NMS Flashcards
1
Q
Total body water
A
65% Intracellular
35% Extracellular- 25% Interstitial, 10% Intravascular
2
Q
2/3 rule
A
Total body water comprises approximately 2/3 of body weight; of this, 2/3 is intracellular, and one third extracellular. Of the extracellular, 2/3 is interstitial, and 1/3 is intravascular.
3
Q
Blood volume
A
Approx. 7% of body weight
4
Q
Body water excreted
A
- urine- minimum = 0.5 mL/kg/hr
2. insensible loss (sweat, respiration, stool) = 600-900 mL/24 hr
5
Q
Fluid requirement
A
First 10 kg = 4 cc/kg/hr
Second 10 kg = 2 cc/kg/hr
1 cc/kg/hr for every kg above
6
Q
1/2 normal Saline (0.5% NaCl)
A
77 mEq/L Na+
77 mEq/L Cl-
Osmolarity = 154 mOsm/L
7
Q
Normal Saline (0.9% NaCl)
A
154 mEq/L Na+
154 mEq/L Cl-
Osmolarity = 308 mOsm/L
8
Q
Hypertonic Saline (3.0% NaCl)
A
513 mEq/L Na+
513 mEq/L Cl-
Osmolarity = 1027 mOsm/L
9
Q
Lactated Ringer’s
A
130 mEq/L Na+ 4 mEq/L K+ 2.7 mEq/L Ca++ 98 mEq/L Cl- 28 mEq/L Lactate
Osmolarity = 525 mOsm/L
10
Q
Plasmalyte
A
140 mEq/L Na+ 5 mEq/L K+ 3 mEq/L Mg++ 98 mEq/L Cl- 27 mEq/L Acetate 23 mEq/L Gluconate
Osmolarity = 294 mOsm/L
11
Q
Signs of acute volume loss
A
tachycardia
hypotension
decreased urine output
12
Q
Signs of gradual volume loss
A
loss of skin turgor
thirst
alterations in body temperature
changes in mental status
13
Q
Signs of acute hypervolemia
A
acute shortness of breath
tachycardia
complications- acute CHF
14
Q
Signs of chronic hypervolemia
A
peripheral edema
pulmonary edema
15
Q
hyponatremia
A
serum Na+ < 130 mEq/L
16
Q
Hyperosmolar hyponatremia
A
Dilutional
Causes: hyperglycemia, mannitol infusion, other osmotic particles present
Tx: correct hyperglycemia or other source
17
Q
Normo-osmolar hyponatremia
A
Pseudohyponatremia
Causes: hyperglycemia, hyperlipidemia, hyperproteinemia
Tx: none required
18
Q
Hypo-osmolar hyponatremia
A
True hyponatremia
Hypovolemic
Hypervolemic
Euvolemic
19
Q
Hypovolemic hypo-osmolar hyponatremia
A
most common
total body sodium low
hypovolemia = ADH secretion, decreased free water excretion
Increased intake of free water from thirst or infusion of hypotonic solution
Dx: Urine osmolarity HIGH, Na LOW
Tx: isotonic fluid infusion, Na+ replacement if deficit is severe
20
Q
Hypervolemic hypo-osmolar hyponatremia
A
total body sodium high
low cardiac output (less blood to kidneys, free water not excreted)
hypoalbuminemic (ex: cirrhosis) or other edematous state salt (Renin-angiotensin) and free water (ADH) cannot be excreted
Dx: Urine osmolarity HIGH, Na LOW
Tx: treat underlying medical condition, NaCl and free water restriction
21
Q
Euvolemic hypo-osmolar hyponatremia
A
syndrome of inappropriate antidiuretic hormone (SIADH)
can be stimulated by stress response to trauma and surgery.
