Endocrine Metabolic Disorders

Question 1

The four types of cells found in the islets of Langerhans include:

Answer 1

delta, PP (pancreatic polypeptide), alpha, and beta

Question 2

Beta cells compose

Answer 2

60-70% of the islet mass and secrete the hormone insulin

Question 3

Alpha cells compose

Answer 3

25% of the islet cells and secrete the hormone glucagon

Question 4

The delta cells secrete

Answer 4

somatostatin

Question 5

Hormones are classified in three major groups:

Answer 5

peptides or proteins: insulin, glucagon
amino acid: dopamine & epi
steroids: lipid soluble derived from cholesterol ex. estrogen, progesterone

Question 6

In the liver, insulin promotes

Answer 6

the storage of excess glucose in the form of glycogen (glycogenesis)

Question 7

______ is the key hormone controlling glucose removal from the plasma, it facilitates the transport of glucose by stimulating uptake into liver, muscle, and adipose tissue.

Answer 7

Insulin

Question 8

Insulin is synthesized within the

Answer 8

beta cells and released via exocytosis to the capillary then it enters portal circulation

Question 9

The half-life of insulin is

Answer 9

5 to 8 minutes

Question 10

The major degradation sites of insulin are the

Answer 10

liver and kidney

Question 11

Pancreatitis is the

Answer 11

inflammation of the pancreas which is commonly caused by gallstones & alcohol
-can also be caused by trauma such as ERCP, obstruction, and certain meds

Question 12

Clinical presentation of pancreatitis is

Answer 12

abdominal pain, N/V, & febrile

Question 13

Anesthesia considerations for pancreatitis include:

Answer 13

early hydration is recommended, pain medications & electrolytes should be monitored, & patient should be NPO until pain and inflammation has resolved

Question 14

Complications of pancreatitis include

Answer 14

pancreatic necrosis- cell death secondary to inflammation

Question 15

Labs with pancreatitis include

Answer 15

elevated WBC and possible ARF, liver dysfunction and electrolyte abnormalities

Question 16

The most common complication of chronic pancreatitis is

Answer 16

pancreatic pseudocyst- contains only fluid

Question 17

The fourth most common cause of cancer deaths in the US is due to

Answer 17

pancreatic cancer

Question 18

There is a correlation between _______ and pancreatic cancer

Answer 18

obesity, smoking, and chronic pancreatitis

Question 19

Symptoms of pancreatic cancer include

Answer 19

abdominal pain, weight loss, pain suggests retroperitoneal invasion and jaundice indicates biliary obstruction

Question 20

The only effective treatment for pancreatic cancer is

Answer 20

surgical resection
-patients with tumors in the head of the pancreas develop painless jaundice and are usually candidates for surgical resection
most common technique is pancreatectomy or a whipple

Question 21

Cystic fibrosis is an

Answer 21

autosomal recessive disorder and is a mutation of chromosome 7; this results in defective chloride ion transport in the epithelial cells in the lungs, pancreas, liver, GI, & reproductive organs

Question 22

The primary cause of morbidity and mortality in cystic fibrosis is

Answer 22

chronic pulmonary infection

Question 23

In cystic fibrosis, decreased chloride leads to

Answer 23

decreased transport of Na & H2O which causes viscous secretions that contribute to luminal obstruction and scarring of exocrine glands

Question 24

With cystic fibrosis, elective surgical procedures

Answer 24

should be delayed until optimal pulmonary function is obtained

Question 25

Describe appropriate pharmacologic management of the patient with cystic fibrosis.

Answer 25

volatile agents decrease airway pressure by decreasing bronchial smooth muscles and decreasing hyperactive airways it is recommended to avoid anticholinergic drugs to maintain secretions in a less viscous state requires frequent suctioning, bronchodilators & deep sedation

Question 26

Type 1 diabetes is caused by

Answer 26

T cell mediated autoimmune destruction of beta cells in the pancreas -at least 80-90% of beta cell function must be lost before hyperglycemia occurs

Question 27

Diagnosis of type 1 diabetes is through

Answer 27

BG >200, & hgA1c more than 7

Question 28

The most associated complication of type 1 diabetes is

Answer 28

DKA

Question 29

Patients with type 1 diabetes will present with

Answer 29

hyperglycemia, fatigue, weight loss, polyuria, blurred vision, and intravascular volume depletion

Question 30

Type 2 diabetes causes

Answer 30

insulin resistance & beta cell insufficiency

Question 31

Insulin resistance in type 2 diabetes causes

Answer 31

circulating free fatty acids, cytokines, insulin antagonist & target tissue defects at insulin receptors

Question 32

Impaired glucose in type 2 diabetes is associated with

Answer 32

increased body weight, decreases in insulin secretions and reduction in peripheral insulin action

Question 33

Increased insulin levels may

Answer 33

desensitize target tissues, causing a decreased response to insulin

Question 34

Symptoms of type 2 diabetes include

Answer 34

polyuria, polydipsia fatting glucose of >126 2 hour plasma glucose level >200 during oral glucose test

Question 35

List the factors that contribute to insulin resistance

Answer 35

abdominal obesity excess calorie consumption lack of exercise genetic susceptibility

Question 36

Side effects of diabetes include

Answer 36

strokes, fatigue, lack of energy, pancreas malfunction

Question 37

Describe the factors that contribute to metabolic syndrome.

