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ACVN - SURGICAL NURSING > Endocrinology - surgical patient management > Flashcards

Endocrinology - surgical patient management Flashcards

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1
Q

what is the thyroid made up of?

A

▪ Paired bilobed gland
▪ Larynx
▪ Trachea
▪ Blood vessels
▪ Nerves
▪ Ectopic tissue

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2
Q

what are benign surgical conditions of the thyroid?

A
  • Adenoma
  • Adenomatous Hyperplasia
  • Cysts
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3
Q

what is a functional surgical condition??

A

producing throid hormones

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4
Q

what type of mass are benign masses in cats?

A

functional

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5
Q

which masses are typically non-functional?

A

benign masses in dogs

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6
Q

what can functionalthyroid masses in cats cause?

A

hyperthyroidism

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7
Q

what malignant neoplasia can occur in the thyroid?

A
  • Carcinoma
  • Adenocarcinoma
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8
Q

what pre-operative thryoidectomy considerations are there of the cat?

A

*ASA status
* Systemic effects of hyperthyroidism
* Body condition score - weight loss, muscle loss
* Metastasis?
* Cardiovascular - tachycardia, hypertension
* Renal - pre-renal azotaemia
* Ocular - retinal detachment
* Co-morbidities unrelated to hyperthyroidism - CV, renal, increased anaesthetic risk, cachexia, arthritis
* Medical stabilisation
* Complications

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9
Q

what are the pre-operative considerations for thyroidectomy in the dog?

A
  • Far fewer systemic effects as non-functional
  • Body condition score: may be reduced due to effects of the cancer
  • Metastasis? Hopefully we’ve ruled this out pre-op
  • Up to 40% dogs have mets at presentation
  • Co-morbidities often present as typically older animals
    *Medical stabilisation
  • Pre-op not needed as non-functional
  • Post-op requirement will depend on surgery e.g. unilateral vs bilateral
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10
Q

how should you prep for a thyroidectomy?

A
  • Wide ventral neck clip and from level of jaw to thoracic inlet
  • Patient position in dorsal recumbency with sandbag etc under neck to elevate.
  • Keep neck straight
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11
Q

what are complications that can arise form a thyroidectomy?

A
  • Haemorrhage
  • Seroma formation
  • Laryngeal paralysis
  • Horners
  • Hypocalcaemia
  • Recurrence
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12
Q

what pre-emptive peri-operative support can you provide during thyroidectomy?

A

vpre-op vitamin d or post-op oral calcium

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13
Q

what does parathyroid hormone do?

A

increase blood calcium

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14
Q

how many parathyroid glands are there and what are they?

A

4
* Left extracapsular (cranial)
* Right extracapsular
* Left intracapsular (caudal)
* Right intracapsular

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15
Q

what medical treatment can be done for primary hyperthyroidism?

A

▪ Ethanol injection
▪ Heat ablation

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16
Q

what surgical treatment can you do for primary hyperthyroidism?

A

parathyroidectomy

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17
Q

what post-operative treatment can you do for primary hyperthyroidism?

A

monitor for hypoglycaemmia

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18
Q

what pre-operative considerations are there for parathyroidectomy?

A

*Systemic effects
* Hypercalcaemia
* Affects renal function
* Co-morbidities as typically older animals
Medical stabilisation to improve ASA status
* Diuresis with high levels of IVFT to ‘dilute’ the calcium?
* Support renal function

19
Q

what are the complciations of parathyroidectomy?

A
  • Haemorrhage
  • Seroma formation - depends on size of mass
  • Laryngeal paralysis
  • Horners
  • Hypocalcaemia
    *hypothyroidism
20
Q

what post-op care would you provide after a parathyroidectomy?

A

*IVFT
* Standard care according to clinical appearance and losses
Analgesia
* Avoid NSAIDs
Monitor for complications
* Renal function
* Calcium => More shortly
Prognosis
* Usually good
* Hypocalcaemia can be transient (days) , or can take weeks / months to recover

21
Q

what are the clinical signs associated with iatrogenic hypoparathyroidisms?

A
  • Initially
  • Inappetence
  • Weakness / Lethargy
  • Ptyalism
  • Pawing at face
  • More advanced
  • Tremors
  • Tetany
  • Seizures, coma and death
22
Q

how can you monitor for hypoglycaemia after parathyroidectomy?