free water retained
Dx: Urine osmolarity HIGH, urine Na HIGH
Tx: free water restriction
22
Q
Acute hyponatremia symptoms
A
acute cerebral edema
seizures
coma
23
Q
Chronic hyponatremia symptoms
A
usually well tolerated
confusion/decreased mental status
irritability
decreased deep tendon reflexes
24
Q
Hypernatremia
A
serum Na+ > 150 mEq/L
Sxs: volume depletion (tachy, hypotension)
dehydration (dry mucous membranes, decreased skin turgor)
lethargy
confusion
coma (water shift into intracellular in CNS)
25
Hypovolemia hypernatremia
volume deficit, more free water lost than Na+
Tx: calculate free water deficit
replace half within 8 hrs
second half over 16 hrs
26
Hypervolemia hypernatremia
iatrogenic infusion of too much sodium
rare
Tx: decrease Na+ infusion
free water infusion
diuretics
27
Free water deficit
= 0.6 x BW in kg x (pNA/140 - 1)
28
Hypokalemia
serum K+ < 3.5 mEq/L
Severe < 3.0 mEq/L or less
Sxs: ileus, weakness, respiratory failure, cardiac dysrhythmias
29
ECG changes in hypokalemia
seen when K+ < 3.0 mEq/L
```
T-wave flattening
T-wave inversion
depressed ST segments
U wave development
prolonged QT interval
ventricular tachycardia
```
30
Causes of hypokalemia
renal- diuretics, vomiting, renal tubular acidosis
extrarenal- diarrhea, burns
intracellular shift- insulin, alkalotic state
medical disease- hyperaldosteronism, cushing syndrome
31
Treatment of hypokalemia
every 10 mEq of K+ should increase serum concentration by 0.1 mEq/L
32
Hyperkalemia
serum K+ > 6 mEq/L
Sxs: diarrhea, cramping, nervousness, weakness, flaccid paralysis, cardiac dysrhythmias
33
ECG changes in hyperkalemia
peaked T waves
widened QRS
ventricular fibrillation
34
Causes of hyperkalemia
Renal failure with inappropriate consumption/admin of K+
Extracellular shift- rhabdomyolysis, massive tissue necrosis, metabolic acidosis, hyperglycemia
Medical disease-Addison's disease
35
Treatment of hyperkalemia
Acutely- IV Ca++, stablizes cardiac myocyte membrane to prevent dysrhythmias; glucose/insulin to shift K+ intracellularly; Bicarbonate to shift K+ intracellulary
Removal- ion-exchange resin (K-exylate) binds K+ in colon; Lasix only if kidneys can excrete; Dialysis
36
Respiratory acidosis
decreased ventilation relative to CO2 production, increased CO2 concentration
Causes: most common- decreased alveolar ventilation (respiratory depression, CNS disorder, physical), increased CO2 production (excess enteral carbs)
Tx: increase alveolar ventilation
37
Metabolic acidosis
loss of HCO3-, accumulation of strong anions, accumulation of weak acids
Causes: weak acid (anion gap; renal failure, lactic acidosis, DKA, toxins), strong anion (no gap; hyperchloremic acidosis), loss of bicarb (no gap; excess renal excretion, diarrhea)
Tx: underlying metabolic condition
bicarb only if pH < 7.2
38
Respiratory alkalosis
increase in alveolar ventilation with decrease in CO2 levels
Causes: anxiety, pain, shock, sepsis, toxins, CNS dysfunction, over ventilation
Tx: decrease ventilation, most self-limited
39
Metabolic alkalosis
pH over 7.45 and HCO3- > 26 mEq/L
causes: vomiting, diarrhea (loss of gastric contents), drugs that limit renal excretion of HCO3- (steroids, diuretics)
40
Primary hemostasis
Platelet adherence- glycoprotein Ib and vWF
Platelet activation- produce thromboxane A2 (vasoconstrict); Glycoprotein IIb/IIIa expressed for platelet-platelet adhesion (fibrinogen needed)
41
Extrinsic pathway
Tissue Factor (TF) binds Factor VII -> VIIa acivates Factor X -> Xa converts prothrombin -> thrombin (Va cofactor) -> fibrinogen -> fibrin
XIIIa mediates cross linking of fibrin
42
Intrinsic pathway
Factor XIIa activates XI -> XIa activates IX -> IXa activates X -> Xa converts prothrombin -> thrombin (Va cofactor) ->fibrinogen -> fibrin
XIIIa mediates cross linking of fibrin
43
Protein C and S
degrade factors V and VIII
44
Antithrombin III
inhibits thrombin-Xa complexes
45
Fibrinolysis
t-PA and urokinase-type plasminogen activator (uPA) convert plasminogen -> plasmin which cleaves fibrin
46
Prothrombin time (PT)
measures extrinsic cascade
measurement of vitamin K-dependent coag factors (II, VII, X)
used to monitor warfarin therapy
47
Activated partial thromboplastin time (aPTT)
measures intrinsic cascade
used to monitor pts on IV unfractionated heparin
48
