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AS - N935 Advanced Patho II > Endocrine - Metabolic > Flashcards

Endocrine - Metabolic Flashcards

1
Q

Islet of Langerhans

A

1-2% pancreas weight
Hormone produced & secreted into capillary blood vessel
Venous blood from islet drains into hepatic portal vein & then into general circulation
4 types α β Δ & pancreatic polypetide

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2
Q

Pancreas

A

α 25% islet cells & secrete glucagon
β 60-70% islet mass & secrete insulin
Δ cells secrete hormone somatostatin

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3
Q

Peptides or Proteins

A

Insulin - facilitates glucose transport

Glucagon

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4
Q

Amino Acids

A

Dopamine
Epinephrine
Norepinephrine

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5
Q

Steroids

A

Lipid soluble derived from cholesterol

Estrogen or progesterone

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6
Q

Insulin Half-Life

A

5-8 minutes

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7
Q

Insulin Degradation

A

Liver & kidney

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8
Q

What does not require insulin or glucose?

A

Brain

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9
Q

Glucose Storage

A

Liver insulin promotes

Excess glucose → glycogen (via glycogenesis)

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10
Q

Pancreatitis

A

Pancreas inflammation

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11
Q

Pancreatitis Causes

A

Gallstone & alcohol

Trauma - ERCP, obstruction, & medications

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12
Q

Pancreatitis S/S

A

Abdominal pain
N/V
Febrile

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13
Q

Pancreatitis

Anesthetic Considerations

A

Hydration
Pain management
Monitor electrolytes
NPO until pain & inflammation resolved

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14
Q

Pancreatitis Preop

A

↑WBC
Liver dysfunction
Electrolyte abnormalities

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15
Q

Pancreatitis Complications

A

Pancreatitis necrosis - cell death 2° inflammation

Pancreatic pseudocyst

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16
Q

Pancreatic Pseudocyst

A

Contains only fluid

Most common complication d/t chronic pancreatitis

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17
Q

Pancreatic Cancer

A

4th most common cancer in US

Correlation b/w obesity, smoking, & chronic pancreatitis

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18
Q

Pancreatic Cancer S/S

A

Abdominal pain
Weight loss
Pain suggests retroperitoneal invasion
Jaundice indicates biliary obstruction

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19
Q

Pancreatic Cancer

Treatment

A 
Surgical resection
Painless jaundice → pancreas head tumor
Pancreatectomy or Whipple 
Surgical 5 year survival 10%
Non-surgical 5mos
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20
Q

Cystic Fibrosis

A

Autosomal recessive disorder
Chromosome 7 mutation
Results in defective chloride ion transport in lungs, pancreas, liver, GI, & reproductive organs epithelial cells
↓Cl¯ ↓Na+/H2O → viscous secretions → luminal obstruction & exocrine gland scarring
1° morbidity & mortality cause = chronic pulmonary infection

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21
Q

CF Anesthetic Considerations

A

Delay elective surgical procedures until obtain optimal pulmonary function
Volatile agents ↓airway pressure via ↓bronchial smooth muscle & hyperactive airways
Avoid anticholinergic drugs to maintain secretions in less viscous state (thin)

22
Q

Type 1 Diabetes

A

T-cell mediated autoimmune pancreas β cell destruction

80-90% β cell function lost before hyperglycemia occurs

23
Q

T1D S/S

A

Hyperglycemia, fatigue, weight loss, polyuria, blurred vision, & IV volume depletion
Polyuria/polydipsia/polyphagia

24
Q

T1D

Diagnosis

A

Blood glucose >200mg/dL

HbA1C >7

25
Q

Diabetic Ketoacidosis

A

Blood glucose >250mg/dL

Most commonly associated w/ T1D

26
Q

Type 2 Diabetes

A

β cell insufficiency & insulin resistance
Insulin resistance → circulating free fatty acids, cytokines, insulin antagonist, & target tissue defects at insulin receptors
Impaired glucose associated w/ ↑body weight, ↓insulin secretion, & reduction in peripheral insulin action
↑insulin level desensitizes target tissues ↓insulin response
Polyuria/polydipsia/polyphagia

27
Q

T2D S/S

A

Polyuria, polydipsia, weight loss
Fasting glucose >126mg/dL
2 hour plasma glucose level >200 during oral glucose test

28
Q

What factors contribute to insulin resistance?

