Endocrine Disorders Overview
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Endocrine Disorders Overview

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Questions and Answers

What is an important factor that contributes to the high mortality rate associated with mesenteric ischemia?

  • Rapid diagnosis
  • Immediate surgical intervention
  • Presence of clear CT findings
  • Vague signs and symptoms (correct)

    • What complication is indicated by a tensely distended abdomen in ICU patients?

  • Mesenteric ischemia
  • Pulmonary embolism
  • Acute pancreatitis
  • Abdominal Compartment Syndrome (correct)

    • Which of the following findings might suggest increased pressure in the mediastinum due to abdominal issues?

  • Improved oxygen saturation
  • Increased PIP and MAP (correct)
  • Hypotension
  • Decreased heart rate

    • What is the primary concern when considering decompression in cases of Abdominal Compartment Syndrome?

    <p>Risk versus benefit analysis</p> Signup and view all the answers

    In a patient presenting with tachycardia, tachypnea, and a soaked bed, what is the most likely etiology after cranial surgery?

    <p>Diabetes Insipidus</p> Signup and view all the answers

    What vital sign is indicative of potential shock in a 35-year-old female with a temperature of 103.1?

    <p>Pulse of 130</p> Signup and view all the answers

    Sepsis often presents with which combination of acute changes?

    <p>Low blood pressure and fever</p> Signup and view all the answers

    What is the most common characteristic of Abdominal Compartment Syndrome?

    <p>Elevated intra-abdominal pressure</p> Signup and view all the answers

    What could be a subtle indication on a CT scan suggestive of mesenteric ischemia?

    <p>Vague and subtle findings</p> Signup and view all the answers

    What is one of the long-term risks in patients presenting with abdominal surgery-related complications?

    <p>Development of chronic ischemia</p> Signup and view all the answers

    What are the classic symptoms associated with hyperglycemia in diabetes mellitus?

    <p>Polyuria, Polydipsia, Polyphagia</p> Signup and view all the answers

    In a patient presenting with myxedema coma, which of the following is a key presentation triad?

    <p>Altered mental status, lethargy, thermoregulatory failure</p> Signup and view all the answers

    What characterizes an Addisonian crisis?

    <p>Sudden onset of shock and altered mental status</p> Signup and view all the answers

    Which disorder is characterized by excessive fluid intake leading to insufficient antidiuretic hormone?

    <p>Dipsogenic Diabetes Insipidus</p> Signup and view all the answers

    What is one of the common presentations of a pheochromocytoma?

    <p>Hypertensive crisis</p> Signup and view all the answers

    What is the main concern in septic shock?

    <p>Increased capillary permeability and vasodilation</p> Signup and view all the answers

    What is a common cause of upper gastrointestinal bleeding?

    <p>Peptic ulcer disease</p> Signup and view all the answers

    Which condition would most likely lead to presenting with Coke-colored urine?

    <p>Rhabdomyolysis</p> Signup and view all the answers

    What is the primary treatment strategy for patients with rhabdomyolysis?

    <p>Fluid administration to maintain urine output</p> Signup and view all the answers

    Which of the following is NOT a complication of chronic hyperthyroidism?

    <p>Hemorrhage from esophageal varices</p> Signup and view all the answers

    What is a primary symptom of Addisonian crisis?

    <p>Sudden onset shock</p> Signup and view all the answers

    What complication can arise from untreated hyperthyroidism during acute illness?

    <p>Thyroid Storm</p> Signup and view all the answers

    Which of the following is a notable laboratory finding in patients with diabetes insipidus?

    <p>Hemoconcentration</p> Signup and view all the answers

    What is the main therapeutic intervention for managing severe cases of rhabdomyolysis?

    <p>Dialysis</p> Signup and view all the answers

    Which of the following conditions presents with elevated amylase and lipase levels?

    <p>Pancreatitis</p> Signup and view all the answers

    What is a characteristic symptom of Cushing's syndrome?

