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Pathophysiology CVP 622 > Test 1 content-Endocrine > Flashcards

Test 1 content-Endocrine Flashcards

1
Q

____ and ____ aren’t totally perfused in total cpb and either cant ______ or make their usual contributions to _____

A
  • Heart and lungs
  • secrete hormones
  • Drug metabolism
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2
Q

Exposure to pump, oxygenator and tubing does what?

A
  • traumatizes cellular blood elements
  • Causes plasma protein to be absorbed and removed from circulation
  • Stimulates and immune response
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3
Q

_____ and ____ alter blood concentrations or electrolytes, hormones and serum proteins

A

hemodilution and anticoagulation

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4
Q

Hypothermia reduces rate of _____, which does what?

A

biochemical reactions which further alters hormonal responses

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5
Q

Physiological alterations during cpb w/ non pulsatile perfusion

A
  • changes in blood flow distribution between organs

* Some hormonal alterations during bypass could be lessened or prevented by using pulsatile perfusion

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6
Q

How are stress hormones affected/altered on cpb?

A

stress hormone levels increase

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7
Q

Why is summarizing lit on endocrine, metabolic and electrolyte response difficult?

A
  • Different pt populations
  • Different techniques
  • Cardoplegia
  • perfusate temp
  • priming solutions
  • anesthetic and adjunct drugs
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8
Q

What portion of the pituitary gland secretes hormones?

What does the pituitary gland regulate?

A
  • Anterior portion

* Regulate the adrenal cortex, thyroid, ovaries and testes

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9
Q

Gonadotropin responses during bypass

not well analyzed or documented

A
  • Maggio saw significant preoperative decreases in testosterone conc. in men and increases in women undergoing cardiac surgery
  • Estradiol levels increased in men and decreased in women
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10
Q

What is pituitary apoplexy?

A
  • Rupture of a tumor/bleeding

* Rare issue typically in patients w/ pituitary adenomas (tumors)

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11
Q

Diagnosis of pituitary apoplexy and what can be done?

CPB alone doesnt lead to hypopituitarism

A
  • Confirmed w/ CT or MRI

* Hormonal replacement and prompt hypophysectomy (removal of pit. gland)

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12
Q

Posterior pit. gland secretes ___ and ____ and is a potent regulator of?

A
  • Vasopressin or other ADH’s

* Renal water excretion

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13
Q

What does ADH do?

A

*Increases renal vascular resistance and at high conc. increases peripheral vasc. resistance. and reduces renal BF.

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14
Q

What does ADH stimulate in connection w/ the coagulation cascade and what does that do?

A
  • Stimulates the release of von willebrand factor

* Perhaps improving hemostasis during and after cardiac surgery

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15
Q

General anesthesia and surgery are associated w/ ______

A

Increases in ADH

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16
Q

Stimuli that provoke ADH release include:

A

*Plasma osmolarity, decreased blood volume or pressure, hypoglycemia, angiotensin, stress and pain

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17
Q

An exaggerated ADH response to bypass can occur during these times:

A
  • Dec. in circulating BV upon initiating bypass

* Transient hypotension that can occur at initiation of bypass

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18
Q

_____ during CPB curbs the exaggerated ADH response particularly after bypass but doesn’t stop it from happening

A

Pulsatile perfusion

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19
Q

At high conc. vasopressin (ADH):

A
  • Increases peripheral vascular resistance

* Decreases cardiac contractility and coronary blood flow

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20
Q

Low systemic vascular resistance and high CO within the first 4 postop hours is what/

A

Vasoplegic syndrome

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21
Q

Vasoplegia is more likely in patients w/ ________

A

A pre op reduced ejection fraction and or in patients receiving chronic treatment w/ ACE inhib. and in patients w/ high ADH levels pre op

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22
Q

ADH concentrations ____ during CPB irrespective of anesthesia or the perfusion technique

A

Increase

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23
Q

Adrenal hormones catecholamines (products from adrenal medulla)

A
  • NE

* EPI

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24
Q

Adrenal cortical hormones

A
  • cortisol
  • leptin
  • adrenocorticotropic hormone
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25
Q

Elevations of plasma EPI and NE underlie many hemodynamic issues during bypass including:

A

*Peripheral vasoconstriction shifts in intra organ blood flow

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26
Q

With hypothermia there is an increase in EPI and NE levels

A
  • NE: 4 fold inc.

* EPI: 10 fold inc.

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27
Q

NE and EPI peak at different times during bypass:

A

NE: Peaked at cross clamp removal and rewarming also rising again at 2-4 hours after surgery
EPI: Peaked at target hypothermic temp.

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28
Q

Main feature in the metabolic stress response

A

*Increased secretion of cortisol

29
Q

CPB modifies cortisol responses to surgery by:

A
  • Briefly decreasing upon initiation of CPB (likely due to hemodilution)
  • During bypass levels increase significantly above baseline
  • After bypass patients have elevated concentrations for more than 48 hours
30
Q

How can peak CPB cortisol conc. be decreased?