Hemophilia A
Factor VIII deficiency
49
Hemophilia B
Factor IX deficiency
50
von Willibrand disease
most common congenital coagulopathy (1-2%)
vWF deficiency, treated with intranasal/IV DDVAVP
51
Clean wound
incision made under sterile conditions, nontraumatic procedure, does not enter bowel, tracheobronchial tree, genitourinary system, or oropharynx
should be closed primarily, infection rate less than 2%
52
Clean-contaminated wound
bowel, tracheobronchial tree, genitourinary system, or oropharynx was entered under sterile conditions. No evidence of active infection
should be closed primarily, infx rate 3-4%
53
Contaminated wound
major contamination of wound during procedure (ex: stool from colon), fresh traumatic wounds
should be left open, infx rate 7-10%
54
Dirty and infected wounds
established infection present before procedure (ex: appendiceal abscess)
should be left open, infx rate 30-40%
55
Normal wound healing phases
1. Coagulation phase
2. Inflammatory phase ~ 1 wk
a. cellular- PMN (24-48 hr) and macrophages remove necrotic tissue and debris; epithelial bridging
b. vascular- angiogenesis
c. mediators
3. Proliferative phase- fibroblasts form collagen, wound strength increases, wound contraction, 3 wks
4. Wound remodeling- scar formation
56
Primary closure
skin edges approximated shortly after wound incurred
57
Secondary intention
wounds with risk or current infection left open, heal by epitheliazation and wound contraction
58
Delayed primary closure
heavily contaminated wounds, left open 3-5 days, then primarily closed
59
Skin grafts
graft contains epidermis and portion of dermis, provide epithelial coverage for healing
60
Flaps
Rotation flap- retains normal blood supply, rotated to fill in a defect
Free flap- removed from normal blood supply, moved to another area, vasuclature reanastomosed (ex: toe to hand to form thumb)
61
Fick equation
to determine caloric requirements
cardiac output x arterial-venous oxygen content difference = oxygen consumption
62
Systemic vascular resistance (SVR)
SVR = [(MAP - CVP)/CO] x 80
| normal: 800-1200 dynes.sec/cm5
63
Pulmonary vascular resistance (PVR)
PVR = [(MPAP - PCWP)/CO} x 80
| normal: 20-120 dynes.sec/cm5
64
Dopamine
low dose (1-3 ug/kg/min)- receptors in kidney and intestine, increases blood flow
med dose (3-10 ug/kg/min)- beta receptor agonist, increase in cardiac contractility, incr CO
high dose (>10 ug/kg/min)- alpha agonist and vasoconstrictor
65
Dobutamine
affects both beta-1 and -2 receptors, increase in cardiac output, vasodilation
66
Norepinephrine
alpha agonist, vasoconstriction, mild beta activity, some increase in cardiac contractility
67
Epinephrine
alpha agonist, some beta agonist effect. vasoconstriction and increased cardiac output
68
Phenylephrine
alpha agonist, pure arterial constriction
69
Nitroprusside
primarily arterial vasodilator
reflex tachy, metabolite is cyanide
70
Nitroglycerin
primarily venodilator, coronary artery dilator
71
Shock
inadequate tisse perfusion to maintain normal cellular metabolism
72
Hypovolemic shock
most common type of shock, hemorrhage most common cause. perfusion defect due to blood loss (decreased preload) -> decreased CO
loss of RBC volume reduces O2 carrying capacity (Hgb)
Tx: volume replacement (2 x IV), stop blood loss
73
Cardiogenic shock
inadequate cardiac performance -> decreased CO
most commonly related to MI, also CHF, valvular disease
central venous pressures are elevated
Tx: inotropic support (dopa or dobutamine), nitro to reverse cardiac ischemia
74
Neurogenic shock
loss of sympathetic tone -> peripheral vasodilation -> relative hypovolemia, decreased cardiac performance
can be result of vasovagal response, cervicothoracic spinal cord injury, spinal anesthesia
Tx: volume resuscitation, consider phenylephrine or NEpi if unresponsive to volume replacement
75
Septic shock
toxins released by microbes -> hyperinflammatory derangements, hypovolemia, cardiac dysfunction, vasodilation
Tx: volume resuscitation, central venous access, consider dobutamine if SvO2 < 70%, consider NEpi or dopa if MAP < 65 mmHg
76
Obstructive shock
physical obstruction that decreases cardiac output (ex: tension pneumo, cardiac tamponade, massive PE, venous air embolism)
Tx: volume resuscitation, correct underlying condition.