    <p>Weight gain and thin skin</p> Signup and view all the answers

    Which type of abdominal bleeding is typically characterized by melena?

    <p>Upper gastrointestinal bleeding</p> Signup and view all the answers

    What condition is indicated by referred pain to the left shoulder?

    <p>Spleen pathology</p> Signup and view all the answers

    In cases of severe dehydration due to Addison's disease, which vital sign may be observed?

    <p>Hypotension</p> Signup and view all the answers

    Which disorder leads to hypernatremia as a result of hemoconcentration?

    <p>Diabetes Insipidus</p> Signup and view all the answers

    What vital sign is most concerning for hypoperfusion in a 35-year-old female with a high fever?

    <p>Pulse 130</p> Signup and view all the answers

    Which of the following conditions is the MOST likely cause of the presenting symptoms in the 45-year-old female post-glioblastoma surgery?

    <p>Diabetes Insipidus</p> Signup and view all the answers

    What aspect of mesenteric ischemia contributes to its 80% mortality rate?

    <p>Delayed presentation and vague symptoms</p> Signup and view all the answers

    What immediate risk is presented by the tense abdominal compartment syndrome?

    <p>Decreased cardiac output</p> Signup and view all the answers

    What laboratory finding is most likely to be present in patients suspected of sepsis?

    <p>Elevated white blood cell count</p> Signup and view all the answers

    Which symptom is commonly observed in patients experiencing abdominal compartment syndrome?

    <p>Hypotensive episodes</p> Signup and view all the answers

    What significant risk does decompression pose in cases of abdominal compartment syndrome?

    <p>Potential for massive hemorrhage</p> Signup and view all the answers

    What might vague CT findings in mesenteric ischemia indicate?

    <p>Non-specific abdominal pain</p> Signup and view all the answers

    In an ICU patient with abdominal compartment syndrome, what occurs due to the abdomen compressing the mediastinum?

    <p>Compression of cardiac structures</p> Signup and view all the answers

    What is NOT a typical presentation in a patient suffering from myxedema coma?

    <p>Hyperactivity</p> Signup and view all the answers

    Study Notes

    Diabetes Mellitus

    • Impaired ability to synthesize glucose
    • Glucose spills into urine
    • Three P’s of hyperglycemia: Polyuria, Polydipsia, Polyphagia
    • Prolonged hypoglycemia can cause neuronal damage

    Thyroid Disorders

    • Myxedema Coma
      • Low thyroid, results from chronic, untreated hypothyroidism
      • Slowed metabolism
      • Key presentation triad:
        • Altered mental status, lethargy
        • Thermoregulatory failure
        • Precipitating event
    • Thyroid Storm
      • Critical hyperthyroidism
      • Known hyperthyroidism with acute changes
      • New onset a-fib, new onset dilated cardiomyopathy, new onset psychosis w/ abnormal vitals
      • Hyperthermia
      • CONSIDER IN ANY SEPTIC-APPEARING PATIENT WITHOUT ANY FOCUS OF INFECTION!

    Adrenal Disorders

    • Adrenal Insufficiency
      • Addison’s Disease
        • Deficiency of steroid hormones, chronic disease
        • Improper regulation of sodium, potassium, and water
      • Addisonian Crisis
        • Sudden onset exacerbation of Addison’s symptoms
        • Shock, AMS, hyperthermia, severe n/v leading to dehydration
        • Can be caused by TBI in patients with no history of Addison’s
    • Cushing’s Syndrome
      • Too much cortisol production by adrenals
      • Weight gain, depression, weakness, thin skin, bruising
      • Does not present emergently
    • Pheochromocytoma
      • Catecholamine secreting tumor
      • May present in hypertensive crisis
      • Manage acutely with antihypertensives
      • Requires surgical removal of tumor

