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N935 Pathophysiology > Parathyroid Gland > Flashcards

Parathyroid Gland 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

parathormone

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3
Q

How is parathormone managed?

A

dependent on plasma calcium concentration

released into the blood stream by negative feedback mechanism

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4
Q

What is the half life of parathyroid hormone?

A

4 minutes

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5
Q

What is the average parathyroid hormone level?

A

8-51pg/mL

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6
Q

What is released in responses to hypocalcemia?

A

release parathyroid hormone

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7
Q

What is released in response to hypercalcemia?

A

releases calcitonin

suppression of both synthesis and release

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8
Q

What does parathyroid hormone regulate?

A

a normal calcium concentration

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9
Q

What are the three interfaces that calcium affects?

A

GI tract
bone
renal tubules

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10
Q

How is calcium utilized in the GI tract?

A

when the body has low calcium, parathyroid hormone increases calcium absorption from the food we ingest and phosphate reabsoprtion to increase serum levels of calcium and phoshphat

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11
Q

What is the purpose of calcium in bones?

A

Calcium is absorbed in the bones for bone strength

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12
Q

Reabsorption

A

in regards to physiology:

absorption into the circulation

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13
Q

What are the four processes that occur when serum calcium is low and sensed by the parathyroid gland?

A
  1. Calcium is reabsorbed into the blood stream via bones
    a. Bone reabsorption: absorption into circular in bones
    Osteoclast break down bone tissue and release minerals in bones and release into blood stream
    1. Calcium is reabsorbed from kidney after being reabsorbed in blood stream in exchange for calcium
    2. Also, in the kidney vitamin D is activated and travels to the intestine where parathyroid hormone and vitamin D increases the absorption of active transport of calcium and phosphate to get reabsorbed into the blood stream
    3. Kidney: Calcium is coming from kidneys after being excreted and being reabsorbed into blood stream in exchange for phosphate phosphorus
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14
Q

What are osteoclasts?

A

cells found on the surface of bones and are multi-nucleated cells that contain numerous mitochondria and lysosomes

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15
Q

What is calcitonin

A

opposes the effect of PTH

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16
Q

Where is calcitonin secreted?

A

parafollicular cells of the thyroid

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17
Q

When is calcitonin secreted?

A

increased serum calcium (hypercalcemia)

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18
Q

What are the three ways calcitonin lowers blood calcium?

A

inhibits osteoclasts activity in bones (promotes bone storage of calcium)
inhibits renal tubular cell reabsorption of Ca2+
inhibits Ca2+ absorption in the intestines

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19
Q

What is the role of vitamin D?

A

fat soluble molecule that increases the intestinal absorption of calcium, magnesium and phosphate

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20
Q

What two types of Vitamin D come from our diet?

A 
vitamin D2 (cholecalciferol)
vitamin D3 (ergocalciferol)
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21
Q

What is the synthesis of vitamin d2 dependent on?

A

sun exposure

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22
Q

Where are both vitamin d forms hydrolyzed and form?

A

in the liver

25-hydroxyvitamin

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23
Q

What happens to 25-hydroxyvitamin in the kidney?

A

metabolized again into 1,25 hydroxyvitamin D

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24
Q

Where are vitamin D receptors in the body?

