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Advanced Health Assessment Unit 2 > Endocrine & Metabolic Disorders Part 2 > Flashcards

Endocrine & Metabolic Disorders Part 2 Flashcards

1
Q

Adrenal Medulla: epi and norepi
Adrenal Cortex: glucocorticoids (cortisol), mineralocorticoids (aldosterone), and androgens

A

Adrenal Hormones

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2
Q

Controls release of cortisol, homeostasis, carbohydrate, protein, FFA metabolism, circulatory function, immune function, temperature regulation, anti-inflammatory actions.
-ACTH is released in periods of stress (trauma, surgery, intense exercise)

A

HPA Axis

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3
Q

Binds receptors in sweat glands, alimentary tract (GI), distal convoluted tubule of the kidney; major regulator of extracellular fluid volume & K homeostasis; RAAS system

A

Mineralocorticoids (Aldosterone)

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4
Q

Abnormal adrenal cortex function may render inability to appropriately respond in periods of stress (surgery) and critical illness!

A

This is bad

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5
Q

-Prolonged excess of cortisol (long term steroid use)
-Pituitary & adrenal adenomas
-Ectopic ACTH-secreting tumors

A

Cushing Syndrome

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6
Q

Due to the pituitary gland secreting excessive ACTH

A

Cushing’s Disease

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7
Q

S/sx:
-obesity/OSA (moon face/buffalo hump), HTN w/ volume overload, electrolyte imbalance (K), metabolic derangements (glucose intolerance), GERD, myopathy/weakness/bruising, susceptibility to infection & poor wound healing

A

Cushing Syndrome

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8
Q

-ECG and electrolyte panel will show Hypokalemia, hyperBG, LVH, and ischemia
Tx: treat HTN, normalize intravascular volume, diuresis with spironolactone, correct electrolytes and BG, conservative use of NMB with skeletal muscle weakness, full reversal of NMB needed before extubation, use etomidate, airway, IV access, and positioning (Obestity/OSA)

A

Cushing Syndrome

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9
Q

Why use etomidate with Cushing Syndrome?

A

Inhibits steroid synthesis

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10
Q

Due to the destruction of the adrenal gland
-Autoimmune adrenalitis, TB, tumor, surgery, HIV, radiation

A

Primary Adrenal Insufficiency

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11
Q

Due to the anterior pituitary gland failing to secrete sufficient ACTH.
-Autoimmune adrenalitis, TB, tumor, surgery, HIV, radiation

A

Secondary Adrenal Insufficiency

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12
Q

Due to processes that interfere with the release of ACTH.
-Exogenous high-dose glucocorticoid therapy leads to reduced adrenal cortisol synthesis in response to stress
-Prednisone >20 mg/day for >3 weeks

A

Tertiary Adrenal Insufficiency

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13
Q

Adrenal hormones that modify the effect of catecholamines on vascular tone - can cause hypotension refractory to vasopressor therapy and fluid resuscitation during periods of stress.

A

Glucocorticoids

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14
Q

S/Sx: fatigue, loss of appetite, wt loss, abdominal pain, N/V, myalgias, hypoBG, hypoNa, hyperK, orthostatic hypotension, hyperpigmented skin

A

Adrenal Insufficiency

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15
Q

-Determine electrolytes & manage BG (K & Na)
-If suspected, give supplemental steroids
-Myopathy: Skeletal muscle weakness: conservative approach to NMB d/t increased sensitivity, respiratory insufficiency post-op
-Can be refractory to vasopressor therapy & fluid resuscitation, anticipate hypovolemia
-Continue glucocorticoid/mineralocorticoid drug therapy on day of surgery
-AVOID etomidate
-Steroid supplements advisable for major procedures in patients taking >20mg/day of prednisone

A

Anesthesia Considerations for Adrenal Insufficiency

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16
Q

Patients are at an increased risk of AI for ____ after high-dose corticosteroid therapy due to the suppression of hypothalamic-pituitary-adrenal axis

A

1 year

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17
Q

Patients taking >20 mg/day of steroids need supplementation during major surgical procedures.
-Hydrocortisone 25mg IV at induction + hydrocortisone 100mg over 24 hrs

Minor (25 mg), Moderate (50-75mg), Severe (100-150mg)

A

Corticosteroid Stress Dosing

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18
Q

Catecholamine-secreting tumors that originate from chromaffin cells of adrenal medulla.

