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Pathophys II > Endocrine Metabolic Disorders > Flashcards

Endocrine Metabolic Disorders Flashcards

1
Q

The four types of cells found in the islets of Langerhans include:

A

delta, PP (pancreatic polypeptide), alpha, and beta

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2
Q

Beta cells compose

A

60-70% of the islet mass and secrete the hormone insulin

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3
Q

Alpha cells compose

A

25% of the islet cells and secrete the hormone glucagon

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4
Q

The delta cells secrete

A

somatostatin

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5
Q

Hormones are classified in three major groups:

A

peptides or proteins: insulin, glucagon
amino acid: dopamine & epi
steroids: lipid soluble derived from cholesterol ex. estrogen, progesterone

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6
Q

In the liver, insulin promotes

A

the storage of excess glucose in the form of glycogen (glycogenesis)

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7
Q

______ is the key hormone controlling glucose removal from the plasma, it facilitates the transport of glucose by stimulating uptake into liver, muscle, and adipose tissue.

A

Insulin

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8
Q

Insulin is synthesized within the

A

beta cells and released via exocytosis to the capillary then it enters portal circulation

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9
Q

The half-life of insulin is

A

5 to 8 minutes

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10
Q

The major degradation sites of insulin are the

A

liver and kidney

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11
Q

Pancreatitis is the

A

inflammation of the pancreas which is commonly caused by gallstones & alcohol
-can also be caused by trauma such as ERCP, obstruction, and certain meds

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12
Q

Clinical presentation of pancreatitis is

A

abdominal pain, N/V, & febrile

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13
Q

Anesthesia considerations for pancreatitis include:

A

early hydration is recommended, pain medications & electrolytes should be monitored, & patient should be NPO until pain and inflammation has resolved

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14
Q

Complications of pancreatitis include

A

pancreatic necrosis- cell death secondary to inflammation

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15
Q

Labs with pancreatitis include

A

elevated WBC and possible ARF, liver dysfunction and electrolyte abnormalities

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16
Q

The most common complication of chronic pancreatitis is

A

pancreatic pseudocyst- contains only fluid

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17
Q

The fourth most common cause of cancer deaths in the US is due to

A

pancreatic cancer

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18
Q

There is a correlation between _______ and pancreatic cancer

A

obesity, smoking, and chronic pancreatitis

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19
Q

Symptoms of pancreatic cancer include

A

abdominal pain, weight loss, pain suggests retroperitoneal invasion and jaundice indicates biliary obstruction

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20
Q

The only effective treatment for pancreatic cancer is

A

surgical resection
-patients with tumors in the head of the pancreas develop painless jaundice and are usually candidates for surgical resection
most common technique is pancreatectomy or a whipple

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21
Q

Cystic fibrosis is an

A

autosomal recessive disorder and is a mutation of chromosome 7; this results in defective chloride ion transport in the epithelial cells in the lungs, pancreas, liver, GI, & reproductive organs

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22
Q

The primary cause of morbidity and mortality in cystic fibrosis is

A

chronic pulmonary infection

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23
Q

In cystic fibrosis, decreased chloride leads to

A

decreased transport of Na & H2O which causes viscous secretions that contribute to luminal obstruction and scarring of exocrine glands

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24
Q

With cystic fibrosis, elective surgical procedures

A

should be delayed until optimal pulmonary function is obtained

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25
Q

Describe appropriate pharmacologic management of the patient with cystic fibrosis.

A

volatile agents decrease airway pressure by decreasing bronchial smooth muscles and decreasing hyperactive airways
it is recommended to avoid anticholinergic drugs to maintain secretions in a less viscous state
requires frequent suctioning, bronchodilators & deep sedation

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26
Q

Type 1 diabetes is caused by

A

T cell mediated autoimmune destruction of beta cells in the pancreas
-at least 80-90% of beta cell function must be lost before hyperglycemia occurs

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27
Q

Diagnosis of type 1 diabetes is through

A

BG >200, & hgA1c more than 7

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28
Q

The most associated complication of type 1 diabetes is

A

DKA

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29
Q

Patients with type 1 diabetes will present with

A

hyperglycemia, fatigue, weight loss, polyuria, blurred vision, and intravascular volume depletion

30
Q

Type 2 diabetes causes

A

insulin resistance & beta cell insufficiency

31
Q

Insulin resistance in type 2 diabetes causes

A

circulating free fatty acids, cytokines, insulin antagonist & target tissue defects at insulin receptors

32
Q

Impaired glucose in type 2 diabetes is associated with

A

increased body weight, decreases in insulin secretions and reduction in peripheral insulin action

33
Q

Increased insulin levels may

A

desensitize target tissues, causing a decreased response to insulin

34
Q

Symptoms of type 2 diabetes include

A

polyuria, polydipsia
fatting glucose of >126
2 hour plasma glucose level >200 during oral glucose test

35
Q

List the factors that contribute to insulin resistance

A

abdominal obesity
excess calorie consumption
lack of exercise
genetic susceptibility

36
Q

Side effects of diabetes include

A

strokes, fatigue, lack of energy, pancreas malfunction

37
Q

Describe the factors that contribute to metabolic syndrome.

