceptable
What are 3 major pancreatic enzymes ?
- Lipase
- Amylase
- Trypsin
What is the pancreas endocrine function ?
- Produces Insulin
- Produces glucagon
How does insulin work ?
- Glucose can enter freely into the cells
- Helps muscle and tissue oxidation of glucose (combine)
How does glucagon work ?
- Increases glyconeogenesis in liver
What is the exocrine function (digestive enzyme?)
- Fat digestion
What does lipase do ? What is the normal level ?
- Fat digestion
- 25-125 IU/dL or 60 - 160 somogyi units/dL
What does amylase do ? What is the normal level ?
- Carbohydrate digestion
- 22-51 U/L
What does trypsin do ? What is the normal level ?
- Protein digestion
Pancreatitis is it a priority medical condition ?
- Hyperglycemia with or without diabetes
- Priority medical condition, it is emergent
Cullen’s sign (Pancreatitis)
- Discoloration to around belly area
Blue- black
Greenish to brown or yellow
- Abd pain
- Indicates necrosis ( dead tissue)Grey Turner’s Sign ( Pancreatitis )
- Blue discoloration of the flanks ( lumbar area)
- Bruising and ecchymosis ( retroperitoneal hemorrhage)
What are complications in pancreatitis ?
- Hypovolemia
- Hyperglycemia
- Tachycardia
- Hypocalcemia
- Shock
What is the diet for pancreatitis ?
- Limited fat
- Protein intake
- High calorie
- Bland
What are signs of having pancreatic tumors ?
- Jaundice ( initial or advanced )
- Anorexia/nausea/vomiting
- Indigestion
- Flatulence
- Weight loss
- Dark urine ( due to bile being reabsorbed)
- Clay colored stool
- Ascites and dull abd pain ( absent in early stage )
What is Whipple Surgery? what is It done for ?
- Whipple’s surgery is done for cancer of the
Head of the pancreas
Duodenum ( first section of the small intestine )
Jejunum ( Between duodenum and ileum )
Gallbladder and common bile duct
How long does it take for the resected liver to regenerate ?
6- 8 weeks
What treatment is given post op to Whipple’s Surgery or Pancreatitis ? what are these also used in ?
- Pancrease ( aids in digestion of food )
- Panncreatin ( pan 2400 ), used to treat malabsorption
- Pancrealipase (Creon)
- Viokase
Gallbladder
- Stores and concentrates bile to digest fats and oils
Cholecystitis (related to gallbladder)
- Inflammation of gallbladder ( acute or chronic )
- Primary effects obese women
What are the 5 Fs in cholecystitis ? (pneumonic)
- Female
- Fat
- Fair
- Forty
- Fertile
Murphy’s sign ( assessment for cholecystitis)
- Unable to take a deep breath when fingers are pressed below hepatic margin
Cholelithias
- Presence of one or more calculi (gallstones) in the gallbladder
Acute Cholecystitis
- Sudden inflammation of he gallbladder and causes severe abd pain
Chronic Cholecystitis
- Long standing swelling and irritation of the gallbladder
What diet should Pt. with gallbladder problems have ? and which medication is used for pain ?
- Low fat
- Morphine or Meperidine (Demerol)
If for pancreatitis answer Morphine
If for cholecsystitis or pancreatitis answer Demerol
Cholecystography ( Gallbladder series ) Explain.
Prepping
Diet
Prepping Pt.
- Explain
- Check iodine allergies
- If oral cholecystogram is to be done ( administer bilopaque or telepaque tablets as ordered
- If IV cholecystogram is to be done the dye will be given just before exam in radiation department
Diet
- Low fat meal in the evening before test
- No further food after evening meal
- Black coffee, tea, or water may be taken for breakfast
- Give prescribed laxatives or enemas
Post Cholecystography diet
- Low fat
- High protein
- High calorie ( low calorie if overweight)
Cholangiography
- Endoscope study of biliary disorders to visualize bile ducts, presence of stones, strictures, or tumors or patency of common bile duct after surgery (Vit C after surgery)
Percutaneous Transhepatic Cholangiography (PTC)
Explain procedure
(percutaneous meaning through the skin)
- Dye injected through skin and abdominal wall into vessel or bile duct
- X-ray liver and bile ducts
- Thin needle is inserted through the skin below ribs and into the liver
- Dye injected into liver and bile ducts and X-ray is taken
What will you do if there is a blockage while doing a PTC ?
