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Exocrine vs endocrine
- pancreas is both- enz thru ducts, also secs ends
- ductless, chem mess
- closely w nervous syst
- chem messenger
- neg feedback loop
- -hi level, trigger to stop producing
- further prod inhib
- further prod increased
monitors/works w/controlled by___
- other endocrine glands
Oxytocin and ADH
Posterior has everything else
- Tropics: GH, ACTH adrenocorticotropic hormone (adrenal cortex),
- TSH (thyroid stim h),
- (FSH, LH) Gonadotropic hormone - targets sex hormone
- (MSH) Melanocyte stim hormone- targets skin
Hormones produced in____
Two hormones released
Thyroid gland is located__
Lobes connected by___
Secretes via____ hormones___ and ____
____ necc for form of hormones
Regulates___and___, ___, ______
Controlled by ___, released by____
Also, ____ cells
- each lobe on each side of trachea
- follicular cells
- T4 (thyroxine), Tri-iodothyronine (T3)
- Growth and dev, metab, act of nerv syst
- TSH, pituitary
____ releases____, puts Ca into bones, out of Bstream
____ releases____, Pulls Ca from bones, int Bstream
- Thyroid Calcitonin
- Parathyroid releases parathormone, antagonist to Calcitonin
nerves excited, tetany
impaired <3 function
- Adrenal cortex
- Adrenal medulla
Adrenal glands/cortex release 3 steroids:
- Mineral corticoids
- -water, e balance, indirect BP control
- -main one is Aldosterone, regulates salt, K+ levs
- -involved in glucose metab
- -extra reserves in times of stress
- -ANTI INFLAMM properties
- Sex H
- -Androgens +estrogens
2 hormones in times of stress
- Epinephrine, norepinephrine
- inc heart, BP, cause liver to rel glucose res. for F or F
Pancreas is located___
Exo and Endo tissue
Islets of langerhans secrete 2 H
- Insulin, the butler to the cells,
- Beta cells secrete in response to inc glucose lev
- just opens the doors, and
- Alpha cells secrete in response to dec glucose lev
Pineal gland, located _____secretes____, prev child's _____, induces___, affects___, impacts___
3rd ventricle, melatonin, sex maturation, sleep, mood, your period
Thymus is in_____
Active role in____ in ____ and ____
- upper thorax
- immune system, first few months of life, in utero
- measure glucose over 3 month period, if over 6, not good control
- lifespan of RBCs
- says over 6% of hemoglobins that look funky, because glucose can destroy them
Get Btests from handout review on own
measures___of hormones sec, spec grav (____)
determines if neg FB mechs are intact, suppress thyroid, does TSH increase to compensate
stim hormones administered, if endocrine responds to stim, disorder may be in the hypothal or pit
If endocrine gland does not responsd, prob w spec endocrine gland
You need a baseline first, give drug, monitor B lev in 30 min, 60 min, 90 min after you give
facial nerve is tapped at angle of the jaw of facial muscles on same side will contract
Where are glucocorticoids released from and when?
From the adrenal cortex, when blood glucose decreases, corticotropin releasing hormone from hypothalamus=>ACTH from anterior pituitary=>glucocorticoids from adrenal cortex.
How do glucocorticoids increase blood glucose?What is the target?What if you have too much? What if too little?
stimulating gluconeogenesis in liver, inhibiting glucose use by the cell, protein anaboliam, fatty acid mobilizationinhibit inflammatory responsecushing'sAddison's (chronic) renal crisis (acute)
Too much ADH can cause
overproduction of GH in adults
Overprod of GH in kids
not enough ADH,
too much pee? DDVAP
Too much ADH?
- If you couldn't pee, you would "sigh" about it
How does radioactive iodine work on Hyperth?
Iodine gets sucked in, can destroy some overproductive parts
Cancer of thyroid- common?
What kind of nodule?
Rare to see what SE?
What kind is more common and prognonsis? What kind has poor prognosis?
