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AS - N935 Advanced Patho II > Endocrine - Metabolic > Flashcards

Endocrine - Metabolic Flashcards

(52 cards)

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1
Q

Islet of Langerhans

A

1-2% pancreas weight
Hormone produced & secreted into capillary blood vessel
Venous blood from islet drains into hepatic portal vein & then into general circulation
4 types α β Δ & pancreatic polypetide

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2
Q

Pancreas

A

α 25% islet cells & secrete glucagon
β 60-70% islet mass & secrete insulin
Δ cells secrete hormone somatostatin

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3
Q

Peptides or Proteins

A

Insulin - facilitates glucose transport

Glucagon

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4
Q

Amino Acids

A

Dopamine
Epinephrine
Norepinephrine

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5
Q

Steroids

A

Lipid soluble derived from cholesterol

Estrogen or progesterone

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6
Q

Insulin Half-Life

A

5-8 minutes

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7
Q

Insulin Degradation

A

Liver & kidney

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8
Q

What does not require insulin or glucose?

A

Brain

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9
Q

Glucose Storage

A

Liver insulin promotes

Excess glucose → glycogen (via glycogenesis)

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10
Q

Pancreatitis

A

Pancreas inflammation

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11
Q

Pancreatitis Causes

A

Gallstone & alcohol

Trauma - ERCP, obstruction, & medications

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12
Q

Pancreatitis S/S

A

Abdominal pain
N/V
Febrile

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13
Q

Pancreatitis

Anesthetic Considerations

A

Hydration
Pain management
Monitor electrolytes
NPO until pain & inflammation resolved

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14
Q

Pancreatitis Preop

A

↑WBC
Liver dysfunction
Electrolyte abnormalities

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15
Q

Pancreatitis Complications

A

Pancreatitis necrosis - cell death 2° inflammation

Pancreatic pseudocyst

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16
Q

Pancreatic Pseudocyst

A

Contains only fluid

Most common complication d/t chronic pancreatitis

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17
Q

Pancreatic Cancer

A

4th most common cancer in US

Correlation b/w obesity, smoking, & chronic pancreatitis

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18
Q

Pancreatic Cancer S/S

A

Abdominal pain
Weight loss
Pain suggests retroperitoneal invasion
Jaundice indicates biliary obstruction

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19
Q

Pancreatic Cancer

Treatment

A 
Surgical resection
Painless jaundice → pancreas head tumor
Pancreatectomy or Whipple 
Surgical 5 year survival 10%
Non-surgical 5mos
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20
Q

Cystic Fibrosis

A

Autosomal recessive disorder
Chromosome 7 mutation
Results in defective chloride ion transport in lungs, pancreas, liver, GI, & reproductive organs epithelial cells
↓Cl¯ ↓Na+/H2O → viscous secretions → luminal obstruction & exocrine gland scarring
1° morbidity & mortality cause = chronic pulmonary infection

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21
Q

CF Anesthetic Considerations

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A

Delay elective surgical procedures until obtain optimal pulmonary function
Volatile agents ↓airway pressure via ↓bronchial smooth muscle & hyperactive airways
Avoid anticholinergic drugs to maintain secretions in less viscous state (thin)

22
Q

Type 1 Diabetes

Study These Flashcards
A

T-cell mediated autoimmune pancreas β cell destruction

80-90% β cell function lost before hyperglycemia occurs

23
Q

T1D S/S

Study These Flashcards
A

Hyperglycemia, fatigue, weight loss, polyuria, blurred vision, & IV volume depletion
Polyuria/polydipsia/polyphagia