A

intestines, kidneys, bone, parathyroid gland

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25
What is the role of vitamin D in the body?
calcium homeostasis and metabolism helps transport proteins absorb calcium in the intestine bone reabsorption reabsorption of calcium in the distal nephron
26
What is the calcium lab value important to us?
ionized calcium
27
What is the normal total serum calcium concentration
9.5-10.5mg/dL
28
What is a normal ionized calcium?
4.75-5.7mg/dL
29
What calcium is free and unbound?
ionized calcium
30
What compromises bound calcium?
calcium that is bound to protein (albumin)
31
How of calcium is bound to albumin
50%
32
How much calcium is ionized?
40%
33
How much calcium is bound to chelating agents?
10%
34
What are examples of chelating agents?
phosphate citrate sulfate
35
What happens to serum calcium in acidosis?
increase
36
What happens to serum calcium in alkalosis?
decrease
37
What does ionized calcium fraction depend on ?
pH
38
What decreases as pH decreases?
protein binding decreases as pH decreases
39
Describe protein binding and ionized fraction of calcium in alkalosis?
increased protein binding decrease ionized fraction of calcium
40
Describe protein binding and ionized fraction of calcium in acidosis?
decrease calcium binding to protein | increased ionized fraction
41
For each 0.01 decrease in pH, ionized calcium...
increases by 0.05mmol/L
42
Where is total calcium of the body stored?
99% in the bone | 1% in the ECF and ICF
43
What is the purpose of calcium in the bone ?
bone formation | reservoir for ECF (Ca2+)
44
What is the role of calcium in the extracellular fluid?
blood clotting | excitability of nerve and muscle
45
What is the role of calcium in the ICF?
metabolic regulation for action of hormones and enzyme activitation
46
What are disorders related to PTH?
reduced production impaired PTH due to peripheral resistance parathyroid gland adenomas
47
What are diseases of reduction production of PTH
digeorge syndrome catch 22 syndrome autoimmune
48
What is hyperparathyroidism?
excess production of PTH
49
What is the most common cause of hyperparathyroidism
hypercalcemia
50
What defines hypercalcemia?
total serum calcium above 10.4mg/dL
51
How is hyperparathyroid classified?
primary secondary ectopic
52
What is primary hyperparathyoridism?
parathyroid gland destruction | excess secretion of parathromone
53
What is secondary hyperparathyroidism?
appropriate response to hypocalcemia as seen in CKD
54
what can cause primary hyperparathyroidism?
benign adenoma hyperplasia carcinoma
55
What are majority of the primary hyperparathyroidism cases?
benign adenoma (80-90%)
56
How many primary hyperparathyroidisms are asymptommatic?
50%
57
What are the manifestations of primary hyperparathyroidism
manifestations of hypercalcemia in the kidney and skeletal sytem calcium deposits in renal parenchyma or recurrent nephrolithiasis and skeletal pathology
58
What calcium levels do primary hyperparathyroidism symptoms present?
11.5-12mg/dL
59
What are neuromuscular S/S in primary hyperparathyroidism?
skeletal muscle weakness
60
What are renal S/S in primary hyperparathyroidism?
polyuria polydipsia decreased GFR kidney stones
61
What are hemoatopoietic S/S in primary hyperparathyroidism?
anemia
62
What are cardiac S/S in primary hyperparathyroidism?
prolonged PR interval shortened QT interval systemic hypertension
63
What are gastrointestinal S/S in primary hyperparathyroidism?
vomiting abdominal pain peptic ulcer pancreaitis
64
What are skeletal S/S in primary hyperparathyroidism?
skeletal demineralization collapse of vertebral bodies pathologic fractures
65
What are nervous S/S in primary hyperparathyroidism?
somnolence decreased pain sensation psychosis
66
What are ocular S/S in primary hyperparathyroidism?
calcifications (band keratopathy) | conjunctivitis
67
How do you diagnosis hyperparathyroidism?
``` PTH assay calcium levels vitamin D levels renal levels CT scans ```
68
What are medical management practices for hyperparathyroidism with mild hypercalcemia (12mg/dl)?
hydration
69
What are medical management practices for hyperparathyroidism with moderate to severe hypercalcemia (13-15mg/dl)?
IV saline hydration and furosemide to promote Na/Ca diuresis
70
What are surgical management implications for hyperparathyroidism?
definitive treatment intraoperative PTH assay is measured before and at 5 minute intervals after adenoma removal to confirm a rapid fall to normal
71
What must occur with multiple-gland hyperplasia?
all glands must be identified and either: all three removed with partial excision of the fourht (leaving good blood supply) total parathyroidectomy with immediate transplantation of a removed, minced parathyroid gland into the forearm muscles
72
What is hypoparathyroidism?
absence or deficiency in PTH secretion resistance of peripheral tissues to the effects of the hormone iatrogenic (removed surgically with thyroidectomy)
73
What does hypoparathyroidism result in?
hypocalcemia
74
What are causes of hypoparathyroidism?
``` decreased or absent parathyroid hormone accidental removal of parathyroid glands during thyroidectomy parathyroidectomy to treat hyperplasia idiopathic (Digeorge) resistance of peripheral tissues to effects of parathyroid hormone congenital pseudohypoparathyroidism acquired hypomagnsemia chronic renal failure malabsorption anticonvulsant therapy (phenytoin) osteoblastic metatases acute pancreatitis ```
75
What are signs of hypocalcemia?
``` neuronal irritability skeletal muscle spasms tetany seizures fatigue and mental status prolonged QT interval congestive heart failure hypotension ```
76
What are symptoms of acute hypocalcemia?
stridor laryngospasm apnea
77
How does tetany occur?
normally calcium blocks sodium channels and inhibits depolarization of nerve and muscle fibers reduced calcium lowers the threshold for depolarization hypocalcemia
78
What is the treatment for hypocalcemia?
electrolyte replacement calcium and vitamin D hypomagnesia (oral and IV replacement)
79
What is the treatment for severe and symptomatic hypocalemia?
10-20ml of 10% calcium gluconate or 3-5 ml of 10% calcium chloride followed by a continous infusion of calcium (1-2mg/kg/h)
80
Do you want to treat hypocalcemia prior to surgery?
yes
81
What the major anesthetic risks with hypocalcemia?
decreased cardiac contractility and dysrhythmias tetany altered response to muscle relaxants risk for laryngospasm
82
What will result without treatment to an overactive parathyroid gland?
fatigue, bad memory, kidney stones and ostopporosis
83
Whta does a parathyroid gland tumor cause?
hyperparathyroidism
84
What is the most common amount of over active parathyroid glands?
single 70% two/three 25% all four 5% <1% cancer of parathyroid
85
Anesthetic management during parathyroidectomy
concern for cardiac dysrhythmias secondary to elevated calcium NIMS ETT (assess RLN) effects of NMR are unpredictable s/c to hypercalcemia (consider qualitative NMB monitoring) careful positioning (risk fo fractures)
86
What are post-operative complications to parathyroidectomy?
``` similar to thyroid surgery RLN injury hematoma hypocalcemia acute hypocalcemia (only if severe deficit preop or injury to all parathyroid glands) ```
87
Intraoperative implications for parathyroid surgery
``` supine arms tucked gel head ring ether screen adn 2 clicks down on bed for neck extension 2 PIVs antiemetic coverage GA with NIMs ETT (videocope) inhalation agent remifentanil infusion no antibiotics ```
88
What is neccessary for parathyroid surgery?
large IV for PTH sampling NBP cuff can be used as tourniquet with stopcock inserted between 6inch connector tubing and IV tubing can use arterial line Saph IV
89
Describe PTH sampling during surgery
baseline PTH sample scheduled PTH samples in or at: time 0 (at removal of parathyroid as alerted by surgeon) time 5, 10, 14 min post parathyroid removal

N935 Pathophysiology (6 decks)

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