- small, fixed firm nodule
- sx hyperthyroidism
- well contained and differentiated, slow growing "Papillary carcinoma"- good prog
- Follicular and anaplastic carc- poor prog
- hypercalcemia, ca leaves bones to bstream
- kidney stones, skeletal pain, on weight-bearing, patho fractures, fatigue, drowsiness, N, anorexia
- X-ray shows decalcification
- PTH increased
- Ca increased, Ph decreased
- MRI CT Ultrasound locate adenoma
May result from
- Hypertrophy of one or more para glands
Adenoma, renal failure, pyelonephritis, glomerulonephritis
x, etiology get form slides
Careful w falls why?
Parathyroid prog cancer?
- Remove tumor, one or more glands, monitor elytes, strain uriine for stones, low Ca diet
- Inadvertant removal during thyroidectomy (think of the leg guy)
neuromuscular exct/muscle spasms, tetany, laryngeal spas (inflammation of voice box), stridor, cyanosis, parkinson-like syndrome
What would you see in blood? Urine?
what would you give
- Dec serum Ca
- Increased urinary Ca
- Increased serum phos
- Deceased urinary phos
- Give Ca gluconate or ca cl IV
- Extravasation may cause tissue nec
- Too fast, cardiac arrest
- excess cortisol (cushing's cortex cortisol)
- Plas level of adrenocortical hormones are inc
- hyperplasia of adrenal tiss due to overstim by PGland
- Tumor of adrenal cortex, ACTH secreting tumor outside of PGland, overuse of corticosteroid drugs
Adrenal hyperfunctions (Cushings)
Moonface, buffaolo hump, thin arms, legs,weight gain, hairy, voice deepening, ecchymoses and petechiae, think skin, hypokalemia, proteinuria, inc Ca excretion, immunocompromised, depression, loss of libido, abdominal enlargement, loss of libido
Dx tests for Cushing's
24 H urine____?
- clinical sx
- Plasma cortisol inc
- ACTH increased or decreased (depending on Tumor's location)
- 24 H urine (inc lev of steroids)
- hyperglucose (may need insulin coverage)
Adrenal hyperfunction (Cushing's)
- Treat causative factor
- Adrenalectomy for adrenal tumor
- radiation or surg rem of pituitary tumor
- Mitotane (Lysodren)/cytotoxic agent
- Low salt (to offset more water retention), High K, red cal and carbs
What if Cushing's is from corticosteroids, do one or more of these:
- gradually taper/discontinue corticosteroids
- reduce dose
- Convert to alt-day regimen
Adrenal hypofunction (Addison's disease)
Adrenal glands don't secrete adequate amts of flucocort and mineralcort
TB most common, Adrenalectomy, Pituitary hypofunction, long term steroid therapy, autoimmune response (against adrenal cortex), AIDS, metastatic cancer, fungal inf
When do signs show up?
What are they related to?
What are they?
- Not til 90% adrenal cortex destroyed
- Imbal of hormones, ntr, elytes
- N/V/D anorexia
- headache, disoriented, ab and lower back pain, anxiety
Dark pigmented skin, hypoglycemia, weight loss, anxiety, hypoglycemia, hyponatremia, hyperkalemia, assess for adrenal crisis
- ACTH stim test (baseline first) then give ACTH, see if serum corticoids increase. Take level 30, 60, sometimes 90 min, take levels
- Normal- see peak and decline
- If pituitary ok, low cortisol levels, if not okay, see inc
- Restore fluid, elyte bal, replace hormones, high salt, low K diet
- IV corticosteroids in sol of saline, glucose, severe adrenal crisis is life-threatening emergency (abnormal low or high temp, very low Na+, high K+)
Cushing sx vs addison's
cushing's- bad memory, conc, insom, irritatb, weakness, extremity wasting, back pain, rib pain, kyphosis, thin skin (dec collagen), red cheeks, acne, petechiae and ecchymosis, bad healing, tires easily, insom, malaise, depression, inc app, wt gain, dema, buffalo hump....