77
Miscellaneous shock
cyanide toxicity, severe hypoxia, normovolemic severe anemia, profound hypoglycemia, anaphylaxis
78
Carcinoma
malignancy from epithelium
79
Adenocarcinoma
malignancy from epithelium with glandular component
80
Sarcoma
malignancy from mesodermal tissues
81
Steps necessary for malignancy
1. expression of cell adhesion molecules
2. produce extracellular matrix molecules
3. produce cytoskeletal proteins for motility
4. produce angiogenic factors for neovascularization
82
Classic symptoms of cancer
```
CAUTION
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
```
83
Postop fever
1. Wind - post op days 1-3
2. Water - UTI, post op days 3-5
3. Wound infections - post op days 5-8
4. Walk - venous complications
5. Wonder drugs
84
Indications for operative repair of fistula
```
FRIEND
Foreign body at fistula
Radiation injury
Injured bowel or inflammatory bowel disease
Epithelialization of fistula tract
Neoplasia or cancer
Distal obstruction beyond fistula
```
85
symptomatic anemia
```
tachycardia
oliguria
hypotension
fatigue
syncope
tachypnea
dyspnea
transient ischemic attack
```
86
preoperative risk factors for mortality in noncardiac surgery
```
Admission serum albumin
ASA class
Disseminated cancer
Emergency operation
Age
Blood urea nitrogen (BUN) > 40 mg/dL
DNR orders
Operation complexity score
SGOT > 40 IU/mL
Weight loss > 10% in 6 months
Functional status
WBC > 11,000/mm3
```
87
Perioperative pulmonary edema
Causes: Volume overload
Cessation of positive pressure ventilation (increase in preload)
Anesthetic induced myocardial depression
Postop HTN
70% develop within first hour after surgery
88
Indications for emergent dialysis
```
AEIOU
metabolic Acidosis, can't give bicarb
Electrolyte - hyperkalemia
Intoxication of medication
volume Overload, severe
Uremia - pericarditis, mental status changes, asterixis
```
89
Anterior mediastinum
from sternum to pericardium
| contains thymus, lymph nodes, ascending and transverse aorta, great veins
90
Visceral mediastinum
from pericardium to anterior longitudinal spinal ligament
| contains pericardium, heart, trachea, hilar structures of lung, esophagus, phrenic nerves, lymph nodes
91
Paravertebral sulci
potential spaces
| contain sympathetic chains, intercostal nerves, descending thoracic aorta
92
Immediate life-threatening thoracic injuries
1. Airway obstruction
2. Tension pneumothorax
3. Open pneumothorax
4. Massive hemothorax
5. Cardiac tamponade
6. Flail chest
93
Potentially life-threatening thoracic injuries
1. Tracheobronchial disruption
2. Aortic disruption
3. Diaphragmatic disruption
4. Esophageal disruption
5. Cardiac contusion
6. Pulmonary contusion
94
Most common chest wall deformity
Pectus excavatum (funnel chest)
95
Poland's syndrome
unilateral absence of costal cartilages, pectoralis muscle, and breast
96
Thoracic outlet syndrome (TOS)
compression of neurovascular bundle at thoracic outlet. Brachial plexus compression occurs most offen, vascular compression less frequently
97
Common metastatic pulmonary tumors
Colorectal
Breast
Melanoma
Renal
98
Anterior mediastinum mass
```
4 T's
Thymoma
Teratoma - from branchial cleft pouch
Terrible Lymphoma
Tumor- Germ cell (seminoma, embryonal cell carcinoma, teratocarcinoma, choriocarcinoma, endodermal sinus)
```
99
Classic triad of mitral stenosis
apical diastolic rumble
opening snap
loud first heart sound
100
Coronary artery disease risk factors
```
HTN
Smoking
Hypercholesterolemia
Family history of heart disease
DM
Obesity
```
101
Stable angina
Unchanged for a prolonged period
102
Unstable angina
recent change from previously stable pattern, includes new-onset angina
103
Angina at rest
unprovoked by activity
104
Graft of choice for CABG
Internal mammary artery (IMA) - 90% 10 year patency
105
Tumors with mets to heart
Melanoma
Lymphoma
Leukemia
106
Acute pericarditis
```
Bacterial infection
