Flashcards in Test #2 Endocrine ARTICLES - Dwayne Deck (66):
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Glucogneogenesis?
The break down of fat and muscle for energy
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Glycogenolysis?
The breakdown of glycogen into glucose
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Type 2 Diabetes
Non insulin dependent
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Type 1 Diabetes
Insuiln dependent
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Type 2 diabetes sub catagories
Obese and nonobese
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Slow progressing adult insulin dependent DM is called?
(LADA) Latent autoimmune diabetes adult
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The highest percent of those that have DM have what type?
Type 2
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Signs and symptoms of DM
polydipsia, polyuria, polyphagia, tiredness, irritability, fungal infections, poor wound healing, deterioration in vision
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Type 2 DM results from?
Insulin resistance leading to elevated BGL and over working and eventually failing of the beta cells
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NORMALLY type 1 DM Pt's are under or over weight?
Under weight
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NORMALLY type 2 DM Pt's are under or over weight?
Over weight
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T3 or T4 are more potent?
T3
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T3 or T4 is released more from the thyroid?
T4
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Anterior or posterior pituitary secretes TSH
anterior
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Hypothyroid can be caused by?
Hashimoto thyroiditis, thyroidectoy, radioactive iodine anti-thyroid medication and iodine deficiency, Myxedema
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Hypothyroid S/S?
hypoactive reflexes, depression cold intolerance, muscle fatigue and weight gain
Myocardial contraction, HR, Stroke volume and cardiac output decrese
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Preop managment
Hypothyroid require less sedation and are prone to resp depression, premedicate w H2 blocker and reglan R/T decrease GI motility
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Intra-op
Blunted baroreceptor reflex, more susceptible to hypotension with induction agents. Ketamine is recommended, drug metabolism maybe slower
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Hyperthyroidism?
Graves disease (most common 60-80%), toxic multinodular goiter, toxic adenoma, thyroiditis, TSH secreting pituitary tumor, overdose of thyroid hormone
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clinical manifestations?
weight loss, hyperactive reflexes, fine tremors, exopthalmos, or goiter
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Treatment
methimozole, propylthiourcil, propranolol
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Anesthetic Implications
preferably Euthyroid, antithyroid drugs and beta blockers continue through day of surgery. NO NMB R/T inability to assess the RLN. Treat Hypotension with Neo, not ephedrine, it releases catacholamines.
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Anesthetic Implications intr-op
Avoid SNS stimulating drugs: ketamine, panc, ephedrine
usually vasodilated and chronically hypovolemic producing sever hypotension during induction
NMB administer w caution R/T thyrotoxicosis is linked to myopathies and mysthenia gravis
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Post-op : Thyroid storm
most likely onset 6-24 hrs post-op
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Post-op Hypocalcemia:
due to removal of parathyroid glands, check in 24 hrs
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Post-op Stridor
Bilat recurrent laryngeal nerve damage
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Adrenal gland cortex secretes?
mineralcorticoids (aldosterone), androgens and glucocorticoids (cortisol)
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Adrenal gland medula secretes?
catecholamine's ( epi, norepi, dopamine)
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Phenochromocytoma
tumor of the chromaffin cells secreting maninly norepi, some epi and dopaimine
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Phenochromocytoma
80% in the adrenal medulla 20% external
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Phenochromocytoma S/S
Cardinal signs: HA, HTN, sweating and tachycardia,
Acute onset: pulmonary edema, MI CVA
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Phenochromocytoma Pre-op
Phenoxybenzamine the most common prescribed alpha blocker OR may use Metyrosine
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Phenochromocytoma
NEVER Beta block before alpha blocking R/T the unopposed alpha leads to Vasoconstriction and HTN Crisis. Most common Beta blocker propranolol used
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alpha blockade stopped when
24-48 hrs before surgery
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Surgery parameters
NO BP > 160/90
NO BP < 80/45 when standing
NO ST changes
NO S/S of excessive catacholamines, no more then 1 PVC q 5 min.
GOAL HR 60-80
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Intra-op
Nipride to lower BP R/T vasodillatory effect speed of onset and short durration
Magnesuim to block catacholamines
betablock w esmolol or labetalol
nicardipine most common CCB used
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adrenal insuffiency
Addison's disease, septicemia, autoimmune disorders
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adrenal insuffiency
Assoc. w glucocorticoid and mineralcorticoid deficiency
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adrenal insuffiency Anesthetic considerations
Avoid etomidate R/t Adrenal suppression
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Addison crisis Treatment
Fluids w dextrose, steroid replacement, inotropes, electrolyte correction
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Cushing's
Glucocorticoid excess
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Cushing's
Anterior pituitary tumor secreting to much ACTH
moon face, truncal obesity, HTN, OSA,
Elevated Na, Bicarb, low Ca and K
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Cushing's Anesthetic Implications
Volume overloaded, Hypo K, metabloic acidosis
consider spironolactone and K supplements
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Hyperparathyroidism
Number 1 symptom in MEN1 (multiple endocrine neoplasm)
Ca level > 5.5
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Phenochromcytoma provoking agents, AVOID
glucogon, histamine, reglan
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Stress response (surgery)
inhibits secretion of insulin and increases resistance, releases catacholamines and increases metabolism
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Pair the disease process with the correct DM
Hyperglycemic Hyperosmolar syndrome HHS, DKA
DM type 1, DM type 2
Type 1 DKA
Type 2 HHS
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HbA1c measures what
Average glucose concerntration over 3 mths
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Metformin should be stopped haw many days in advance
2-3 days and for 48 hr after
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Metformin should be stopped for what procedures
those w contrast dye, hypoperfusion of the kidneys, lactate accumulation or tissue hypoxia
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Insulin administration:
If given once a day they take their dose
If given twice a day they half the AM dose and take the full PM dose
Omit short acting doses for the day of the procedure
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Hyperglycemia reduces what drugs effect?
Morphine
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Primary motor inervation of the larynx is from what nerve
RLN (recurrent)
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The RLN controls the opening and closing of the vocal cords by which muscles
Posterior cricoarytenoid and the lateral arytenoid muscles
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The Superior Laryngeal Nerve controls the opening and closing of the vocal cords by which muscles
Cricothyroid
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80 % of metabolism activity is from what hormone??
unbound T3
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T3 is composed of
1 di-iodotyrosine compounds link w a mono-iodotyrosine
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Thyrotropin releasing hormone is secreted by what?
hypothalamus
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Thyrotropin releasing hormone stimulates the production of what?
TSH from the anterior pituitary
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TSH is transported to the thyroid and stimulates the release of what?
T3, T4
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3 most common complications of a thyroidectomy?
hypocalcemia, RLN damage and hematoma at the site
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Hypocalcemia causes
excitability in sensory and motor nerves
perioral numbness and tingling, ABD pain, paresthesia in extremities, carpalpedal spasms, SZ, laryngospasms, mental status changes.
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Chvostek sign? Hypocalcemia
facial contraction with facial nerve tapping
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Trousseau sign? Hypocalcemia
carpalpedal spasm after BP cuff inflation
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Hypocalcium Tx
10 ml of 10% calcium IV over several minutes the 2 mg/kg/hr
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