    Pituitary Disorders

    • Diabetes Insipidus
      • Insufficient antidiuretic hormone
        • Neurogenic: pituitary disorder
        • Nephrogenic: poor renal response to ADH
        • Dipsogenic: excessive fluid intake
        • Gestagenic: rare complication of pregnancy
      • Huge amounts of dilute urine
      • Hemoconcentration, hypernatremia
      • Supportive care, treat primary cause
    • SIADH
      • Too much antidiuretic hormone
        • Production
        • Secretion
      • Dilutional lab value derangements
      • Urine osmolality increases
      • Hyponatremia

    Anaphylaxis

    • CONSIDER ANAPHYLAXIS IN THE PRESENCE OF TWO OR MORE INVOLVED SYSTEMS, EVEN IN THE ABSENCE OF AIRWAY INVOLVEMENT OR HYPOTENSION.
      • Respiratory
      • Hypotension
      • Skin Signs
      • Gastrointestinal
    • PRIORITIZE EPINEPHRINE
      • Underutilized
      • Safe, effective
      • Adult dose: 0.3mg IM vastus lateralis
      • Pediatric dose: 0.01mg/kg IM vastus lateralis
      • Deleterious cardiac effects are a myth

    Sepsis

    • “Life threatening organ dysfunction caused by a dysregulated host response to an infection.”
      • Cytokine release
      • Malperfusion
      • Massive loss of vascular tone
    • Septic shock
      • Increased capillary permeability
      • Leading cause of mortality in infection
      • Increased capillary permeability and vasodilation causes distributive shock
    • Sepsis Related Organ Failure Assessment Tool (qSOFA)
      • GCS ≤ 12
      • Systolic BP ≤ 100 mmHg
      • RR ≥ 22 breaths/minute
    • qSOFA scores
      • 2 or 3 points = increased risk of mortality
    • Other signs of sepsis
      • GCS 0.3 mg/dL or 1.5x baseline
      • Increased BUN
      • Hyperkalemia
      • Edema

    Acute Renal Failure (ARF)

    • Types of ARF
      • Prerenal
        • Pathology BEFORE the kidney
        • Hypoperfusion of kidneys
      • Intrarenal
        • Pathology WITHIN the kidney
        • Intrinsic kidney disease
        • Rhabdomyolysis
        • Toxicity (ibuprofen overuse, etc.)
      • Postrenal
        • Pathology AFTER the kidney
        • Obstruction

    Rhabdomyolysis

    • Excessive muscle breakdown, causing myoglobinemia
      • Crush injuries
      • Extended down time post fall
      • Exertional
    • Presents with Coke-colored urine, extreme muscle pain, edema
    • Elevated CK
      • Mild: 1,000-5,000 u/L
      • Moderate: 5,000-15,000 u/L
      • Severe: >15,000 u/L

    Rhabdomyolysis Treatment

    • Fluid administration
      • LR
      • Titrate fluids to maintain 100mL/hour urine output
    • Dialysis in severe cases
    • Protect patient from nephrotoxins

    Abdominal Pathology

    • GI Bleeding
      • Upper (UGIB)
        • Presents with: hematemesis, melena
        • Causes: Esophageal varices, excessive vomiting, peptic ulcer disease, Mallory-Wiess tear
      • Lower (LGIB)
        • Presents with: hematochezia
        • Causes: colitis, Crohn’s, diverticulitis, internal hemorrhoids
    • Treatment of GI Bleeding
      • Blood transfusion
      • Antibiotics
      • Proton Pump Inhibitors
      • TXA
      • Octreotide
    • Esophageal Varices
      • Results from late stages of portal hypertension
      • Life threatening hemorrhage requires tamponade tube: Minnesota or Blakemore
    • Pancreatitis
      • Presents with: epigastric pain, n/v, inflammatory ileus, elevated amylase (3x baseline) and lipase
      • Inflammatory
        • Caused by: gallstones, chronic alcohol abuse, ERCP complications
      • Necrotizing
        • Dysregulated caustic secretions
        • MODS, SIRS
    • Disorders of the Spleen
      • Presents with Kehr’s sign: referred pain to left shoulder
      • Causes: splenomegaly, atrial fibrillation
    • Bowel Problems
      • Ileus
      • Diverticulitis
        • LUQ pain
        • Usually constant and present for days
      • Colitis
        • Bloody diarrhea, colicky abdominal pain
      • Crohn’s Disease
        • Variable symptoms for years
        • Fatigue
        • Prolonged diarrhea with weight loss
      • Appendicitis
        • Periumbilical pain that radiates to RUQ
        • Rebound tenderness
        • McBurney’s Point
        • Surgery vs.antibiotics
      • Mesenteric Ischemia
        • 80% mortality
        • Vague signs and symptoms
        • Subtle and vague CT findings
    • Abdominal Compartment Syndrome
      • Primarily affects critical ICU patients
      • Tensely distended abdomen
      • Abdomen pushes on mediastinum compressing heart
      • Causes increased PIP and MAP
      • Compresses renal vasculature
      • Decompression: huge risk v.benefit analysis

