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Med-Surg > Endocrine System & Gallbladder > Flashcards

Endocrine System & Gallbladder Flashcards

1
Q

During the day, when are cortisol levels at their peak ?

A

in the morning and toward the end of sleep
- to help prepare us for our days and get up
- released by the adrenal cortex

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2
Q

What are the adrenal gland hormones ?

A
  • sugar (glucocorticoids)
  • salt (mineralocorticoids) (aldosterone)
  • sex (androgens)
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3
Q

What is hyperadrenal ?

A
  • too much sugar
  • too much salt
  • too much sex hormones
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4
Q

What does Aldosterone regulate ?

A

sodium and potassium balance
- therefore regulates water balance

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5
Q

What does the adrenal cortex secrete ?

A

steroid hormones
- glucocorticoids (cortisol) , mineralocorticoids, androgens

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6
Q

What do glucocorticoids do ?

A

inhibit the inflammatory response
- considered anti-inflammatory

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7
Q

What do mineralocorticoids do ?

A

aldosterone
- essential for maintaining fluid and electrolyte balance

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8
Q

What do androgens do ?

A

regulate pubic and axillary hair growth and sex drive in females

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9
Q

What is the function of cortisol ?

A
  • secreted by the adrenal cortex
  • the most abundant and potent glucocorticoid
  • necessary to maintain life (can survive with high levels but not low)
  • regulates glucose, inhibits inflammatory action, support response to stress, promotes metabolism
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10
Q

What is the precursor for steroid hormone synthesis ?

A

cholesterol

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11
Q

What does the adrenal medulla secrete ?

A
  • secretes catecholamines: involved in stress response and prolong effects of SNS
  • epinephrine (for stress response) is the major hormone (75%)
  • norepinephrine
  • dopamine
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12
Q

What causes Cushing’s syndrome/disease ?

A

over-secretion of the corticosteroid, especially glucocorticoids
- endogenous and exogenous
- most common cause is chronic use of corticosteroids (popular is prednisone)

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13
Q

What are some endogenous causes of Cushing’s ?

A
  • adrenal carcinoma (cancer of the adrenal)
  • congenital adrenal hyperplasia
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14
Q

What are corticosteroids used for ?

A
  • organ transplant
  • allergic reaction
  • autoimmune disease
  • severe allergies
  • chronic and acute inflammatory conditions
  • asthma and COPD
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15
Q

What are some S&S of Cushing’s ?

A
  • weight gain with increase appetite “Moon face”
  • unexplained hypokalemia
  • impaired glucose intolerance (elevated glucose)
  • easy bruising and petechiae (fragile blood vessels)
  • HTN: Na and water retention and dependent edema
  • hirsutism on face of women (or in areas not common)
  • gynecomastia (enlarged male breasts) in men
  • decreased immune system (high risk for infections without fever) & poor would healing
  • weakness, fatigue, and sleep disturbances
  • gastric upset/ulcers: due increase in hydrochloric acid
  • thin, and fragile skin/thinning/balding of hair/ osteoporosis
  • striae: reddened lines on abdomen
  • diarrhea is more likely
  • emotional irritability: depression
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16
Q

What is the primary causes of Addison’s disease ?

A
  • idiopathic autoimmune dysfunction
  • cancer
  • adrenalectomy
  • radiation of the abdomen
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17
Q

What are the secondary causes of Addison’s disease ?

A

abrupt steroid withdrawal
- taking steroids so that adrenal gland won’t secrete so much cortisol and then we get use to those levels and once you stop taking the prednisone it causes Addison’s crisis

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18
Q

What are some S&S of Addison’s ?

A
  • unexplained hyperkalemia
  • weight loss, N/V
  • hyperpigmentation
  • craving salt (hyponatremia)
  • weakness and fatigue
  • hypoglycemia
  • constipation or diarrhea
  • dehydration
  • orthostatic hypotension (Dizziness)
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19
Q

What is Tx for Addison’s crisis ?

A
  • hydrocortisone (will need to take forever)
  • FLUIDS
  • Na
20
Q

What is Addison’s crisis ?

A

life threatening condition because of low cortisol levels
- causes: stress, infection, post-adrenal surgery, abrupt withdrawal of corticosteroids

21
Q

What are some special considerations for older adults with their hormones ?

A
  • decreased hormone production and secretion
  • subtle changes of aging often mimic manifestation of endocrine disorders
  • altered hormone metabolism and biologic activity
  • decreased responsiveness of target tissues to hormones, and alterations in circadian rhythms
22
Q

What levels of cortisol cause Cushing’s ?

A

high levels

23
Q

What levels of cortisol cause Addison’s ?

A

low levels

24
Q

What is Cholelithiasis ?

A

stones in the gallbladder
- aka gallblader disease
- most common disorder of biliary system

25
Q

What is cholecystitis ?