A

Abdominal obesity
Excess calorie consumption
Lack exercise
Genetic susceptibility

29
Q

Metabolic Syndrome

A 
Insulin resistance
Visceral obesity
Low HDL cholesterol
HTN
↑triglycerides
30
Q

Metabolic Syndrome S/S

A 
Fasting glucose >110mg/dL
Abdominal waist >40in (M) or >35in (F)
Triglyceride >150
HDL <40mg/dL (M) or <50mg/dL (F)
Blood pressure > 130/85
31
Q

Diabetes Complications

A 
DKA
Hyperosmolar hyperglycemic state
Hypoglycemia - diaphoresis, tachycardia, & nervous (general anesthesia masks S/S)
Monitor electrolytes
Impaired mental status
Anxiety
Lightheaded
Coma
32
Q

DKA

A

Most commonly caused by an infection
↓insulin → free fatty acids catabolism → ketones
ABSOLUTE ↓insulin → hyperglycemia

Polyuria, dyspnea, N/V

33
Q

HHS

A

RELATIVE ↓insulin → hyperglycemia
Glycogenolysis & gluconeogenesis → osmotic diuresis

Polyuria, polydipsia, confusion, lethargy

34
Q

Oral Antidiabetics

A

Sulfonylureas
Biguanides (Metformin)
Glitazones
Glucosidase inhibitors

35
Q

Insulin Secretion

A

50 units/day (adults)

36
Q

Insulin Functions

A

Facilitates glucose & K+ into adipose & muscle cells
↑glycogen, protein, & fatty acid synthesis
↓glycogenolysis & gluconeogenesis, lipolysis, & catabolism

37
Q

Short Acting Insulin

A

Regular

ONLY IV

38
Q

Rapid Acting Insulin

A

Lispro & apart

39
Q

Intermediate Acting Insulin

A

NPH
Lispro protamine
Lente

40
Q

Long Acting Insulin

A

Glargine

Ultralente

41
Q

Diabetes Preop

A

+ prayer sign indicates cervical spine immobility (unable to align palms flat)
Potential difficult intubation
T1D 30%

42
Q

Diabetes Anesthetic Considerations

A

Glycemia control to prevent infection, improve wound healing, & ↓morbidity/mortality
Assess cervical spine mobility

43
Q

Insulinoma

A

Benign pancreatic tumors

Women 2x

44
Q

Insulinoma Diagnosis

A

Whipple’s triad

  • Hypoglycemia w/ fasting
  • Symptomatic glucose <50mg/dL
  • Symptom relief w/ glucose admin
45
Q

Insulinoma Anesthetic Considerations

A

Preop management w/ Diazoxide (inhibits insulin release from β cells)
Treatment = surgical intervention
Monitor blood glucose intraop
Hyperglycemia after tumor removed
Continue to monitor blood glucose under general anesthesia hypoglycemia S/S masked under GA

46
Q

Diabetic Neuropathy S/S

A

Hypertension
Painless myocardial ischemia
Reduced HR response to Atropine & Propranolol
Resting tachycardia
Lack diaphoresis
↑risk ST segment & T wave abnormalities
Limited ability to compensate → cardiovascular instability (post-induction hypotension or sudden cardiac death)

47
Q

Intraop Blood Glucose Management

A

Avoid hypoglycemia
Maintain blood glucose <180mg/dL
Dependent on patient baseline

48
Q

Hyperglycemia associated w/ ______

A

Infection
Poor wound healing
↑mortality
Worse neuro outcomes

49
Q

Surgical Stress Response

A

↑counter regulatory hormones

↑inflammatory mediators → stress hyperglycemia

50
Q

Hs

A 
Hypoglycemia
Hypovolemia
Hydrogen ions
Hypoxia
Hypothermia
Hyper/hypokalemia
51
Q

Ts

A 
Thrombosis
Toxins
Tamponade (cardiac)
Trauma
Tension pneumothorax
52
Q

Hyperkalemia Treatment

A

Insulin 10 units
50% dextrose
Bicarbonate
Calcium gluconate - stabilizes the myocardium via lowering threshold potential
Kayexalate
Albuterol β agonist shifts K+ intracellular

AS - N935 Advanced Patho II (20 decks)

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