Endocrine System & Gallbladder

Question 1

During the day, when are cortisol levels at their peak ?

Answer 1

in the morning and toward the end of sleep
- to help prepare us for our days and get up
- released by the adrenal cortex

Question 2

What are the adrenal gland hormones ?

Answer 2

• sugar (glucocorticoids)
• salt (mineralocorticoids) (aldosterone)
• sex (androgens)

Question 3

What is hyperadrenal ?

Answer 3

• too much sugar
• too much salt
• too much sex hormones

Question 4

What does Aldosterone regulate ?

Answer 4

sodium and potassium balance
- therefore regulates water balance

Question 5

What does the adrenal cortex secrete ?

Answer 5

steroid hormones
- glucocorticoids (cortisol) , mineralocorticoids, androgens

Question 6

What do glucocorticoids do ?

Answer 6

inhibit the inflammatory response
- considered anti-inflammatory

Question 7

What do mineralocorticoids do ?

Answer 7

aldosterone
- essential for maintaining fluid and electrolyte balance

Question 8

What do androgens do ?

Answer 8

regulate pubic and axillary hair growth and sex drive in females

Question 9

What is the function of cortisol ?

Answer 9

• secreted by the adrenal cortex
• the most abundant and potent glucocorticoid
• necessary to maintain life (can survive with high levels but not low)
• regulates glucose, inhibits inflammatory action, support response to stress, promotes metabolism

Question 10

What is the precursor for steroid hormone synthesis ?

Answer 10

cholesterol

Question 11

What does the adrenal medulla secrete ?

Answer 11

• secretes catecholamines: involved in stress response and prolong effects of SNS
• epinephrine (for stress response) is the major hormone (75%)
• norepinephrine
• dopamine

Question 12

What causes Cushing’s syndrome/disease ?

Answer 12

over-secretion of the corticosteroid, especially glucocorticoids
- endogenous and exogenous
- most common cause is chronic use of corticosteroids (popular is prednisone)

Question 13

What are some endogenous causes of Cushing’s ?

Answer 13

• adrenal carcinoma (cancer of the adrenal)
• congenital adrenal hyperplasia

Question 14

What are corticosteroids used for ?

Answer 14

• organ transplant
• allergic reaction
• autoimmune disease
• severe allergies
• chronic and acute inflammatory conditions
• asthma and COPD

Question 15

What are some S&S of Cushing’s ?

Answer 15

• weight gain with increase appetite “Moon face”
• unexplained hypokalemia
• impaired glucose intolerance (elevated glucose)
• easy bruising and petechiae (fragile blood vessels)
• HTN: Na and water retention and dependent edema
• hirsutism on face of women (or in areas not common)
• gynecomastia (enlarged male breasts) in men
• decreased immune system (high risk for infections without fever) & poor would healing
• weakness, fatigue, and sleep disturbances
• gastric upset/ulcers: due increase in hydrochloric acid
• thin, and fragile skin/thinning/balding of hair/ osteoporosis
• striae: reddened lines on abdomen
• diarrhea is more likely
• emotional irritability: depression

Question 16

What is the primary causes of Addison’s disease ?

Answer 16

• idiopathic autoimmune dysfunction
• cancer
• adrenalectomy
• radiation of the abdomen

Question 17

What are the secondary causes of Addison’s disease ?

Answer 17

abrupt steroid withdrawal
- taking steroids so that adrenal gland won’t secrete so much cortisol and then we get use to those levels and once you stop taking the prednisone it causes Addison’s crisis

Question 18

What are some S&S of Addison’s ?

Answer 18

• unexplained hyperkalemia
• weight loss, N/V
• hyperpigmentation
• craving salt (hyponatremia)
• weakness and fatigue
• hypoglycemia
• constipation or diarrhea
• dehydration
• orthostatic hypotension (Dizziness)

Question 19

What is Tx for Addison’s crisis ?

Answer 19

• hydrocortisone (will need to take forever)
• FLUIDS
• Na

Question 20

What is Addison’s crisis ?

Answer 20

life threatening condition because of low cortisol levels
- causes: stress, infection, post-adrenal surgery, abrupt withdrawal of corticosteroids

Question 21

What are some special considerations for older adults with their hormones ?

Answer 21

• decreased hormone production and secretion
• subtle changes of aging often mimic manifestation of endocrine disorders
• altered hormone metabolism and biologic activity
• decreased responsiveness of target tissues to hormones, and alterations in circadian rhythms

Question 22

What levels of cortisol cause Cushing’s ?

Answer 22

high levels

Question 23

What levels of cortisol cause Addison’s ?

Answer 23

low levels

Question 24

What is Cholelithiasis ?

Answer 24

stones in the gallbladder
- aka gallblader disease
- most common disorder of biliary system

Question 25

What is cholecystitis ?