A

inflammation of the gallbladder
- usually associated with cholelithiasis
- in chronic conditions, restricting fats is good (need bile to breakdown fat and makes the gallbladder work harder)

26
Q

What are S&S of Cholecystitis ?

A
  • fever and leukocytosis
  • jaundice (because of bilirubin and bile)
  • N/V
  • anorexia
  • abdominal distention
  • feeling of fullness
  • fat intolerance (feels pain after eating fatty foods 3-6 hrs after and lying down)
  • pain
27
Q

Where is the pain felt in cholecystitis ?

A
  • right upper quad or right shoulder
  • may radiate to back
  • increases with deep breathing
    (rt lower quad is where appendix is)
28
Q

What are risk factors of gallbladder disease ?

A
  • female
  • multiparity (many pregnancies)
  • age older than 40 yrs
  • estrogen therapy (oral contraceptives affect cholesterol production and increase the likelihood of gallbladder cholesterol saturation)
  • sedentary lifestyle
  • genetics/ ethnicity
  • obesity
29
Q

How does Cholelithiasis develop ?

A

balance that keeps cholesterol, bile salts, and calcium in solution is altered which leads to precipitation
- bile secreted by liver supersaturated with cholesterol

30
Q

What is the pathophysiology of Cholecystitis ?

A

inflammation
- confined to mucous lining or entire wall
- cystic duct may become occluded
- scarring and fibrosis may occur after attack which can decrease functioning

31
Q

What is Biliary Colic ?

A

happens when a stone is lodged in the ducts or when gallstones move through the ducts and spams occur
- spasms happen in response to stone
- pain can be very painful and followed by tachycardia, diaphoresis, and prostration
- residual tenderness in RUQ

32
Q

What are some manifestations of Gallbladder disease ?

A
  • inflammation (high WBC, fever)
  • RUQ tenderness, abdominal rigidity
33
Q

What are manifestations of total obstruction syndrome (gallstones) ?

A
  • jaundice (lack of bile flow to duodenum)
  • dark amber urine
  • clay colored stools (no bilirubin reaching small intestine to be converted to urobilinogen)
  • pruritus (deposition of bile salts in skin tissues causing itchiness)
  • intolerance to fatty foods (no bile in small intestine for fat digestion)
  • bleeding tendencies(lack of or decreased vitamin K
  • steatorrhea: fatty stools
34
Q

What are manifestations of overall cholecystitis ?

A
  • fat intolerance
  • N/V
  • restlessness/diaphoresis
  • dyspepsia
  • heartburn/indigestion
  • flatulence
35
Q

What are some complications of cholecystitis ?

A
  • gangrenous cholecystitis
  • subphrenic abscess
  • pancreatitis
  • cholangitis
  • biliary cirrhosis
  • fistulas
  • gallbladder rupture to peritonitis
36
Q

What are lab test results for gallbladder disease ?

A
  • increased WBC count (due to inflammation)
  • increased serum bilirubin level (due to obstruction)
  • increased urinary bilirubin level
  • increased liver enzymes levels (if there is pancreatic involvement)
  • increased serum amylase level
37
Q

What is a laparoscopic cholecystectomy ?

A

tx of choice for gallstones
- remove gallbladder through 1-4 puncture holes
(surgery I saw)
- minimal post-op pain
- can resume normal activities within 1 week
- few complications

38
Q

What is Extracorporeal Shock-Wave Lithotripsy (ESWL) ?

A
  • only if stones can’t be removed via endoscope
  • high energy shock waves disintegrate stones
  • takes 1-2 hrs
  • used in conjunction with bile acids
39
Q

What meds are used for Cholecystitis ?

A

Pain control: NSAIDS and anticholinergic (decrease secretion and counteract smooth muscle spasms)
- Infection control: antibiotic tx, cholecystectostomy (used to drain purulent material from obstructed gallbladder)
- Maintenance of F&E balance: NG tube is severe N/V

40
Q

What is an Open (incisional) Cholecystectomy ?

A

removal of gallbladder through right subcostal incision
- T tube inserted into common bile duct
- more intensive

41
Q

What is a T-tube used for ?

A

ensures patency of duct until the edema produced by the trauma of exploring and probing the duct has subsided
- allows excess bile to drain
- located in the common bile duct which is connected to the gallbladder

42
Q

What is nutritional therapy for Cholelithiasis ?

A
  • small, frequent meals with some fat (promote gallbladder emptying)
  • diet low in saturated fat
  • high in fiber and calcium
  • reduced calorie diet if pt is obese
  • avoidance of rapid weight loss (can promote gallstone formation)
43
Q

What are some considerations for after laparoscopic cholecystectomy ?

A
  • liquids first day
  • light meals for several days
44
Q

What are some considerations for after incisional cholecystectomy ?

A
  • liquids to regular diet after return of bowel sounds
  • may need to restrict fats for 4-6 weeks
  • encourage coughing, turning and deep breathing
45
Q

What causes obstructive jaundince ?

A

lack of bile flow to the duodenum

Med-Surg (23 decks)

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