11. CIS Flashcards
(40 cards)
What are responses to short term stress responses:
- Glycogenolysis -> increase blood glucose
- increased BP, RR, BMR
- Increased altertness
- decreased digestive and kidney fx.
What are responses to long term stress responses:
- Relase of mineralcorticoids (increase in Na+, water and BP)
- Release of cortisol: glycogenlysis and gluconeogenesis, protein breakdown, lipolysis, immune system compromisation
What is relative adrenal insufficiency (adrenal crisis)?
Inability of HPA axis to keep up with demand; causing insufficient mineralcorticoids.
How can we determine if a case is [primary acute adrenal insufficiency]?
- Look at ACTH levels: should be elevated.
- ACTH stimulation (cosyntropin) test: ACTH administration should not cause a rise in cortisol.
Primary adrenocortical insuffiency is also called what?
- acute adrenal crisis
- relative adrenal insuffiency
What sx will you see in pts with primary chronic adrenocortical insuffiency (__________)?
Addisons disease
- Malaise
- Fatigue
- Weight loss or anorexia
- Hyperpigmentation
- Can have normal levels of things because the body has had time to compensate.
In the U.S , the most common etiology of Addisons dz is _____
autoimmune
If a patient comes in with Addisons disease and they have a serious illness or trauma, particularly if they lose trauma, what should the doc do?
GIVE THEM CORTICOSTERIODS
PTH directly releases Ca2+ from the bone and promotes synthesis of 1,25 (OH)2 D in the kidney. What does that do?
- Increase Ca2+ from bone
- Absorb Ca2+ in the intestines.
What does end stage renal disease cause?
- secondary hyperparathyroidism d/t end stage renal disease-
Low Ca2+, increased Pi, High PTH, increased bone turnover (renal osteodystrophy)
In secondary hyperparathyroidism d/t ESRF we can see what occur?
renal osteodystrophy- alternative areas of scleros and osteoporosis that looks “Striped”. It is caused by a high bone turnover.
If a patient has secondary hyperparathyroidism, we will see enlargement of all 4 or 1 PT gland?
Low Ca2+ -> enlargement of all glands.
If a patient has primary hyperparathyroidism, will we see enlargement in one PT gland or all?
One: just the hyperfunctioning one. Indicative of a neoplasm.
What is type 1 DM?
Autoimmune disease caused by failure of T-cells self-tolerance. Thus, they attach antigens in the pancreatic beta cells. This is called insulinitis.
What does insulin do via the MAPK pathway and PI-3K pathway?
- MAPK: cell growth, proliferation and gene expression
- PI-3K: make lipids, proteins and glycogen; cell survival and proliferation and insert GLUT4 vesicle on membrane
What are the 4 T’s of T1DM?
- Toilet
- Thirsty- excess sugar in blood pulls fluid from tissues, causing child to drink and pee more.
- Tired- lack of sugar in cells makes kids tired
- Thinner- eat more than usual but lose weight bc without energy sugar, muscle tissue and fat stores shrink.
What kind of appetite will someone with T1DM have?
Extreme hunger because without enough insulin into cells; childs muscles and organs lack NRG -> triggers hunger.
What is diabetic ketoacidosis?
Complication seen in T1DM. Without insulin, glucose cannot be used as fuel for cells. Thus, FFA -> Ketoacids in the liver -> causing acidosis. This results in:
- Labored breathing, which can cause abdominal pain.
- N/V
- Fruity breath
Does an enlarged thyroid (goiter) always have to cause physiological problems?
Such as altered levels of TSH, T3 and T4.
No. It can be euthyroid (non-toxic goiter).
For example, it can move the trachea to the side and cause difficulty breathing.
What is Pembertons sign?
Facial flushing and venous dilation when the arms are raised.
Indicated a goiter.
What are effects seen in hyperthyroidism?
Increase in BMR, weight loss, heat intolerance, palpitations and tachycardia.
Why are cardiac effects of hyperthyroidism important? (3)
- 1st sx noticed by pts
- 1st sx noticed by DOC
- Cause dz and death in the patient d/t CAH or cardiac arrest
What are effects seen in hypothyroidism?
- Mental and physical sluggish (slowing
- Weight gain
- Cold intolerance
- Decrease CO.
Why do goiters develop?
- Iodine deficiency,
- Goitrogens
- Genetics
- Alcohol, smoking, obesity/insulin resistance.