A

visceral obesity, insulin resistance, high triglycerides, low HDL-cholesterol, HTN, & procoagulant state

38
Q

Metabolic syndrome of insulin resistance is typically seen in patients with

A

type 2 DM

39
Q

Metabolic syndrome is diagnosed with at least three of the following:

A

fasting glucose level >110
abdominal waist 40 inches in men and 35 inches in women
triglyceride level >150
HDL<40 mg/dL in men, and 50 mg/dL in women
blood pressure >130/85

40
Q

Three life threatening complications of diabetes include

A

DKA, HHS, & hypoglycemia

41
Q

DKA is most commonly caused by

A

infection

42
Q

Describe how DKA occurs.

A

decreased insulin leads to catabolism of free fatty acids into ketones

43
Q

Treatment of DKA consists of

A

correcting hypovolemia, hyperglycemia and total body potassium deficit
when glucose moves intracellular so does potassium so it is critical to monitor frequent labs

44
Q

If a patients BIS severely drops off

A

it may be a result of severe hypoglycemia

45
Q

Compare the symptoms of DKA vs. HHS.

A

DKA: polyuria, dyspnea, & N/V
HHS: polyuria, polydipsia, confusion & lethargy

46
Q

Describe the four major classes of oral antidiabetic medications:

A

sulfonylureas, Biguanides (metformin), glitazones, & glucosidase inhibitors (acarbose, miglitol)

47
Q

_________ have long half lives and are often discontinued 24-48 hours prior to surgery

A

sulfonylureas & metformin

48
Q

_______ are usually the initial treatment for type 2 diabetes

A

sulfonylureas;

MOA stimulates insulin secretion from pancreatic beta cells

49
Q

Second generation agents for DMII include

A

glyburide glipizide

most potent and side effects are hypoglycemia

50
Q

Oral medications may cause

A

harmful cardiac side effects
-these drugs may inhibit myocardial protection by decreasing ATP channels in the myocardium which leads to a larger myocardial infarction

51
Q

_______ decrease hepatic gluconeogenesis and enhance glucose utilization across the cell membranes

A

biguanides

52
Q

The most serious side effect of oral medications is

A

lactic acidosis- this can occur if too much metformin accumulates due to acute or chronic dehydration

53
Q

Adults secrete about ____ units of insulin

A

50 units of insulin each day from the beta cells

54
Q

The most important anabolic hormone is

A

insulin

55
Q

Insulin facilitates ___________ into the adipose and muscle cells therefore increasing glycogen, protein, and fatty acid synthesis and decreasing glycogenolysis and gluconeogensis

A

glucose & potassium

56
Q

Describe the different types of insulin

A

Intermediate: NPH, lente, lispro protamine
Short acting: regular
rapid acting: lispro & apart
long acting: glargine & ultralente

57
Q

Systematic manifestations of hypoglycemia include

A

diaphoresis, tachycardia, and nervousness

58
Q

_______ will mask the signs of hypoglecmia

A

General anesthesia; treatment would be to give 50% dextrose

59
Q

The _____ depends on glucose as an energy source which makes it the most susceptible to hypoglycemia. If not treated, _____ may occur

A

brain

mental status changes, anxiety, lightheaded, and coma may occur

60
Q

Aggressive preoperative glucose control has been shown to

A

limit the infection, improve wound healing, and decrease in morbidity and mortality

61
Q

Anesthetic management of the patient with DM includes

A

cervical spine mobility should be assessed preoperatively in diabetic patients to reduce the risk of unanticipated difficult intubation
positive prayer sign represents cervical spine immobility

62
Q

Insulinoma is a

A

benign pancreatic tumor that occurs in women twice as often than as in men

63
Q

The diagnosis of insulinoma is via

A

whipple’s triad: hypoglycemia with fasting, glucose of less than 50 with symptoms, relief of symptoms with administration of glucose

64
Q

Patients with insulinoma will be managed in preop with

A

diazoxide which inhibits insulin from beta cells

surgical intervention is the treatment

65
Q

When performing surgery on the patient with insulinoma,

A

intraoperative hypoglycemia may occur and then hyperglycemia after the tumor is removed

66
Q

Signs of diabetic neuropathy include

A

HTN, painless myocardial ischemia, reduced HR to atropine or propranolol, resting tachycardia, lack of sweating

67
Q

Diabetic patients may have an increased risk of

A

ST segment and T wave abnormalities

having a history of HTN & DM increases the likelihood diabetic autonomic neuropathy

68
Q

Diabetic neuropathy may limit the ability to

A

compensate & may predispose the patient to CV instability

69
Q

The goal of intraoperative blood glucose management is to avoid

A

hypoglycemia while keeping blood glucose below 180 mg/dL

70
Q

Hyperglycemia has been associated with

A

infection, poor wound healing, & increased mortality, & it worsens neuro outcomes

71
Q

The stress of surgery causes increases in

A

counter regulatory hormones and inflammatory mediators which contribute to stress hyperglycemia

Pathophys II (43 decks)

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