Triad of S/Sx: Headache, Diaphoresis, and Tachycardia (paroxysmal HTN)

A

Pheochromocytoma

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19
Q

Diagnosed via plasma-free metanephrines, urinary fractionated metanephrines (broken down catecholamines), CT scan of abd (tumor on adrenals)
-ECG, ECHO, Chest XR, electrolyte panel, BG, CBC

A

Pheochromocytoma

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20
Q

S/Sx: tachycardia, palpitations, HTN, angina, hx MI, dyspnea, orthopnea, CHF, orthostatic hypotension, headache, diaphoresis, feelings of apprehension, abd pain, nausea, malnutrition, GI bleeding, diarrhea → avoid abd palpation bc it could precipitate a crisis

A

Pheochromocytoma

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21
Q

-Outpatient: alpha blockade initiated 10-14 days prior to surgery
-Beta blockade after alpha blockade (don’t want to do Beta first due to risk of failure)
-Day of Surgery: aggressive hydration, take all BP meds DOS, expect major hemodynamic changes (A-line, vasoactive meds, plan for post-op care, IV access, prefer less invasive)

A

Anesthesia Considerations for Pheochromocytoma

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22
Q

Hormones are synthesized here:
-TSH, ACTH, FSH, LH, GH, PL
-More likely to have adenomas (non-cancerous)

A

Anterior Pituitary

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23
Q

Secretes hormones synthesized in the hypothalamus
-Oxytocin, ADH, and Endorphins
-More likely to have metastatic tumors

A

Posterior Pituitary

24
Q

Results from excess growth hormone (stimulates overgrowth of skin, connective tissue, cartilage, bone, viscera).
S/Sx:
-airway abnormalities (macroglossia, vocal cord dysfunction, overgrowth of tissue), soft tissue hypertrophy (macrognathia (enlarged jaw), enlarged nose, facial structures, hands/feet), OSA, Visceromegaly (VQ mismatch), HTN, CAD, Valvular dz, Heart failure, Headache, Papilledema, Visual impairment, DM, Arthropathy/arthralgia, Fractures (positioning implications)

A

Acromegaly

25
Q

Higher risk for difficult airway and ventilation! Need a smaller ETT.

A

Acromegaly

26
Q

Most present for transsphenoidal surgical excision of pituitary adenoma.
-Assess neuro exam and document deficits

A

Acromegaly

27
Q

Hormone synthesized in the hypothalamus & secreted by posterior pituitary in response to profound hypovolemia or inc osmolarity (increases urine osmolarity, decreases serum osmolarity, increases blood volume) → potent vasoconstrictor (coronary, splanchnic, and renal vasculature)
-Promotes hemostasis by increasing VWF & factor 8

A

ADH

28
Q

Triggers for secretion:
-increased plasma Na & osmolarity, decreased BP, angiotensin 2, stress/pain/nausea, meds (thiazide diuretics, chemo, SSRIs)

A

ADH

29
Q

-Euvolemic Hyponatremia
-Elevated ADH with hyponatremia (Na <135) → hypo-osmolality plasma w/ conc urine in euvolemic state
-Associated with malignancy, CNS disorders, head trauma, PNA, meds (SSRIs), post-op stress

A

SIADH

30
Q

S/Sx:
-HA, lethargy, disorientation, hallucinations, N/V, seizure, coma (hyponatremia)
-Potentiates NMB - full reversal required. Delayed emergence and delirium noted.
Tx: water restriction and diuresis, or if severe: 3% saline + lasix. Slow IV correction to avoid CNS effects

A

SIADH

31
Q

Insufficient production of ADH (trauma to posterior pituitary, surgery, tumor, brain injury, sarcoidosis)

A

Neurogenic Diabetes Insipidus

32
Q

Inadequate response to ADH by target cells in the kidney

A

Nephrogenic Diabetes Insipidus

33
Q

S/Sx: polyuria, polydipsia, alterations in mental status, arrhythmias, high serum osmolality (>295) w/ low urine osmolality (<300)
Diagnosed via water deprivation test

A

Diabetes Insipidus

34
Q

Tx:
-Correct free water deficit
-PO water intake, IV D5W, desmopressin
-Postpone elective procedures
-Monitor Na and UOP
-Off label: Carbamazepine, thiazide diuretics, NSAIDs

A

Diabetes Insipidus

35
Q

Most frequent neuroendocrine tumor → originates in the enterochromaffin layer of the intestine; secretes serotonin, histamine, corticotropin, kinins, substance P, prostaglandins, or kallikrein (dopamine)