    Questions:

    • The patient is a 35-year-old female with no past medical or psychiatric history. Her husband called 911 after she pulled a hose into the house and began to spraying the walls screaming that the house was on fire. He is adamant that she is healthy but stated that she has been very tired for the past two weeks which is abnormal. Her vital signs are Pulse 130, RR 28, BP 86/42, SpO2 99%, Temp 103.1. You suspect: Thyroid Storm
    • The patient is a 45-year-old female who is 3 weeks status post-surgery to remove a glioblastoma. She presents with tachypnea, tachycardia, and she is lying in a bed that is soaked with urine. The most likely etiology is: Diabetes Insipidus

    Diabetes Mellitus

    • Impaired ability to synthesize glucose
    • Glucose spills into urine
    • Three P’s of Hyperglycemia: Polyuria, Polydipsia, Polyphagia
    • Prolonged hypoglycemia can cause neuronal damage

    Thyroid Disorders

    Myxedema Coma

    • Low thyroid, results from chronic, untreated hypothyroidism
    • Slowed metabolism
    • Key presentation triad: Altered mental status, lethargy, Thermoregulatory failure
    • Precipitating event

    Thyroid Storm

    • Critical hyperthyroidism
    • Known hyperthyroidism with acute changes
    • New onset a-fib
    • New onset dilated cardiomyopathy
    • New onset psychosis w/ abnormal vitals
    • Hyperthermia
    • Consider in any septic-appearing patient without any focus of infection!

    Adrenal Disorders

    Adrenal Insufficiency

    • Addison’s Disease
      • Deficiency of steroid hormones, chronic disease
      • Improper regulation of sodium, potassium, and water
    • Addisonian crisis
      • Sudden onset exacerbation of Addison’s symptoms
      • Shock, AMS, hyperthermia, severe n/v leading to dehydration
      • Can be caused by TBI in patients with no history of Addison’s

    Cushing’s Syndrome

    • Too much cortisol production by adrenals
    • Weight gain, depression, weakness, thin skin, bruising
    • Does not present emergently

    Pheochromocytoma

    • Catecholamine secreting tumor
    • May present in hypertensive crisis
    • Manage acutely with antihypertensives
    • Requires surgical removal of tumor

    Pituitary Disorders

    Diabetes Insipidus

    • Insufficient antidiuretic hormone
    • Neurogenic : pituitary disorder
    • Nephrogenic : poor renal response to ADH
    • Dipsogenic : excessive fluid intake
    • Gestagenic : rare complication of pregnancy
    • Huge amounts of dilute urine
    • Hemoconcentration, hypernatremia
    • Supportive care, treat primary cause

    SIADH

    • Too much antidiuretic hormone
    • Production
    • Secretion
    • Dilutional lab value derangements
    • Urine osmolality increases
    • Hyponatremia

    Anaphylaxis

    • Consider anaphylaxis in the presence of two or more involved systems, even in the absence of airway involvement or hypotension.
    • Respiratory
    • Hypotension
    • Skin signs
    • Gastrointestinal
    • Prioritize epinephrine
      • Underutilized
      • Safe, effective
      • Adult dose: 0.3mg IM vastus lateralis
      • Pediatric dose: 0.01mg/kg IM vastus lateralis
      • Deleterious cardiac effects are a myth