A

*By deeper planes of anesthesia

31
Q

On pump cortisol increased _____ from baseline ____ on CPB

A
  • 5 fold

* 2 hours after on CPB

32
Q

Off pump cortisol increased ____ from baseline after off pump CABG

A

*3 fold

33
Q

Adipocyte derived hormone that is thought to moderate the acute systemic inflammatory response to CPB and surgery and interact w/ the hypothalamic pituitary adrenal axis

A

*Leptin

34
Q

Leptin binds to receptors in the ____ and _____

A

*Hypothalamus and affects energy metabolism

35
Q

Leptin is structurally similar to ___ and affects…

A

*Cytokines and affects immunity and may modulate stress responses

36
Q

How do leptin levels correlate w/ plasma cortisol levels

A

Inversely

37
Q

Leptin levels w/ cardiac surgery and CPB

A

*On pump coronary surgery cases showed a greater decrease in leptin compared to off pump

38
Q

Adrenocorticotropic hormone (ACTH) is secreted by the ____ and is part of the _____

A
  • Anterior pituitary gland

* Hypothalamic pituitary adrenal axis

39
Q

ACTH is produced in response to _____

A

Biological stress

40
Q

Effects of ACTH

A

*Increased production and release of cortisol by the cortex of the adrenal gland

41
Q

What happens to ACTH concentrations during bypass?

A

ACTH concentrations fall during bypass and increase one hour after pulsatile perfusion is restored

42
Q

A family of biologically active peptides including:

A
  • atrial natriuretic (ANP)
  • brain natriuretic peptide (BNP)
  • c-type natriuretic peptide (CNP)
43
Q

ANP expressed in _____ role in CNS _____ produced and stored mostly in the _____ released in response to ____

A
  • cardiac myocytes
  • remains unclear
  • atrium
  • atrial distension
44
Q

BNP expressed in ____ role in cns _____ present in both _____ tends to be elevated in patients with _____

A
  • Cardiac myocytes
  • Remains unclear
  • Atrial and ventricular tissues
  • Ventricular dysfunction
45
Q

CNP expressed in _____ has significant ______ is not a significant source of CNP

A
  • Nervous system and endothelial cells
  • Paracrine vasodilatory effects
  • heart
46
Q

Stimuli of ANP and BNP release associated w/ CPB

A
  • Myocardial ischemia
  • Catecholamines
  • Endothelin-1
  • Prostacyclin
  • Cytokines
47
Q

Both ANP and BNP
_____ glomular filtration
______ renin release
______ aldosterone concentrations in the blood

A
  • Increase
  • inhibit
  • reduce
48
Q

Both ANP and BNP:
______ renal vasoconstrictors
______ arterial BP
and they regulate vascular volume by….

A
  • Antagonize
  • reduce

Increasing sodium excretion and decreasing vasomotor tone

49
Q

The renin angiotensin aldosterone axis regulates:

A
  • Arterial BP
  • Intravascular volume
  • Electrolyte balance
50
Q

RAA axis

patients w/ HF activation leads to:

A
  • Hemodynamic and renal dysfunction
  • inflammation
  • Cardiac remodeling
51
Q

The ____ stimulates renin release in response to ____

A
  • Sympathetic N.S.

* Pain, emotion and stress

52
Q

_____ secretes renin in response to sodium depletion and falls in BV, or reduced renal perfusion

A

*Renal juxtaglomerular apparatus

53
Q

Renal juxtaglomerular apparatus secretes renin in response to ____

A

Sodium depletion, falls in BV, or reduced renal perfusion

54
Q

What catalyzes the conversion of angiotensinogen to the decapeptide angiotensin I in the blood?

A

Renin

55
Q

What catalyzes the conversion of angiotensin l to angiotensin ll?

A

ACE

56
Q

Where is ACE present?

A

*In blood vessel walls, particularly in the pulmonary vasculature

57
Q

Conversion from angiotensin l to angiotensin ll is nearly complete during one pass through ______

A

the lungs

58
Q

Angiotensin ll raises the blood pressure through 2 mechanisms

A
  • Direct vasoconstriction

* Stimulation of aldosterone secretion by the adrenal glands

59
Q

Aldosterone stimulates the renal distal tubules to ____ sodium and ____ potassium and hydrogen ions into tubular fluid

A
  • reabsorb

* secrete

60
Q

Aldosterone also promotes ____ in HF

A

*cardiac remodeling

when heart changes shape, been filled with too much blood and gets to big, doesnt work properly

61
Q

Renin activity is shown to ____ during and shortly after CPB

A

Increase

62
Q

_____ and ____ concentrations rise significantly during and shortly after CPB in patients undergoing non-pulsatile perfusion

A

*Angiotensin ll and aldosterone

63
Q

ACE concentrations change markedly during and after cardiac surgery, but if corrected for hemodilution, ______

A

*Minimal response to CPB or hypothermia is observed

64
Q

When ACE levels decrease, they usually ______)

A

Recover to baseline by 24 hrs after bypass

65
Q

What do patients undergoing cardiac surgery have a reduction in?

A

thyroid hormone levels

66
Q

what is a decline in circulating t3 due to?

A

not specific to hypothermia but rather due to a stress response to surgery

67
Q

what does t3 do?

A

regulates the number of beta adrenergic receptors and their sensitivity to agonists
*modulates metabolism, HR, myocardial contractility and oxygen consumption

68
Q

what affects thyroid function?

A

pre cpb heparin lightly increases tree t3 and t4 bc it displaces hormones from binding proteins

Pathophysiology CVP 622 (5 decks)

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