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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
Elevations of plasma EPI and NE underlie many hemodynamic issues during bypass including:
*Peripheral vasoconstriction shifts in intra organ blood flow
26
With hypothermia there is an increase in EPI and NE levels
* NE: 4 fold inc. | * EPI: 10 fold inc.
27
NE and EPI peak at different times during bypass:
NE: Peaked at cross clamp removal and rewarming also rising again at 2-4 hours after surgery EPI: Peaked at target hypothermic temp.
28
Main feature in the metabolic stress response
*Increased secretion of cortisol
29
CPB modifies cortisol responses to surgery by:
* 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
How can peak CPB cortisol conc. be decreased?
*By deeper planes of anesthesia
31
On pump cortisol increased _____ from baseline ____ on CPB
* 5 fold | * 2 hours after on CPB
32
Off pump cortisol increased ____ from baseline after off pump CABG
*3 fold
33
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
*Leptin
34
Leptin binds to receptors in the ____ and _____
*Hypothalamus and affects energy metabolism
35
Leptin is structurally similar to ___ and affects...
*Cytokines and affects immunity and may modulate stress responses
36
How do leptin levels correlate w/ plasma cortisol levels
Inversely
37
Leptin levels w/ cardiac surgery and CPB
*On pump coronary surgery cases showed a greater decrease in leptin compared to off pump
38
Adrenocorticotropic hormone (ACTH) is secreted by the ____ and is part of the _____
* Anterior pituitary gland | * Hypothalamic pituitary adrenal axis
39
ACTH is produced in response to _____
Biological stress
40
Effects of ACTH
*Increased production and release of cortisol by the cortex of the adrenal gland
41
What happens to ACTH concentrations during bypass?
ACTH concentrations fall during bypass and increase one hour after pulsatile perfusion is restored
42
A family of biologically active peptides including:
* atrial natriuretic (ANP) * brain natriuretic peptide (BNP) * c-type natriuretic peptide (CNP)
43
ANP expressed in _____ role in CNS _____ produced and stored mostly in the _____ released in response to ____
* cardiac myocytes * remains unclear * atrium * atrial distension
44
BNP expressed in ____ role in cns _____ present in both _____ tends to be elevated in patients with _____
* Cardiac myocytes * Remains unclear * Atrial and ventricular tissues * Ventricular dysfunction
45
CNP expressed in _____ has significant ______ is not a significant source of CNP
* Nervous system and endothelial cells * Paracrine vasodilatory effects * heart
46
Stimuli of ANP and BNP release associated w/ CPB
* Myocardial ischemia * Catecholamines * Endothelin-1 * Prostacyclin * Cytokines
47
Both ANP and BNP _____ glomular filtration ______ renin release ______ aldosterone concentrations in the blood
* Increase * inhibit * reduce
48
Both ANP and BNP: ______ renal vasoconstrictors ______ arterial BP and they regulate vascular volume by....
* Antagonize * reduce Increasing sodium excretion and decreasing vasomotor tone
49
The renin angiotensin aldosterone axis regulates:
* Arterial BP * Intravascular volume * Electrolyte balance
50
RAA axis | patients w/ HF activation leads to:
* Hemodynamic and renal dysfunction * inflammation * Cardiac remodeling
51
The ____ stimulates renin release in response to ____
* Sympathetic N.S. | * Pain, emotion and stress
52
_____ secretes renin in response to sodium depletion and falls in BV, or reduced renal perfusion
*Renal juxtaglomerular apparatus
53
Renal juxtaglomerular apparatus secretes renin in response to ____
Sodium depletion, falls in BV, or reduced renal perfusion
54
What catalyzes the conversion of angiotensinogen to the decapeptide angiotensin I in the blood?
Renin
55
What catalyzes the conversion of angiotensin l to angiotensin ll?
ACE
56
Where is ACE present?
*In blood vessel walls, particularly in the pulmonary vasculature
57
Conversion from angiotensin l to angiotensin ll is nearly complete during one pass through ______
the lungs
58
Angiotensin ll raises the blood pressure through 2 mechanisms
* Direct vasoconstriction | * Stimulation of aldosterone secretion by the adrenal glands
59
Aldosterone stimulates the renal distal tubules to ____ sodium and ____ potassium and hydrogen ions into tubular fluid
* reabsorb | * secrete
60
Aldosterone also promotes ____ in HF
*cardiac remodeling | when heart changes shape, been filled with too much blood and gets to big, doesnt work properly
61
Renin activity is shown to ____ during and shortly after CPB
Increase
62
_____ and ____ concentrations rise significantly during and shortly after CPB in patients undergoing non-pulsatile perfusion
*Angiotensin ll and aldosterone
63
ACE concentrations change markedly during and after cardiac surgery, but if corrected for hemodilution, ______
*Minimal response to CPB or hypothermia is observed
64
When ACE levels decrease, they usually ______)
Recover to baseline by 24 hrs after bypass
65
What do patients undergoing cardiac surgery have a reduction in?
thyroid hormone levels
66
what is a decline in circulating t3 due to?
not specific to hypothermia but rather due to a stress response to surgery
67
what does t3 do?
regulates the number of beta adrenergic receptors and their sensitivity to agonists *modulates metabolism, HR, myocardial contractility and oxygen consumption
68
what affects thyroid function?
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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