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34 Cards in this Set
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- Back
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he rate of ADH released into the bloodstream is directly related to the _____
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osmolality of the ECF
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what triggers the release of ADH into the circulation?
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a severe decrease in vascular volume and other stesses such as pain
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an increase in ECF osmolality is corrected by...
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ingesting water and adding it to the ECF
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a decrease in ECF osmolality is corrected by...
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excreting water and removing it from the ECF
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ECF osmolality (and hence sodium concentration) is regulated by....
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ADH
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ADH regulates....
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ECF osm and hence sodium concentration
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ADH is synthesized in the....
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paraventricular and supraoptic nuclei of the hypothalamus
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ADH is transported in the axoplasmic fluid of the hypothalmic-hypophyseal nerves to storage sites in nerve terminals of the....
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posterior pituitary (neurohypophysis)
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What stimulates the release of ADH from the posterior pituitary?
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nerve action potentials
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What is the neurohypophysis?
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posterior pitiuitary
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what is the adenohypophysis?
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anterior pituitary
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Which is the more potent vasoconstrictor, ADH or angiotensen II?
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ADH
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The paraventricular and supraoptic stimuli are more sensitive to changes in ______ than any other stimulus.
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changes in ECF osmolality
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What is the most powerful stimulus triggering the release of ADH?
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an increase in ECF osmolality
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ADH location of action?
effect? |
distal tubule and collecting duct
increased absorption of water leading to a small amount of dilute urine |
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In the absence of ADH, the distal tubule and collectin gduct are ___ to water.
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impermeable, leading to a large amount of dilute urine.
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any stress (trauma, hypotension, emotional, pain, hypovolemia) leads to .....
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an increase in the release of ADH.
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what effect does ADH have on the permeability to water of the distal and collecting ducts?
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increases the premeability
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causes of DI?
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failure of ADH synthesis or ADH release (most common)
insensitivity of the dital tubules and collecting ducts to ADH (nephrogenic) |
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SIADH as a result of surgery from...[5]
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intercranial tumors, hypothyroidism, porphyoria, small oat's Ca of lung
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diagnostic findings with SIADH?
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inappropriate increased urine sodium concentration and urine osm in the presense of hyponatremia and decreased plasma Osm.
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What is the major determinant of ECF volume?
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TOTAL BODY SODIUM (content-load)
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What is the most important hormone is regulating ECF volume?
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aldosterone
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ANP does what?
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released from right atrium and acts on the kidney to increase sodium excretion
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sodium excretion increases when GFR ______
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increases and vice versa.
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3 determinants of Na excretions.
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GFR
aldosterone ANP |
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aldosterone's effect on sodium excretion?
on K excretion? |
aldosterone leads to sodium retention (decresed excretion)
leads to K excretion |
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aldosterone site of action...
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late distal tubule, PRIMARILY the collecting duct
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A pheochromocytoma is a tumor of the _____ or ______ of the _______ that has excessive catecholamine secretion. (norepi)
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adrenal medulla or chromaffin tissue of the paravertebral sympathetic chain
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pheocromocytoma originate in the ______ and are found in the ______.
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adrenal medulla [90%]
abdominal cavity [95%] |
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MANIFESTIONS of pheocromocytoma...
The diagnostic triad is.... |
paroxysmal HTN
sweating tremulousness tachycardia as well as HA, palpitaions, orthostatic hypotension triad is diaphoresis, tachycardia, HA |
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pheocromocytoma patients ussually die from [3]
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CHF
MI intracerebral bleed |
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pheocromocytoma treatment?
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alpha adrenergic blockade
-phenoxybenxamine -prazosin beta block -for tachycardia -correct hypovolemia (may need neo to support BP) |
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pheocromocytoma anesthetic concerns?
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-do not stimulate sympathetic NS
-sedate well during line placement, etc.... -deep anesthesia -control tachycardia (esmolol, etc) |