24
Q

T1D

Diagnosis

Study These Flashcards
A

Blood glucose >200mg/dL

HbA1C >7

25
Diabetic Ketoacidosis
Blood glucose >250mg/dL | Most commonly associated w/ T1D
26
Type 2 Diabetes
β cell insufficiency & insulin resistance Insulin resistance → circulating free fatty acids, cytokines, insulin antagonist, & target tissue defects at insulin receptors Impaired glucose associated w/ ↑body weight, ↓insulin secretion, & reduction in peripheral insulin action ↑insulin level desensitizes target tissues ↓insulin response Polyuria/polydipsia/polyphagia
27
T2D S/S
Polyuria, polydipsia, weight loss Fasting glucose >126mg/dL 2 hour plasma glucose level >200 during oral glucose test
28
What factors contribute to insulin resistance?
Abdominal obesity Excess calorie consumption Lack exercise Genetic susceptibility
29
Metabolic Syndrome
``` Insulin resistance Visceral obesity Low HDL cholesterol HTN ↑triglycerides ```
30
Metabolic Syndrome S/S
``` Fasting glucose >110mg/dL Abdominal waist >40in (M) or >35in (F) Triglyceride >150 HDL <40mg/dL (M) or <50mg/dL (F) Blood pressure > 130/85 ```
31
Diabetes Complications
``` DKA Hyperosmolar hyperglycemic state Hypoglycemia - diaphoresis, tachycardia, & nervous (general anesthesia masks S/S) Monitor electrolytes Impaired mental status Anxiety Lightheaded Coma ```
32
DKA
Most commonly caused by an infection ↓insulin → free fatty acids catabolism → ketones ABSOLUTE ↓insulin → hyperglycemia Polyuria, dyspnea, N/V
33
HHS
RELATIVE ↓insulin → hyperglycemia Glycogenolysis & gluconeogenesis → osmotic diuresis Polyuria, polydipsia, confusion, lethargy
34
Oral Antidiabetics
Sulfonylureas Biguanides (Metformin) Glitazones Glucosidase inhibitors
35
Insulin Secretion
50 units/day (adults)
36
Insulin Functions
Facilitates glucose & K+ into adipose & muscle cells ↑glycogen, protein, & fatty acid synthesis ↓glycogenolysis & gluconeogenesis, lipolysis, & catabolism
37
Short Acting Insulin
Regular | ONLY IV
38
Rapid Acting Insulin
Lispro & apart
39
Intermediate Acting Insulin
NPH Lispro protamine Lente
40
Long Acting Insulin
Glargine | Ultralente
41
Diabetes Preop
+ prayer sign indicates cervical spine immobility (unable to align palms flat) Potential difficult intubation T1D 30%
42
Diabetes Anesthetic Considerations
Glycemia control to prevent infection, improve wound healing, & ↓morbidity/mortality Assess cervical spine mobility
43
Insulinoma
Benign pancreatic tumors | Women 2x
44
Insulinoma Diagnosis
Whipple's triad - Hypoglycemia w/ fasting - Symptomatic glucose <50mg/dL - Symptom relief w/ glucose admin
45
Insulinoma Anesthetic Considerations
Preop management w/ Diazoxide (inhibits insulin release from β cells) Treatment = surgical intervention Monitor blood glucose intraop Hyperglycemia after tumor removed Continue to monitor blood glucose under general anesthesia hypoglycemia S/S masked under GA
46
Diabetic Neuropathy S/S
Hypertension Painless myocardial ischemia Reduced HR response to Atropine & Propranolol Resting tachycardia Lack diaphoresis ↑risk ST segment & T wave abnormalities Limited ability to compensate → cardiovascular instability (post-induction hypotension or sudden cardiac death)
47
Intraop Blood Glucose Management
Avoid hypoglycemia Maintain blood glucose <180mg/dL Dependent on patient baseline
48
Hyperglycemia associated w/ ______
Infection Poor wound healing ↑mortality Worse neuro outcomes
49
Surgical Stress Response
↑counter regulatory hormones | ↑inflammatory mediators → stress hyperglycemia
50
Hs
``` Hypoglycemia Hypovolemia Hydrogen ions Hypoxia Hypothermia Hyper/hypokalemia ```
51
Ts
``` Thrombosis Toxins Tamponade (cardiac) Trauma Tension pneumothorax ```
52
Hyperkalemia Treatment
Insulin 10 units 50% dextrose Bicarbonate Calcium gluconate - stabilizes the myocardium via lowering threshold potential Kayexalate Albuterol β agonist shifts K+ intracellular

AS - N935 Advanced Patho II (20 decks)

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