Viral infection
Uremia
Traumatic hemopericardium
Malignant disease
Connective tissue disorders
```
107
Most common congenital heart defect
Ventricular septal defects (conoventricular most common)
108
Eisenmenger's syndrome
Development of higher pulmonary vascular resistance that leads to reversal of flow across ventricular septal defect
109
Tetralogy of Fallot
1. Obstruction of right ventricular outflow
2. Ventricular septal defect (VSD)
3. Hypertrophy of right ventricle
4. Overriding aorta
110
wet gangrene
infection within nonviable tissue
111
Pentoxifylline
for intermittent claudication
reduces blood viscosity by decreasing plasma fibrinogen and platelet aggregation
GI upset
112
Leriche syndrome
buttock and thigh claudication
absent femoral pulses
impotence (males)
113
Acute lower extremity ischemia
"5 P's"
1. Pain
2. Pallor
3. Paralysis
4. Paresthesias
5. Pulselessness
114
Thrombolytic contraindications
```
sensory and motor changes on presentation
recent surgery (< 2 wks)
known intracranial pathology
```
115
Acute mesenteric ischemia
surgical emergency, 80% mortality
severe abd pain, out of proportion to PE findings
caused by: embolization, thrombosis, nonocclusive ischemia (ex: cardiogenic shock)
116
Riolan's arch
collateral blood supply between SMA and IMA
117
most common causes of renal artery stenosis
atherosclerosis
| fibromuscular dysplasia
118
risk factors for AAA
Age
Smoking
HTN
Family history
Men > Women 4:1
119
Ruptured AAA Dx
```
1 Severe pain
2 Pulsatile, tender abdominal mass
3 Shock (elevated HR, unstable BP, or syncope)
```
120
Ischemic cholitis
suspect with post-op diarrhea, stool is heme +
Tx: Hartmann's procedure: resect necrotic colon, proximal colostomy, distal closure
121
Artery supply to spinal cord
artery of Adamkiewicz, arises between T8-T12
122
classic anterior spinal artery syndrome
Paraplegia
Rectal and urinary incontinence
Loss of pain and temp sensation
Preservation of vibratory and proprioceptive sensation
123
Raynaud's phenomemnon
associated with scleroderma and collagen vascular diseases.
124
Milroy's disease
Lymphedema that is both congenital and hereditary
125
Chief cells
found in fundus of stomach
secrete pepsinogen -> pepsin
stimulated by cholinergic impulses, gastrin, secretin
126
Oxyntic/Parietal cells
found in body/fundus of stomach
produce hydrochloric acid and intrinsic factor
stimulated by gastrin
127
G cells
found in antrum of stomach
| secrete gastrin
128
Carcinoid syndrome
flushing
diarrhea
bronchoconstriction
tricuspid and pulmonary valve disease
only in pts with liver mets or primary extraintestinal carcinoid
129
Crohn's disease surgery indications
intestinal obstruction- most common
abscesses and fistulas
perforation, hemorrhage, intractible sxs- less common
130
most common diverticulum of GI tract
Meckel's diverticulum
2 ft from ileocecal valve
131
Familial Adenomatous Polyposus
autosomal dominant
| mutation of APC gene on chrom 5
132
Amsterdam criteria for HNPCC
Three+ relatives with colon cancer (1 first deg)
Colorectal carcinoma in 2+ generations
1+ diagnosed before age 50
133
Colon cancer risk factors
```
Family history
Ashkenazi Jews
Personal history of colorectal cancer
Personal history of colorectal polyps
Chronic inflammatory bowel disease (UC>Chr)
Age > 50
Diet (high fat, low fruit/veg, high calcium)
low activity level
Obesity
DM
Smoking
EtOH
```
134
most sensitive indicator of recurrent colorectal cancer
CEA- glycoprotein secreted by colorectal tumors
if rising- CXR and abd CT
(nonspecific, also high in cirrhosis, pancreatitis, renal failure, UC, other cancer, smoking)
135
fulminant colitis with toxic megacolon
Dilation of transverse colon
Abdominal pain, tenderness, distention
Fever, leukocytosis, hypoalbuminemia
Risk of colonic perforation
136
serologic markers for IBD
pANCA (UC)
| ASCA (CD)
137
Sulfasalazine
