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42 Cards in this Set

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What 2 systems maintain homeostasis?
nervous
endocrine
Choose one: a)endocrine or b)exocrine glands
secrete their hormone products directly into the surrounding extracellualr fuid?
endocrine glands
exocrine secrete through ducts
What three major categories of hormones are there?
1) peptide or protein
2)amines or amino acid derivatives
3) steroids
Most hormones are of which structure? Can you name some?
peptide: insulin, growth hormone, vasopressin, angitensin, prolactin, erythropoeitin, calcitonin, somatostatin, ACTH, oxytocin, glucagon, and parathyroid hormone
where are prehormones stored? what causes their relsease?
stored in secretory cells in the exocrine gland, and released upon stimulation that causes exocytosis
what are steroid hormones derived from? where are steroid hormones stored?
cholesterol
in contrast to most other hormones, steroid hormones are not stored in discrete secretory granules, but are compartmentalized in the endocrine cell and released into the extracellular fluidby simple diffudion thru the cell membrane
where are most hormones broken down?
liver and kidneys
What is the effect of protein binding on hormones?
longer duration
what general effect does the binding of a hormone to a cellular receptor have?
activates a second messenger
what is downregulation?
receptor # is inversel proportional to circulating hormone
what is upregulation?
low circulating hormone causes an increase in receptors to amplify cellular response
what three general control mechanisms regulate hormone secretion?
1. Neural control(pain, stress)
2. Biorhythms (intrinsic oscillations-genetic)
3. Feedback control
a)negative
b)positive
What is the nickname of the pituitary gland?
The Master Gland
what is the largest portion of the pituitary?
Anterior
the syntesis of what 6 hormones are directed by the hypothalamus?
1. Growth hormone-skeletal muscle development
2. Adrenocorticotropic hormone (ACTH)-adrenal development
3. Thyroid stimulting hormone (TSH)- metabolism
4. follicle Stimulating Hormone (FSH)- gonadal development
5. Lutinizing hormone (LH)- ovulation
6. Prolactin mammary development
Is the vsacular supply of the pituitary primarily arterial or venous?
Primarily venous
What conditions may cause hypopituitary disorders?
1. large pituitary tumors(macroadenomas)
2. Sheehan's syndrome(postpartum shock)
3. irradiation
4. trauma

(according to Rich, most tumors cause hypersecretion and infarcts cause hyposecretion)
what is panhypopituitarism?
generalized pituitary hypofunction (as opposed to reduced output of a single pituitary hormone)
what can cause Sheehan's syndrome?
an infarct of the pituitary following postpartum shock or hemmorrhage. It resultsin hypopituitarism
what is the significance of damage to the anterior pituitary gland?
damage to the anterior pituitary causes partial or complete lossof thyroid, adrenocortical and gonadal function
What is the ususal surgical approach to the anterior pituitary?
transphenoidal, less often:sublabial
What are the implications for the transphenoidal approach usually used for pituitary surgery/
"half-sitting" position
potentialy large blood loss
post op nasal packing-don't extubate till full return of airway reflexes
need smooth and rapid wake up for post op neuro exam
what is often the cause of hypersecrtion from the pituitary?
tumor
What are the three most common hypersecreting pituitary tumors?
1. prolactin-infertility
2. ACTH-Cushing's disease
3. GH-acromegaly
Tell me what you know about growth hormone :)
peaks in childhood, declines with age
no target receptor, affects alltissue
stimulates bone growth
Hyposectretion of growth hormone causes
dwarfism
hypersecretion of growth hormone causes
acromegaly
what physiologic changes are seen in acromegaly?
massive bone growth
increased soft tissue- LARGE LIPS, TONGUE, EPIGLOTTIS!
osteoarthrits
glucose intolerance
skeletal muscle weakness
CV/CAD/HTN
decreased corticosteroids-May need a stress dose of steroids
What % of people with acromegaly have a difficult airway?
31%
what features will cause a difficult airway with acromegaly?
facial deformities, large jaw, subglottic narrowing, large lips, tongue and epiglottis
What complication can result from rapid Na+ correction?
central pontine demyelination syndrome-permanent neurologic damage
What % of body Ca++ is found in bone?
99%
In what three forms is serum Ca++ found ?
1. protein + Calcium=40%
2. diffusable ion + Calcium = 10%
3. IONIZED CALCIUM=50% (this is the only one that counts!)
What effect does alkalosis have on ionized Calcium?
reduces ionized calcium by allowing more to bind with proteins
Which three hormones operate in concert to regulate the plasma concentration of calcium?
1. Vit D (inactive prohormone from sun and milk)
2. Parathyroid hormone (PTH)
3. Calcitonin
What is the effect of decreased parathyroid on calcium levels? wha teffect does this have?
Low serum calcium levels which causes
1. hyperexcitability of the nerve and muscle cells(muscle spasm and tetany) (cramps, numbness in feet)
2. ACUTE LARYNGEAL SPASM!!!(stridor)
What are the two classic signs of latent hypocalcemic tetany and how do you test for htem?
1. Chvostek's sign-ipsilateral twitching when tap facial nerve at the angle of the jaw
2. Trousseau's sign-inflate BP cuff->aggravation of muscle yielding irritability and spasm at the wrist
How is Calcium replacement administered?
slow IV (CaGluconate over 1/2hr; Cacl will cause profound sustained brady-push over 1-5 minutes)
What altertion in Calcium is frequently observed s/p parathyroid surgery for hyperparathytoidism?
hypocalcemia within hours or 1-2 post op days, resulting from rapid bone uptake of Ca (bone hunger)
What sx of hypocalcemia may alert the anesthetist ?
1. laryngeal spasm (unilateral=stridor; bilat =inability to move air)
2. prolonged QT interval (delayed veentricular rrpolarization)may lead to hypotension, decreased contractility
The pt is hypocalcemic. In planning anesthesia for surgery, the anesthetist may consider...
using a shorter acting NDMR-hypocalcemia prolongs response to NDMR
What type of lines are necessary for parathyroid surgery
Large Ivs or Aline-frequent Ca levels will need to be drawn and pt will be 180 degrees away form you.