Dfendo

pituitary

• x-ducts
• pancreas is both- enz thru ducts, also secs ends

• end
• ductless, chem mess
• closely w nervous syst

• chem messenger
• neg feedback loop
• -hi level, trigger to stop producing

• further prod inhib
• further prod increased

• other endocrine glands
• hypothalamus

Oxytocin and ADH

Posterior has everything else

• Prolactin
• Tropics: GH, ACTH adrenocorticotropic hormone (adrenal cortex),
• TSH (thyroid stim h),
• (FSH, LH) Gonadotropic hormone - targets sex hormone
• (MSH) Melanocyte stim hormone- targets skin

• Oxytocin
• ADH

hypothamlamus

• oxytocin
• ADH

• each lobe on each side of trachea
• isthmus
• follicular cells
• T4 (thyroxine), Tri-iodothyronine (T3)
• Iodine
• Growth and dev, metab, act of nerv syst
• TSH, pituitary

• Thyroid Calcitonin
• Parathyroid releases parathormone, antagonist to Calcitonin

nerves excited, tetany

impaired <3 function

• Adrenal cortex
• Adrenal medulla

• Mineral corticoids
• -water, e balance, indirect BP control
• -main one is Aldosterone, regulates salt, K+ levs
• Glucocorticoids
• -cortisol
• -involved in glucose metab
• -extra reserves in times of stress
• -ANTI INFLAMM properties
• Sex H
• -Androgens +estrogens

• Epinephrine, norepinephrine
• inc heart, BP, cause liver to rel glucose res. for F or F

• Insulin, the butler to the cells,
• Beta cells secrete in response to inc glucose lev
• just opens the doors, and

• glucagon
• Alpha cells secrete in response to dec glucose lev

3rd ventricle, melatonin, sex maturation, sleep, mood, your period

• upper thorax
• thymosin
• immune system, first few months of life, in utero
• T-lymphocytes

• 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

• amount
• 1.003-1.030

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


protracted hand

From the adrenal cortex, when blood glucose decreases, corticotropin releasing hormone from hypothalamus=>ACTH from anterior pituitary=>glucocorticoids from adrenal cortex.

stimulating gluconeogenesis in liver, inhibiting glucose use by the cell, protein anaboliam, fatty acid mobilizationinhibit inflammatory responsecushing'sAddison's (chronic) renal crisis (acute)

SIADH

overproduction of GH in adults

Overprod of GH in kids

not enough ADH,

too much pee? DDVAP

• "SIADH"
• Peeless
• If you couldn't pee, you would "sigh" about it

Iodine gets sucked in, can destroy some overproductive parts

• no
• 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

• Hypertrophy of one or more para glands
• 30-70

Adenoma, renal failure, pyelonephritis, glomerulonephritis

x, etiology get form slides

• Remove tumor, one or more glands, monitor elytes, strain uriine for stones, low Ca diet
• bones
• good
• bad

• Ca
• phos
• Inadvertant removal during thyroidectomy (think of the leg guy)
• rare

neuromuscular exct/muscle spasms, tetany, laryngeal spas (inflammation of voice box), stridor, cyanosis, parkinson-like syndrome

• 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

• ACTH
• Cushing's

Addision's

Pheochromocytoma

• 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

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

• 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)

• Treat causative factor
• Adrenalectomy for adrenal tumor
• radiation or surg rem of pituitary tumor
• Mitotane (Lysodren)/cytotoxic agent
• Diet
• Low salt (to offset more water retention), High K, red cal and carbs

• gradually taper/discontinue corticosteroids
• reduce dose
• Convert to alt-day regimen

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

• Not til 90% adrenal cortex destroyed
• Imbal of hormones, ntr, elytes
• N/V/D anorexia
• Orthostatic
• 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'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....

• Addison's
• 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

• 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

• Pancreas to duodenum
• bile
• occluded- pancreatitis

• yes
• abcess
• diabetes (II)

• 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

fever

• Amylase
• leaks into lymph or peritoneum, gets absorbed into serum, cleared quickly by kidneys, may return to normal w/in 48h
• Lipase
• Same as amylase, but rise a little later -24 h after acute onset. Remain elevated for 5-7 days.
• Lipase
• Urine test- amylase (usually just do blood)

• 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

no

• Ca
• Ph
• leukocytosis
• Hypoca
• hypoalbuminia
• hyperglycemia (may develop DM)

• 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
• Centrally
• islets of Langerhans

• Bedrest with BRP-decrease flow panc enz
• PCA
• 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
• smokers
• DM
• Pancreatitis
• 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

Often inoperable

Resection of stomach, duodenum, panc. Anastomoses between stomach, common bile duct, panc and jejunum

hemorrhage, resp complications, fl imbal, monitoring endocrine/exocrine functions of the pancreas

• Poor
• 5-12 months
• 5 yr survival rate less than 10%

low grade

• 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

ACE inhibitors, Furosemide, Tetracyclines