Flashcards in Test #2 Endocrine ARTICLES - Dwayne Deck (66)
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1
Glucogneogenesis?
The break down of fat and muscle for energy
2
Glycogenolysis?
The breakdown of glycogen into glucose
3
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
13
T3 or T4 is released more from the thyroid?
T4
14
Anterior or posterior pituitary secretes TSH
anterior
15
Hypothyroid can be caused by?
Hashimoto thyroiditis, thyroidectoy, radioactive iodine anti-thyroid medication and iodine deficiency, Myxedema
16
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
19
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.
23
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
37
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
40
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
44
Hyperparathyroidism
Number 1 symptom in MEN1 (multiple endocrine neoplasm)
Ca level > 5.5
45
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
48
HbA1c measures what
Average glucose concerntration over 3 mths
49
Metformin should be stopped haw many days in advance
2-3 days and for 48 hr after
50
Metformin should be stopped for what procedures
those w contrast dye, hypoperfusion of the kidneys, lactate accumulation or tissue hypoxia
51
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
52
Hyperglycemia reduces what drugs effect?
Morphine
53
Primary motor inervation of the larynx is from what nerve
RLN (recurrent)
54
The RLN controls the opening and closing of the vocal cords by which muscles
Posterior cricoarytenoid and the lateral arytenoid muscles
55
The Superior Laryngeal Nerve controls the opening and closing of the vocal cords by which muscles
Cricothyroid
56
80 % of metabolism activity is from what hormone??
unbound T3
57
T3 is composed of
1 di-iodotyrosine compounds link w a mono-iodotyrosine
58
Thyrotropin releasing hormone is secreted by what?
hypothalamus
59
Thyrotropin releasing hormone stimulates the production of what?
TSH from the anterior pituitary
60
TSH is transported to the thyroid and stimulates the release of what?
T3, T4
61
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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