- Post hypotension, syncope, lethargy, headache, weakness, fatigue, muscle aches, wasting, hyperpigmentation, dec body hair, tires easily, susceptible to infections, weakness, lack of int in activities, N/V, fl and elyte def, hypoglycemia, need for inc salt and dec K+ intake
- Chromaffin cell tumor in medulla
- Flood of epi and norepi
- very rare
- 20-60% malignant
- 10% malignant
massive HTN (300/175), stroke, kidney failure, damage, retinopathy, card dam-heart failure
Pacreas A&P- secretes what? From where?
- Sphinctor of Oddi empties in to duodenum
- Secretes digestive enzymes through duct
- Also hormones (ductless) into bloodstream
- Alpha cells glucagon
- Beta cells insulin
- inflammation can occlude ducts
- pancreas is eating itself
ETOH, trauma, infectious disease, drugs, exact cause unknown
stimulates PT to secrete digestive enzymes
- occlude pancreatic duct
- edema, stones, scar tissue, enzymes build up and teh duct ruptures
- releases digestivve enzymes
- autodigestion-"eat" the pancreas
Test: sphinctor of Oddi
- Pancreas to duodenum
- occluded- pancreatitis
does necrosis occur? What can develop? What disease can develop?
What if abscess
- Severe ab pain, radiates to back, inc
- inc by eating and lying down
- jaundice if bile duct obstructed
- anorexia, N/V/ weight loss, malaise, restlessness
Serum pancreatic enzymes?
Which more useful in diagnosing?
Do they do urine test for these?
- leaks into lymph or peritoneum, gets absorbed into serum, cleared quickly by kidneys, may return to normal w/in 48h
- Same as amylase, but rise a little later -24 h after acute onset. Remain elevated for 5-7 days.
- Urine test- amylase (usually just do blood)
endoscopic retrograde cholangiopancreatography
Also used to do what?
How long procedure?
- Fiberoptic duodenoscope inserted orophyarnyx using dye (allergies, creatnine to make sure kidneys okay- mucomyst? shellfish, iodine)
- Reliable test.
- Also used to eval obstructive, rem bile duct stones, place biliary, panc duct stents to bypass
- NPO 8h
- 1-2 h procedure
Can there be acronyms on a consent?
- hyperglycemia (may develop DM)
TPN must be inserted where?
Watch for destruction of what?
- NGT to dec pancreatic stimulation
- Merepridine (Demerol; never give morphine w/o an antispasmotic because it can cause spasms in sphincter of Oddi- excrutiating pain)
- Propantheline (Pro-Banthine) decreases pancrease activity
- to supplement NTR
- islets of Langerhans
Pain med admin?
- Bedrest with BRP-decrease flow panc enz
- Bland, lowfat, high protein diet
- -No ETOH or GI stims (caffeine)
- -watch for ETOH w/d
- abscess is a major complication
- acute- 1 week hospitalization
- mortality rates for acute necrotizing- 10-50%
- 4th leading cause of cancer death USA, Canada
- High death rate d/t late diagnosing
- 65-80 peak occurrence
- High meat, fat, coffee consumption
- 4-8 months post diagnosis
- Vague sx
- 85% have pain, epigastrium or referred to the back, worse at night, 50% have DM, fatigue, nausea, changes in stool, weight loss, pruritus and jaundice
- Nothing for early detection
- circ carcinoembryonic antigen (CEA) tumor assoc antigen
- CT, ERCP, Ultrasound
Resection of stomach, duodenum, panc. Anastomoses between stomach, common bile duct, panc and jejunum
post op care
hemorrhage, resp complications, fl imbal, monitoring endocrine/exocrine functions of the pancreas
- 5-12 months
- 5 yr survival rate less than 10%
Fever w Pancreatitis?
Why would you look at LFTs?
Why LR wide open?
- Biliary tract disease and alcoholism assoc w/
- Yes, because fever is happening- WBC --------------indicates infection, but not what is growing?
- Signs and sx of dehydration
- -------Open IV tubing, let it flow in. Caution-CHF, etc
What drugs can trigger pancreatitis?
ACE inhibitors, Furosemide, Tetracyclines
If tolerated, nutrition in pancreatitis provided by JTube. Otherwise NPO