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Summer Patho > parathyroid > Flashcards

parathyroid Flashcards

1
Q

how many parathyroid glands are there?

A

4

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2
Q

what do the parathyroid glands produce

A

parathyroid hormone (aka parathormone)

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3
Q

why is PTH released into the blood

A

dependent on plasma calcium concentration - released by negative feedback mechanism

  • hypocalcemia = release
  • hypercalcemia = suppress both synthesis and release
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4
Q

what is half life of PTH?w

A

4 minutes

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5
Q

what is the average PTH level?

A

8-51 pg/mL

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6
Q

what is the goal of the thyroid gland/PTH

A

to maintain normal plasma calcium levels

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7
Q

calcium moves across what 3 interfaces?

A

GI tract, renal tubule, bone

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8
Q

resorption definition

A

absorption into circulation

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9
Q

what do osteoclasts do?

A

they break down the bone tissue and release minerals, resulting in the transfer of calcium from bone tissue to blood

they are found on the surface of bones and are multi-nucleated cells that contain mitochondria and lysosomes that break down bone tissue by digestion and degradation

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10
Q

what does PTH do to the kidneys?

A

stimulates calcium reabsorption, and depresses PO4 reabsorption

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11
Q

what does PTH do to the guts

A

increased calcium and phosphorous reabsorption

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12
Q

what does calcitonin do?

A

it opposes the effects of PTH and lowers blood calcium in 3 ways

  1. inhibits osteoclast activity in bones (promotes bone storage of calcium)
  2. inhibits renal tubular reabsorption of calcium
  3. inhibits calcium reabsorption in intestines
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13
Q

where is calcitonin secreted

A

by parafollicular cells in thyroid

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14
Q

what stimulates calcium secretion

A

hypercalcemia

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15
Q

what does vitamin D do?

A

it increases intestinal absorption of calcium, magnesium, and phosphate

Vitamin D receptors:
helps transport proteins that absorb calcium in intestine
bone resorption
reabsorption of calcium in in distal nephron

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16
Q

how do you get vit D2 (cholecalciferol) and Vitamin D3 (ergocalciferol)

A

you get them through diet
synthesis of D2 is dependent on sun exposure
D2 and D3 get hydrolyzed in liver to 25-hydroxyvitamin and then again in kidney to form 1,25 hydroxyvitamin D

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17
Q

what are the normal calcium levels

A

total - 9.5-10.5

iCal - 4.75-5.7

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18
Q

percentage breakdown of how calcium is hanging out in your body

A

50% serum bound to albumin
40% ionized and active
10% bound to chelating agents (phosphate, citrate, sulfate)

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19
Q

what does acidosis do to serum calcium

A

increases

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20
Q

what does alkalosis do to serum calcium

A

decreases

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21
Q

each 0.1 decrease in pH increases ical by?

A

0.05

22
Q

of the calcium in your body, what percentage is in your bone?

A

99% - helps with bone formation, reservoir for calcium

23
Q

what does calcium do in the ECF?

A

blood clotting

excitability of nerve and muscle

24
Q

what doe calcium do intracellularly?

A

metabolic regulation for action of hormones and enzyme activation

25
Q

hyperparathyroidism - what is it?

A

excess production of PTH

26
Q

what is the most common cause of hypercalcemia

A

hyperparathyroidism

27
Q

what is hypercalcemia defined as

A

20.4

28
Q

what causes primary hyperparathyroidism

A

parathyroid destruction

excessive secretion of PTH d/t benign adenoma (80-90%), hyperplasia (15%), carcinoma (<1%)

29
Q

what causes secondary hyperparathyroidism

A

appropriate response to hypocalcemia as seen in CKD

30
Q

50% of patients with hyperparathyroidism are?

A

ASYMPTOMATIC

31
Q

what are the manifestations of hypercalcemia

A

primary kidneys and skeletal system - calcium deposits in renal parenchyma, recurrent nephrolithiasis, skeletal pathology

32
Q

at what calcium level would you expect symptoms most commonly

A

above 11.5-12

33
Q

how do you diagnose hyperparathyroidism?

A

PTH assay, calcium level, vit D level, renal function, CT scan, has anything happened to neck? albumin?

34
Q

medical management of hyperparathyroidism

A

for mild/asymptomatic

  • mild hypercalcemia (12) = hydration
  • moderate to sever hypercalcemia (13-15) - IV saline hydration and furosemide to promote Na/Ca diuresis
35
Q

surgical management of hyperparathyroidism

A

definitive treatment
intraoperative PTH assay is measure before and at 5 minute intervals after adenoma removal to confirm a rapid fall to normal

36
Q

if you have multiple-gland hyperplasia, what do you do?

A

all glands must be identified and either

  1. remove 3 with partial excision of fourth, leaving good blood supply or
  2. total parathyroidectomy with immediate transplantation of removed, minced parathyroid gland into forearm muscle
37
Q

hypoparathyroidism - what is it

A

absence or deficiency in PTH or resistance of peripheral tissue to the effects of the hormone, can be iatrogenic or removed surgically with thyroidectomy (on accident)

***results in hypocalcemia

38
Q

what are the signs of hypocalcemia?

A 
neuronal irritability
skeletal muscle spasm
tetany
seizure
fatigue and mental status change
prolonged QT
congestive heart failure - chronic
acute hypotension
39
Q

what can acute hypocalcemia cause??

A

stridor, laryngospasm, apnea, and hypotension

40
Q

how do you treat hypocalcemia

A

give electrolyte replacement
calcium and vitamin D
manage hypomagnesemia

41
Q

how is hypomagnesemia managed?

A

oral or IV replacement - calcium and mag functionally compete for transport in the thick ascending limb of look of Henle

42
Q

severe symptomatic hypocalcemia

A

requires 10-20 mL of 10% calcium gluconate or 3-5 mL of 10% calcium chloride followed by a continuous infusion of calcium 1-2mg/kg/h

43
Q

what are the major anesthetic risks of hypocalcemia

A

decreased cardiac contractility and dysrhythmias
tetany
altered response to muscle relaxant
risk for laryngospasm

44
Q

if you don’t treat an overactive parathyroid gland, what problems will arise

A

fatigue, bad memory, kidney stones, osteoporosis

45
Q

what is the incidence of developing a parathyroid tumor

A

1 in 100

and 1 in 50 women over 50

46
Q

anesthetic management of parathyroidectomy

A

elevated calcium can lead to cardiac dysrhythmias
use a NIMs ETT to assess RLN
NMBDs are unpredictable - use qualitative monitors
careful positioning - risk for fracture

supine, arms tucked, gel head ring
ether screen and 2 clicks down on bed for neck extension
2 PIVs antiemetic coverage
GA with NIMs monitoring
inhalation agent
remifentanil
no abx
47
Q

what does hypercalcemia do to the heart rhythm

A

decreases refractory period and increase ventricular excitability

48
Q

what are the postop complications of parathyroid surgery

A

RLN injury, hematoma, hypocalcemia (acute only if severe deficit preop or injury to all glands)

49
Q

if you are doing parathyroid only

A

large IV for PTH sampling
position NIBP cuff to function as torniquet with a stopcock inserted between 6in connector tubing and IV tubing
you could a-line
consider saphenous IV

50
Q

for parathyroid surgery when should you get PTH samples

A

baseline
at time of removal
and then every 5 minutes after that for 15 minutes

Summer Patho (10 decks)

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