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Pathophysiology CVP 622 > Test 1 content-Endocrine > Flashcards

Flashcards in Test 1 content-Endocrine Deck (68)
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1

____ and ____ aren't totally perfused in total cpb and either cant ______ or make their usual contributions to _____

*Heart and lungs
*secrete hormones
*Drug metabolism

2

Exposure to pump, oxygenator and tubing does what?

*traumatizes cellular blood elements
*Causes plasma protein to be absorbed and removed from circulation
*Stimulates and immune response

3

_____ and ____ alter blood concentrations or electrolytes, hormones and serum proteins

hemodilution and anticoagulation

4

Hypothermia reduces rate of _____, which does what?

biochemical reactions which further alters hormonal responses

5

Physiological alterations during cpb w/ non pulsatile perfusion

*changes in blood flow distribution between organs
*Some hormonal alterations during bypass could be lessened or prevented by using pulsatile perfusion

6

How are stress hormones affected/altered on cpb?

stress hormone levels increase

7

Why is summarizing lit on endocrine, metabolic and electrolyte response difficult?

*Different pt populations
*Different techniques
-Cardoplegia
-perfusate temp
-priming solutions
-anesthetic and adjunct drugs

8

What portion of the pituitary gland secretes hormones?

What does the pituitary gland regulate?

*Anterior portion
*Regulate the adrenal cortex, thyroid, ovaries and testes

9

Gonadotropin responses during bypass
(not well analyzed or documented)

*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

10

What is pituitary apoplexy?

*Rupture of a tumor/bleeding
*Rare issue typically in patients w/ pituitary adenomas (tumors)

11

Diagnosis of pituitary apoplexy and what can be done?

(CPB alone doesnt lead to hypopituitarism)

*Confirmed w/ CT or MRI

*Hormonal replacement and prompt hypophysectomy (removal of pit. gland)

12

Posterior pit. gland secretes ___ and ____ and is a potent regulator of?

*Vasopressin or other ADH's

*Renal water excretion

13

What does ADH do?

*Increases renal vascular resistance and at high conc. increases peripheral vasc. resistance. and reduces renal BF.

14

What does ADH stimulate in connection w/ the coagulation cascade and what does that do?

*Stimulates the release of von willebrand factor
*Perhaps improving hemostasis during and after cardiac surgery

15

General anesthesia and surgery are associated w/ ______

Increases in ADH

16

Stimuli that provoke ADH release include:

*Plasma osmolarity, decreased blood volume or pressure, hypoglycemia, angiotensin, stress and pain

17

An exaggerated ADH response to bypass can occur during these times:

*Dec. in circulating BV upon initiating bypass
*Transient hypotension that can occur at initiation of bypass

18

_____ during CPB curbs the exaggerated ADH response particularly after bypass but doesn't stop it from happening

Pulsatile perfusion

19

At high conc. vasopressin (ADH):

*Increases peripheral vascular resistance
*Decreases cardiac contractility and coronary blood flow

20

Low systemic vascular resistance and high CO within the first 4 postop hours is what/

Vasoplegic syndrome

21

Vasoplegia is more likely in patients w/ ________

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

22

ADH concentrations ____ during CPB irrespective of anesthesia or the perfusion technique

Increase

23

Adrenal hormones catecholamines (products from adrenal medulla)

*NE
*EPI

24

Adrenal cortical hormones

*cortisol
*leptin
*adrenocorticotropic hormone

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