Answer 37

visceral obesity, insulin resistance, high triglycerides, low HDL-cholesterol, HTN, & procoagulant state

Question 38

Metabolic syndrome of insulin resistance is typically seen in patients with

Answer 38

type 2 DM

Question 39

Metabolic syndrome is diagnosed with at least three of the following:

Answer 39

fasting glucose level >110 abdominal waist 40 inches in men and 35 inches in women triglyceride level >150 HDL<40 mg/dL in men, and 50 mg/dL in women blood pressure >130/85

Question 40

Three life threatening complications of diabetes include

Answer 40

DKA, HHS, & hypoglycemia

Question 41

DKA is most commonly caused by

Answer 41

infection

Question 42

Describe how DKA occurs.

Answer 42

decreased insulin leads to catabolism of free fatty acids into ketones

Question 43

Treatment of DKA consists of

Answer 43

correcting hypovolemia, hyperglycemia and total body potassium deficit when glucose moves intracellular so does potassium so it is critical to monitor frequent labs

Question 44

If a patients BIS severely drops off

Answer 44

it may be a result of severe hypoglycemia

Question 45

Compare the symptoms of DKA vs. HHS.

Answer 45

DKA: polyuria, dyspnea, & N/V HHS: polyuria, polydipsia, confusion & lethargy

Question 46

Describe the four major classes of oral antidiabetic medications:

Answer 46

sulfonylureas, Biguanides (metformin), glitazones, & glucosidase inhibitors (acarbose, miglitol)

Question 47

_________ have long half lives and are often discontinued 24-48 hours prior to surgery

Answer 47

sulfonylureas & metformin

Question 48

_______ are usually the initial treatment for type 2 diabetes

Answer 48

sulfonylureas; | MOA stimulates insulin secretion from pancreatic beta cells

Question 49

Second generation agents for DMII include

Answer 49

glyburide glipizide | most potent and side effects are hypoglycemia

Question 50

Oral medications may cause

Answer 50

harmful cardiac side effects -these drugs may inhibit myocardial protection by decreasing ATP channels in the myocardium which leads to a larger myocardial infarction

Question 51

_______ decrease hepatic gluconeogenesis and enhance glucose utilization across the cell membranes

Answer 51

biguanides

Question 52

The most serious side effect of oral medications is

Answer 52

lactic acidosis- this can occur if too much metformin accumulates due to acute or chronic dehydration

Question 53

Adults secrete about ____ units of insulin

Answer 53

50 units of insulin each day from the beta cells

Question 54

The most important anabolic hormone is

Answer 54

insulin

Question 55

Insulin facilitates ___________ into the adipose and muscle cells therefore increasing glycogen, protein, and fatty acid synthesis and decreasing glycogenolysis and gluconeogensis

Answer 55

glucose & potassium

Question 56

Describe the different types of insulin

Answer 56

Intermediate: NPH, lente, lispro protamine Short acting: regular rapid acting: lispro & apart long acting: glargine & ultralente

Question 57

Systematic manifestations of hypoglycemia include

Answer 57

diaphoresis, tachycardia, and nervousness

Question 58

_______ will mask the signs of hypoglecmia

Answer 58

General anesthesia; treatment would be to give 50% dextrose

Question 59

The _____ depends on glucose as an energy source which makes it the most susceptible to hypoglycemia. If not treated, _____ may occur

Answer 59

brain | mental status changes, anxiety, lightheaded, and coma may occur

Question 60

Aggressive preoperative glucose control has been shown to

Answer 60

limit the infection, improve wound healing, and decrease in morbidity and mortality

Question 61

Anesthetic management of the patient with DM includes

Answer 61

cervical spine mobility should be assessed preoperatively in diabetic patients to reduce the risk of unanticipated difficult intubation positive prayer sign represents cervical spine immobility

Question 62

Insulinoma is a

Answer 62

benign pancreatic tumor that occurs in women twice as often than as in men

Question 63

The diagnosis of insulinoma is via

Answer 63

whipple's triad: hypoglycemia with fasting, glucose of less than 50 with symptoms, relief of symptoms with administration of glucose

Question 64

Patients with insulinoma will be managed in preop with

Answer 64

diazoxide which inhibits insulin from beta cells | surgical intervention is the treatment

Question 65

When performing surgery on the patient with insulinoma,

Answer 65

intraoperative hypoglycemia may occur and then hyperglycemia after the tumor is removed

Question 66

Signs of diabetic neuropathy include

Answer 66

HTN, painless myocardial ischemia, reduced HR to atropine or propranolol, resting tachycardia, lack of sweating

Question 67

Diabetic patients may have an increased risk of

Answer 67

ST segment and T wave abnormalities | having a history of HTN & DM increases the likelihood diabetic autonomic neuropathy

Question 68

Diabetic neuropathy may limit the ability to

Answer 68

compensate & may predispose the patient to CV instability

Question 69

The goal of intraoperative blood glucose management is to avoid

Answer 69

hypoglycemia while keeping blood glucose below 180 mg/dL

Question 70

Hyperglycemia has been associated with

Answer 70

infection, poor wound healing, & increased mortality, & it worsens neuro outcomes

Question 71

The stress of surgery causes increases in

Answer 71

counter regulatory hormones and inflammatory mediators which contribute to stress hyperglycemia