main medical treatment for UC
138
Sclerosing cholangitis
UC > CD
139
Immunosuppressives for IBD
6-Mercaptopurine
Azathioprine
Methotrexate
IV cyclosporine
140
most common benign hepatic tumor
Hemangioma
141
benign hepatic tumor strongly associated with oral contraceptives and androgenic steroid use
Hepatocellular adenoma
142
sulfer-colloid scan
distinguish between Focal Nodular Hyperplasia and a hepatocellular adenoma: FNH takes up sulfer-colloid, adenoma does not
143
benign hepatic tumor of children
Infantile Hemangioendothelioma
| has malignant potential
144
Most common primary malignant tumor of liver
Hepatocellular carcinoma
145
risk factors for hepatocellular carcinoma
Chronic hep B
Cirrhosis
Hemochromatosis
Schistosomiasis and other parasitic infection
Carcinogens- polycholirnated bipheyls, chlorinated hydrocarbos, vinyl chloride, nitrosamines
146
most common primary malignant liver tumor in children
Hepatoblastoma
147
tumor from bile duct epithelium
Cholangiocarcinoma
148
Pringle maneuver
control and compression of porta hepatis
| used for hemostasis after liver trauma
149
Vasopressin
potent vasoconstrictor, lowers portal pressure
150
Somatostatin
causes splanchnic vasoconstriction, fewer side effects than vasopressin
151
TIPS
Transjugular intrahepatic portosystemic shunt
| between a hepatic vein and a branch of the portal vein
152
Salt and water retention in liver failure
Due to hyperaldosteronism -> decreased aldosterone breakdown by liver
Tx: diuretics, especially aldosterone antagonists
153
Increase bile flow
```
Vagal and splanchnic stimulation
Secretin
Theophylline
Phenobarbital
Steroids
```
154
Release of bile
Colecystokinin (CCK)- humoral control
| vagal and splanchnic nerves also contribute
155
Acalculous cholecystitis
acute or chronic cholecystitis in the absence of stones
acute from burns, sepsis, trauma, or collagen vascular disease
chronic also called biliary dyskinesia
156
Turner's sign
flank eccchymoses from blood dissection of flank tissues
| sign of retroperitoneal hemorrhage from sever pancreatic inflammation and necrosis
157
Cullen's sign
periumbilical ecchymosis from blood dissection up falciform ligament
158
Adrenal cortex
zona glomerulosa- mineralocorticoids (aldosterone)
zona fasciculata- glucocorticoids (cortisol)
zona reticularis- androgens and estrogens
159
Superior parathyroid origin
fourth branchial pouch
close to origin of thyroid
abnormal location- within thyroid, or posterior mediastinum
160
Inferior parathyroid origin
third branchial pouch
| close to thymic anlage, cross superior in descent
161
Tx for symptomatic hypocalcemia
IV Ca2+ gluconate (severe)
162
Thymus embryology
Third branchial pouch
| descends into anterosuperior mediastinum
163
Sxs of myasthenia gravis
```
ptosis
double vision
dysarthria
dysphagia
nasal speech
weakness of arms and legs
```
164
Path of myasthenia gravis
autoantibodies against ACh receptors
165
Tx of MG
Medically- neostigmine, pyridostigmine (drugs that stimulate NMJ)
Surgically- thymectomy
- post-op plasmapharesis
166
MEN I
Hyperparathyroidism
Pancreatic tumors (nonbeta islet cell- ZE synd)
Pituitary tumors
167
Sxs of MEN I
hypercalcemia
hypoglycemia
peptic ulcer (pancreatic gastrinoma)
pituitary mass complaints
168
MEN 2A
Medullary thyroid carcinoma (medullary hyperplasia of C cells- increased calcitonin)
Pheochromocytomas (B/L)
Parathyroid hyperplasia
169
MEN 2B
Medullary thyroid carcinoma
Pheochromocytomas
Marfanoid/multiple mucosal neuromas
170
APUD cells
Amine Precursor Uptake Decarboxylation cell system
171
APUDomas
```
Insulinomas
Gastrinomas (Z-E synd)
Glucagonomas
VIPomas (vasoactive intestinal peptide)
Somatostatinomas
```
172
Pancreatic cholera (WDHA syndrome)
Watery Diarrhea
Hypokalemia (high potassium in stool from hypersecretion)
Achlorhydria
severe diarrhea due to hypersecretion of a pancreatic nonbeta islet cell tumor