- If there is a blockage, a thin flexible tube (stent) is left in liver to drain bile into the small intestines or collection bag outside the body
Surgical cholangiography
- Dye is inserted through a needle or catheter into common bile duct
What must the nurse tell the Pt. Pre procedure
- Explain procedure
- CONSENT must be obtained
- NPO night before the procedure
- Administer laxative as prescribed
Gallbladder Ultrasound
- Determines the cause of upper abd pain ( RUQ)
- Jaundice
- Blockage of bile duct tubes leading from liver to gallbladder and duodenum and leakage of bile after surgery or an injury
- No NPO/NO FULL BLADDER
Cholecintigraphy or HIDA (Hydroxy Imino Diacetic Acid)
- Study of gallbladder through imaging
- Indicates biliary obstruction ( gallbladder stone or cancer )
HIDA Scan
- Determines any blockage in the tubes (bile ducts) that lead from the liver to the gallbladder and small intestine ( duodenum )
- Radio active tracer substance is injected into a vein in the arm
- Liver removes the tracer from the bloodstream and adds it to the bile that normally flows through the bile ducts to the gallbladder
- Gallbladder releases tracer into the beginning of the small intestine
- Camera ( gamma ) takes pictures of the tracer as it moves through the liver, bile ducts, gallbladder, and small intestine
If obstructed the radioactive tracer will not be able to reach the gallbladder coming from the liver
Prep before procedure (HIDA SCAN)
- Low fat diet night before
- NPO after midnight
ERCP (Endoscopic Retrograde Cholangio Pancreatography )
- x-ray ducts (tubes) that carry bile from liver to gallbladder and from gallbladder to small intestine using a fiberscope
- Gallbladder cancer causes these ducts to narrow and block or slow flow of bile ( will cause jaundice )
Where is the endoscope passed through ? (ERCP)
- Passed through the mouth, esophagus, and stomach into the first part of the small intestine
- Catheter is inserted through the endoscope into bile ducts
- Dye injected through catheter into the ducts and x- ray taken
What happens if there is an obstruction during an ERCP ? ( tumor blockage )
- Fine tube is inserted into the duct to unblock it
- Tube or stent may be left in place to keep the duct open
- Tissue samples may also be taken
Peritonoscopy
- Direct visualization of peritoneum and liver (sometimes combined with liver biopsy, air sufflation may be used )
Laparoscopic Cholecystectomy ( what is a helpful finding and how can you confirm diagnosis )
- Murphy’s is useful in establishing diagnosis of cholecystitis
- Confirmation of diagnosis depends on combination of physical finds ( palpation and ultrasound )
Laparoscopic cholecystectomy ( Explain this procedure )
- Carbon dioxide is insufflated into the abd during laparoscopic cholecystectomy
- May irritate the diaphragm and cause referred shoulder pain (this complaint is common ) pain to right shoulder is common due to irritated nerve in diaphragm from the air insufflation of carbon dioxide
- Pain in right shoulder lasts for 24-48 hours or may take several days
Diabetes Mellitus (Type I )
- Body’s pancreas doesn’t produce any insulin
- Onset usually in childhood or adolescence but can happen at any age
- Insulin dependent diabetes mellitus (IDDM) or Juvenile- onset diabetes
In type one what is not being metabolized ? and what is being used for energy ?
- Carbohydrates
- Lipids
- Protein
Fats are being metabolized for energy results in Ketonemia (Acidosis)
Type II Diabetes
- Onset is after the age of 30
- Deficient in insulin or resistant ( body’s cells ignore insulin/body does not respond properly to insulin)
- Can develop in elderly women population
Risk factors of diabetes ( What can cause it ? )
- Obesity
- Metabolic syndrome
- Gestational diabetes
- Baby weighing more than 9 lbs
- Low activity level
- Hypertension
- Cholesterolemia
- Polycystic ovarian syndrome
Frequency of blood sugar check for Type I Diabetes ?
- 3x a day
- Before each meals
Frequency of blood sugar check for Type II Diabetes ?
- 2x a day
- Before breakfast and bedtime
What are signs of Hyperglycemia ?
- Increase in urination (polyuria)
- Increase Thirst
- Blurry vision
- Extreme fatigue
- Dry skin
- Sleepy
- Slow healing injury or infection
Signs of Hypoglycemia
- Shaky
- Sweaty
- Dizzy
- Sudden behavior change
- Hungry
- Weak or tired
- Headache
- Nervous or upset
Onset
Peak
Duration of insulin
- Onset is how soon insulin starts to lower blood glucose after taking it
- Peak is the time insulin is working the hardest to lower your blood glucose
- Duration is how long the insulin lasts, length of time it keeps lowering your blood glucose
