recap parasci

Question 1

regulation of BGL

Answer 1

insulin-secreted by beta cells (islet of langerhan)

• direct effect lowering BGL
• insulin promotes glucose uptake & glucose storage
• Prevents fat & glycogen breakdown

glucagon-secreted by alpha cells

• maintains BGL between meals/fasting
• Exerts main action in liver
• Increases glucose levels via glycogenolysis & gluconeogenesis

Question 2

Type 1 diabetes

Answer 2

Is the complete destruction of the pancreatic beta cells. Usually people are genetically susceptible to type 1 diabetes and undergo a triggering event, resulting in destruction of Beta cells.

• results in hyperglycaemia (in the blood) due to lack of insulin, lack of insulin effect, or both.
• may be in the form of a bad infection, or huge physiological stress causing auto-antibodies to be produced, which destroy beta cells, resulting in lack of insulin secretion

Question 3

DKA

Answer 3

-DKA occurs in type 1 diabetics BGL 20 +where there is no glucose available to the cells, as there is no release of insulin.
-insulin stops breakdown of fats (lipolysis) for energy, and instead uses glucose as fuel instead.
-however due to no insulin, glucose remains in the blood stream, causing hyperglycaemia and body doesnt have energy source.
So uses breakdown of fats (lipolysis) instead, these fats must be converted into ketones to be used for energy, moving the body into a state of ketosis.
Ketones have a fruity smell about them, patients in DKA will smell fruity.
- state of ketosis, acid is being produced, resulting in metabolic acidosis. In order to combat this, bicarbonate is used to buffer the acid:This causes to much CO2 so to remove the carbon dioxide, the body increases the respirations, resulting in ‘Kussmaul’ respirations – of increased rate and depth.

Question 4

Type 2 diabetes

Answer 4

• Type 2 diabetes- most common, results in hyperglycaemia due to insulin resistance.
• However, there is NO autoimmune-mediated destruction of the beta cells.
• caused by impaired insulin production, inappropriate liver glucose production, and/or peripheral insulin receptor insensitivity.

Question 5

HONK

Answer 5

HS or hyperglycaemia non-ketoacidosis (HONK) occurs in type 2 diabetics.

• lesser entry of glucose to the cells, meaning it remains in the vascular (blood) system. Because type 2 diabetes is a slower onset disease, these patients are used to regularly having periods of hyperglycaemia. As such, their BGL may be incredibly high (>30mmol/L).
• Glucose has a large effect on water molecules, causing it to be pulled from any cells it can (generic tissues and the brain). Because of this hyperosmolarity, HHS patients become acutely dehydrated. When water is pulled from the brain, the patient may also begin to suffer neurological symptoms (hemiparesis, seizures, coma).

Question 6

Renin-Angiotensin Aldosterone System (RAAS)

Answer 6

Kidney perfusion decreases when arterial BP drops
In response, kidneys produce & release renin- makes angiotensin 2 which acts on blood vessels, causing vasoconstriction.
Also acts on adrenal gland, causing aldosterone release
Causes kidney tubules to increase sodium reabsorption, resulting in more fluid being retained
Contributes to long-term BP regulation

Question 7

The “Deadly” Trauma Triad: hypovalemic shock

Answer 7

as core temperature decreases, so does body’s ability to stop bleeding, increasing blood viscosity. so body tries to clot blood but result is lots of little clots in blood.
coagulathopy-acidocis-hypothermia

Question 8

sepsis

Answer 8

Pathogen moves from original infection sight into blood causing systemic inflammatory response. Vasodilation, capillary leakage and decreased cardiac output and organ dysfuction can all occur if body cant fight infection.
Sepsis patients must have a clear sight of infection and show signs of systemic inflammatory response…
this includes
-abnormal temp >38 <36.
-tachycadia
-tachypnoea

Question 9

septic shock

Answer 9

occurs when patient has clear signs of infection, inflammatory response and signs of shock.
signs of shock include hypo tension of signs of poor perfusion such as decreased CRT.
May also have confusion, aching muscles, rigors, decreased urine output.

Question 10

meningococcal septicemia

Answer 10

Type of bacteria that has entered the bloodstraem.
Have influenza like symptoms and petchiae (small sponts the size of a pen tip caused by bleeding in capillaries of skin)
-purpura (larger spots that look like small bruises, result of ischemia and bleeding)
Dont blanch when touched.
Can do stuff on road for them.

Question 11

Meningitis

Answer 11

inflammation of meniges in brain.
pt has headche, signs of infection, nausea, photophobia, stiff neck.
Not treated on road.