Endocrine System & Gallbladder Flashcards
During the day, when are cortisol levels at their peak ?
in the morning and toward the end of sleep
- to help prepare us for our days and get up
- released by the adrenal cortex
What are the adrenal gland hormones ?
- sugar (glucocorticoids)
- salt (mineralocorticoids) (aldosterone)
- sex (androgens)
What is hyperadrenal ?
- too much sugar
- too much salt
- too much sex hormones
What does Aldosterone regulate ?
sodium and potassium balance
- therefore regulates water balance
What does the adrenal cortex secrete ?
steroid hormones
- glucocorticoids (cortisol) , mineralocorticoids, androgens
What do glucocorticoids do ?
inhibit the inflammatory response
- considered anti-inflammatory
What do mineralocorticoids do ?
aldosterone
- essential for maintaining fluid and electrolyte balance
What do androgens do ?
regulate pubic and axillary hair growth and sex drive in females
What is the function of cortisol ?
- 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
What is the precursor for steroid hormone synthesis ?
cholesterol
What does the adrenal medulla secrete ?
- secretes catecholamines: involved in stress response and prolong effects of SNS
- epinephrine (for stress response) is the major hormone (75%)
- norepinephrine
- dopamine
What causes Cushing’s syndrome/disease ?
over-secretion of the corticosteroid, especially glucocorticoids
- endogenous and exogenous
- most common cause is chronic use of corticosteroids (popular is prednisone)
What are some endogenous causes of Cushing’s ?
- adrenal carcinoma (cancer of the adrenal)
- congenital adrenal hyperplasia
What are corticosteroids used for ?
- organ transplant
- allergic reaction
- autoimmune disease
- severe allergies
- chronic and acute inflammatory conditions
- asthma and COPD
What are some S&S of Cushing’s ?
- 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
What is the primary causes of Addison’s disease ?
- idiopathic autoimmune dysfunction
- cancer
- adrenalectomy
- radiation of the abdomen
What are the secondary causes of Addison’s disease ?
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
What are some S&S of Addison’s ?
- unexplained hyperkalemia
- weight loss, N/V
- hyperpigmentation
- craving salt (hyponatremia)
- weakness and fatigue
- hypoglycemia
- constipation or diarrhea
- dehydration
- orthostatic hypotension (Dizziness)
What is Tx for Addison’s crisis ?
- hydrocortisone (will need to take forever)
- FLUIDS
- Na
What is Addison’s crisis ?
life threatening condition because of low cortisol levels
- causes: stress, infection, post-adrenal surgery, abrupt withdrawal of corticosteroids
What are some special considerations for older adults with their hormones ?
- 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
What levels of cortisol cause Cushing’s ?
high levels
What levels of cortisol cause Addison’s ?
low levels
What is Cholelithiasis ?
stones in the gallbladder
- aka gallblader disease
- most common disorder of biliary system
What is cholecystitis ?
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)
What are S&S of Cholecystitis ?
- 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
Where is the pain felt in cholecystitis ?
- right upper quad or right shoulder
- may radiate to back
- increases with deep breathing
(rt lower quad is where appendix is)
What are risk factors of gallbladder disease ?
- 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
How does Cholelithiasis develop ?
balance that keeps cholesterol, bile salts, and calcium in solution is altered which leads to precipitation
- bile secreted by liver supersaturated with cholesterol
What is the pathophysiology of Cholecystitis ?
inflammation
- confined to mucous lining or entire wall
- cystic duct may become occluded
- scarring and fibrosis may occur after attack which can decrease functioning
What is Biliary Colic ?
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
What are some manifestations of Gallbladder disease ?
- inflammation (high WBC, fever)
- RUQ tenderness, abdominal rigidity
What are manifestations of total obstruction syndrome (gallstones) ?
- 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
What are manifestations of overall cholecystitis ?
- fat intolerance
- N/V
- restlessness/diaphoresis
- dyspepsia
- heartburn/indigestion
- flatulence
What are some complications of cholecystitis ?
- gangrenous cholecystitis
- subphrenic abscess
- pancreatitis
- cholangitis
- biliary cirrhosis
- fistulas
- gallbladder rupture to peritonitis
What are lab test results for gallbladder disease ?
- 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
What is a laparoscopic cholecystectomy ?
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
What is Extracorporeal Shock-Wave Lithotripsy (ESWL) ?
- 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
What meds are used for Cholecystitis ?
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
What is an Open (incisional) Cholecystectomy ?
removal of gallbladder through right subcostal incision
- T tube inserted into common bile duct
- more intensive
What is a T-tube used for ?
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
What is nutritional therapy for Cholelithiasis ?
- 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)
What are some considerations for after laparoscopic cholecystectomy ?
- liquids first day
- light meals for several days
What are some considerations for after incisional cholecystectomy ?
- liquids to regular diet after return of bowel sounds
- may need to restrict fats for 4-6 weeks
- encourage coughing, turning and deep breathing
What causes obstructive jaundince ?
lack of bile flow to the duodenum