A
  • Vitamin D
  • Monitor blood calcium
  • Monitor clinical signs
  • Calcium administration
23
Q

how would you treat hypoglycaemia after parathyroidectomy?

A
  • oral Vitamin D which takes 24-48hrs to effect
  • Oral calcium - home with patient
  • Intravenous 10% calcium gluconate
24
Q

what should you monitor after giving Intravenous 10% calcium gluconate slowly (10-20 mins)?

A

*Monitor with an ECG for arrhythmia and bradycardia
* Initial bolus followed by constant rate intravenous infusion
* Avoid bicarbonate, lactate or phosphate containing fluids → precipitate calcium

25
Q

what common pancreatic conditions are there?

A

diabetes and pancreatitis

26
Q

what are more uncommon pancreatic conditions?

A

insulinoma, exocrine pancreatic neoplasia, pancreatic abscessation and pancreatic cysts

27
Q

what are the clinical signs of insulinoma?

A

lethargy, tremors, seizures, collapse, peripheral neuropathy due to hypoglycaemia

28
Q

what pre-oeprative management can you do for insulinoma?

A
  • feed every 4-6hrs
  • diabetic diet
  • pre-op starvation?
  • gentle regular exercise
  • manage hypoglycaemia
29
Q

what should you do if a aptient is having a hypoglycaemic crisis?

A
  • give oral glucose or anything sugary
  • one off IV glucose 0.5-1mL/kg of 50% dextrose diluted
  • glucose infusion 2.5% solution
30
Q

what post op management can you do for insulinoma?

A
  • feeding +/- feeding tube
  • manage hypoglycaemia
  • exercise plan
  • drugs (analgesia, steroids, octreotide, chemo
31
Q

what complications can arise after insulinoma surgery?

A
  • Persistence of hypoglycaemia
  • Transient Hyperglycaemia
  • Pancreatitis
  • Can develop Diabetes Mellitus
32
Q

what is internal adrenal anatomy?

A

outer cortex and inner medulla

33
Q

what types of adrenal masses are there?

A

benign/malignant masses and primary or secondary tumours

34
Q

what secondaryadrenal gland conditions are there?

A

adrenal enlargement (pituitary)

35
Q

if there are no clinical signs with adrenal gland disease what is this?

A

incidentaloma

36
Q

what functional clincial signs are there of adrenal gland disease?

A
  • overproduction from cortex *Cushing’s, conns syndrome, mineralcortoicoid, glucocorticoid, masculinising sydrome, androgen
  • overproduction from the medulla production from medulla
  • Phaeochromocytoma / Catecholamines e.g. Norepinephrine and/or Epinephrine => intermittent
    hypertension
37
Q

what are benign adrenal glands enlargements usually?

A

adenomas

38
Q

what are malignant adrenal gland enlargements?

A

adenocarcinoma

39
Q

what can phaeochromactomas be?

A

malignant or benign

40
Q

what systemic effects are there from adrenalectomy?

A

*Conns Syndrome => hypokalaemia
* Cushings Syndrome => endogenous steroid => poor surgical candidate
* Phaeochromocytoma => excess adrenaline/noradrenaline => unstable patient

41
Q

what can you do to stabilise a patient to improve ASA status?

A

*Manage potassium => Potassium supplementation
* Stabilise with medication e.g. Trilostane
* Phaeo – stabilise with medication e.g. Phenoxybenzamine for 2-3 weeks pre-op (alpha adrenergic blocker)

42
Q

how can you manage a patient post-operatively after adrenalectomy?

A
  • cardiovascular function (ECGs and blood pressure)
  • electrolytes
43
Q

what post op complications can occur after arenalectomy?

A
  • Electrolyte abnormalities
  • Hypertension / Hypotension
  • Adrenal insufficiency requiring supplementation like an iatrogenic Addisons > mineralocorticoids and
    glucocorticoids
  • Delayed healing
  • Pulmonary thromboembolism
44
Q

what intra-operative complications can occur during adrenalectomy?

A

*Tumour rupture
* Haemorrhage
* Tachycardia / cardiac arrhythmias
* May need drugs to stabilise e.g. propranolol / lignocaine
* Hypertension / Hypotension
* May need supplementation of gluco- and mineralo-corticoids during surgery (Dexamethasone and Electrolytes (sodium and potassium))

ACVN - SURGICAL NURSING (17 decks)

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