Answer 25

inflammation of the gallbladder - usually associated with cholelithiasis - in chronic conditions, restricting fats is good (need bile to breakdown fat and makes the gallbladder work harder)

Question 26

What are S&S of Cholecystitis ?

Answer 26

- fever and leukocytosis - jaundice (because of bilirubin and bile) - N/V - anorexia - abdominal distention - feeling of fullness - fat intolerance (feels pain after eating fatty foods 3-6 hrs after and lying down) - pain

Question 27

Where is the pain felt in cholecystitis ?

Answer 27

- right upper quad or right shoulder - may radiate to back - increases with deep breathing (rt lower quad is where appendix is)

Question 28

What are risk factors of gallbladder disease ?

Answer 28

- female - multiparity (many pregnancies) - age older than 40 yrs - estrogen therapy (oral contraceptives affect cholesterol production and increase the likelihood of gallbladder cholesterol saturation) - sedentary lifestyle - genetics/ ethnicity - obesity

Question 29

How does Cholelithiasis develop ?

Answer 29

balance that keeps cholesterol, bile salts, and calcium in solution is altered which leads to precipitation - bile secreted by liver supersaturated with cholesterol

Question 30

What is the pathophysiology of Cholecystitis ?

Answer 30

inflammation - confined to mucous lining or entire wall - cystic duct may become occluded - scarring and fibrosis may occur after attack which can decrease functioning

Question 31

What is Biliary Colic ?

Answer 31

happens when a stone is lodged in the ducts or when gallstones move through the ducts and spams occur - spasms happen in response to stone - pain can be very painful and followed by tachycardia, diaphoresis, and prostration - residual tenderness in RUQ

Question 32

What are some manifestations of Gallbladder disease ?

Answer 32

- inflammation (high WBC, fever) - RUQ tenderness, abdominal rigidity

Question 33

What are manifestations of total obstruction syndrome (gallstones) ?

Answer 33

- jaundice (lack of bile flow to duodenum) - dark amber urine - clay colored stools (no bilirubin reaching small intestine to be converted to urobilinogen) - pruritus (deposition of bile salts in skin tissues causing itchiness) - intolerance to fatty foods (no bile in small intestine for fat digestion) - bleeding tendencies(lack of or decreased vitamin K - steatorrhea: fatty stools

Question 34

What are manifestations of overall cholecystitis ?

Answer 34

- fat intolerance - N/V - restlessness/diaphoresis - dyspepsia - heartburn/indigestion - flatulence

Question 35

What are some complications of cholecystitis ?

Answer 35

- gangrenous cholecystitis - subphrenic abscess - pancreatitis - cholangitis - biliary cirrhosis - fistulas - gallbladder rupture to peritonitis

Question 36

What are lab test results for gallbladder disease ?

Answer 36

- increased WBC count (due to inflammation) - increased serum bilirubin level (due to obstruction) - increased urinary bilirubin level - increased liver enzymes levels (if there is pancreatic involvement) - increased serum amylase level

Question 37

What is a laparoscopic cholecystectomy ?

Answer 37

tx of choice for gallstones - remove gallbladder through 1-4 puncture holes (surgery I saw) - minimal post-op pain - can resume normal activities within 1 week - few complications

Question 38

What is Extracorporeal Shock-Wave Lithotripsy (ESWL) ?

Answer 38

- only if stones can't be removed via endoscope - high energy shock waves disintegrate stones - takes 1-2 hrs - used in conjunction with bile acids

Question 39

What meds are used for Cholecystitis ?

Answer 39

Pain control: NSAIDS and anticholinergic (decrease secretion and counteract smooth muscle spasms) - Infection control: antibiotic tx, cholecystectostomy (used to drain purulent material from obstructed gallbladder) - Maintenance of F&E balance: NG tube is severe N/V

Question 40

What is an Open (incisional) Cholecystectomy ?

Answer 40

removal of gallbladder through right subcostal incision - T tube inserted into common bile duct - more intensive

Question 41

What is a T-tube used for ?

Answer 41

ensures patency of duct until the edema produced by the trauma of exploring and probing the duct has subsided - allows excess bile to drain - located in the common bile duct which is connected to the gallbladder

Question 42

What is nutritional therapy for Cholelithiasis ?

Answer 42

- small, frequent meals with some fat (promote gallbladder emptying) - diet low in saturated fat - high in fiber and calcium - reduced calorie diet if pt is obese - avoidance of rapid weight loss (can promote gallstone formation)

Question 43

What are some considerations for after laparoscopic cholecystectomy ?

Answer 43

- liquids first day - light meals for several days

Question 44

What are some considerations for after incisional cholecystectomy ?

Answer 44

- liquids to regular diet after return of bowel sounds - may need to restrict fats for 4-6 weeks - encourage coughing, turning and deep breathing

Question 45

What causes obstructive jaundince ?

Answer 45

lack of bile flow to the duodenum