A

Carcinoid Tumor

36
Q

S/Sx: episodes of flushing, diarrhea, tachycardia, bronchospasm!!
-High levels of serotonin produces inotropy/chronotropy due to NE release
-May lead to HTN, CAD, or CHF

A

Carcinoid Tumor

37
Q

Has a high mortality rate.
-Precipitated by manipulation of tumor, chemical stimulation, tumor necrosis, embolization of hepatic artery → may occur spontaneously during induction of anesthesia
-Ensure a smooth induction - well anesthetized before intubation

A

Carcinoid Crisis

38
Q

Octreotide 100 mcg to suppress release of mediators (3x/day + 100 extra w/ induction). Should be started prior to surgery

A

Treatment of Carcinoid Tumor

39
Q

Rare genetic disorder (hyperplasia or hyperfunction of 2+ components of endocrine system), endocrine disorders typically occur together to produce pheochromocytoma, adenomas of pituitary, parathyroid, medullary thyroid

A

Multiple Endocrine Neoplasia (MEN) Syndrome

40
Q

S/Sx:
-Abdominal/truncal obesity, HTN, insulin resistance (leads to DM), dyslipidemia
-Men>women, CV dz, polycystic ovarian syndrome, fatty liver dz, malignancy, sexual dysfunction, pro-inflammatory, sleep disturbances, hba1c >8% have inc postop complications

A

Metabolic Syndrome

41
Q

Normal: 20-24.9
Overweight: 25-29.9
Obese: 30-34.9
Severely obese: 35-39.9
Extremely obese: > 40
Super obese: > 50

A

Obesity Classifications

42
Q

Commonly associated with DM2, metabolic syndrome, CAD, HTN, elevated cholesterol

A

Obesity

43
Q

Due to the hyperproliferation of fat cells (increased #)
-# fat cells stabilize in adolescence & remain constant in adulthood

A

Childhood Obesity

44
Q

Due to the hypertrophy of existing fat cells (increased size)

A

Adult Obesity

45
Q

> 102cm in Men and >88 cm in women = inc risk of ischemic HD, DM, HTN, DLD, death

A

Waist Circumference

46
Q

Central/abd obesity, higher risk of comorbidities, increased risk for ischemic heart disease/DM/HLD/death, higher risk of difficult airway

A

Android (Apple shaped)

47
Q

Gluteal femoral obesity, increased risk of varicose veins & joint dz. Decreased overall risk comparatively

A

Gynecoid (pear shaped)

48
Q

Fat accumulation causes reduced compliance of lungs & chest wall (rapid shallow breathing, decreased VC/TLC/FRC, V/Q mismatch, association between BMI & asthma
-Inc risk of OSA
-High risk for Difficult Airway!!!!

A

Obesity and Pulmonary/Airway

49
Q

BMI > 30, daytime hypercapnia & sleep apnea progresses to pulm HTN & R side heart failure

A

Obesity Hypoventilation Syndrome

50
Q

Obesity, large tongue, OSA, difficult mask ventilation, rapid desaturation → significant for induction/intubation!!

A

Obesity and risk for difficult airway

51
Q

What is the best predictor for difficult intubation

A

Neck Circumference

52
Q

S/Sx:
-Dyspnea, pedal edema, JVD, hepatomegaly, exercise intolerance, body habitus complicates assessment
-HTN -> LVH -> HF.
-Dysrhythmias common
-Diagnosis with ECG/ECHO

A

Obesity and Cardiac

53
Q

Suggestive of pulmonary HTN & RVH

A

RBBB

54
Q

Suggestive of occult CAD

A

LBBB

55
Q

Increased gastric residual volume/acidity, GERD, Abd pressure, hiatal hernia (All inc risk of aspiration); incidence of fatty liver disease up to 90% of obese patients
-can progress to hepatitis (affects drug metabolism), metabolic syndrome (insulin resistance and DLD), subclinical hypothyroidism 25%

A

Obesity and GI/Metabolic

56
Q

-Inc risk of VTE (give increased dose of prophylaxis)
-Cardiac/stroke implications with weight loss meds
-HgbA1c > 8% = wound infections

Inc BMI = inc comorbidities = inc risk

A

Obesity and Complications

57
Q

-Suitable location, equipment, and personnel
-IV access difficult
-Difficult airway (may need video laryngoscope)
-Potential for aspiration
-Monitor SpO2 postop

A

Anesthesia Implications for Obesity

Advanced Health Assessment Unit 2 (6 decks)

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