    Sepsis

    • “Life threatening organ dysfunction caused by a dysregulated host response to an infection.”
    • Cytokine release
    • Malperfusion
    • Massive loss of vascular tone
    • Septic shock
      • Increased capillary permeability
      • Leading cause of mortality in infection
      • Increased capillary permeability and vasodilation causes distributive shock
    • Sepsis Related Organ Failure Assessment Tool (qSOFA)
      • GCS ≤ 12
      • Systolic BP ≤ 100 mmHg
      • RR ≥ 22

    Acute Renal Failure (ARF)

    • Prerenal : pathology BEFORE the kidney
      • Hypoperfusion of kidneys
    • Intrarenal : pathology WITHIN the kidney
      • Intrinsic kidney disease
      • Rhabdomyolysis
      • Toxicity (ibuprofen overuse, etc.)
    • Postrenal : pathology AFTER the kidney
      • Obstruction

    Rhabdomyolysis

    • Excessive muscle breakdown, causing myoglobinemia
    • Crush injuries
    • Extended down time post fall
    • Exertional
    • Presents with Coke-colored urine, extreme muscle pain, edema
    • Elevated CK
      • Mild: 1,000-5,000 u/L
      • Moderate: 5,000-15,000 u/L
      • Severe: >15,000 u/L

    Rhabdomyolysis Treatment

    • Fluid administration
      • LR
      • Titrate fluids to maintain 100mL/hour urine output
    • Dialysis in severe cases
    • Protect patient from nephrotoxins

    Abdominal Pathology

    GI Bleeding

    • Upper (UGIB)
      • Presents with: hematemesis, melena
      • Causes: Esophageal varices, excessive vomiting, peptic ulcer disease, Mallory-Wiess tear
    • Lower (LGIB)
      • Presents with: hematochezia
      • Causes: colitis, Crohn’s, diverticulitis, internal hemorrhoids

    Treatment of GI Bleeding

    • Blood transfusion
    • Antibiotics
    • Proton Pump Inhibitors
    • TXA
    • Octreotide

    Esophageal Varices

    • Results from late stages of portal hypertension
    • Life threatening hemorrhage requires tamponade tube: Minnesota or Blakemore

    Pancreatitis

    • Presents with: epigastric pain, n/v, inflammatory ileus, elevated amylase (3x baseline) and lipase
    • Inflammatory
      • Caused by: gallstones, chronic alcohol abuse, ERCP complications
    • Necrotizing
      • Dysregulated caustic secretions
      • MODS, SIRS

    Disorders of the Spleen

    • Presents with Kehr’s sign: referred pain to left shoulder
    • Causes: splenomegaly, atrial fibrillation

    Bowel Problems

    • Ileus
    • Diverticulitis
      • LUQ pain
      • Usually constant and present for days
    • Colitis : bloody diarrhea, colicky abdominal pain
    • Crohn’s Disease
      • Variable symptoms for years
      • Fatigue
      • Prolonged diarrhea with weight loss

    Appendicitis

    • Periumbilical pain that radiates to RUQ
    • Rebound tenderness
    • McBurney’s Point
    • Surgery vs.antibiotics

    Mesenteric Ischemia

    • 80% mortality
    • Vague signs and symptoms
    • Subtle and vague CT findings

    Abdominal Compartment Syndrome

    • Primarily affects critical ICU patients

    • Tensely distended abdomen

    • Abdomen pushes on mediastinum compressing heart

    • Causes increased PIP and MAP

    • Compresses renal vasculature

    • Decompression: huge risk v.benefit analysis

    • Questions:*

    • The patient is a 35-year-old female with no past medical or psychiatric history. Her husband called 911 after she pulled a hose into the house and began to spray the walls screaming that the house was on fire. He is adamant that she is healthy but stated that she has been very tired for the past two weeks which is abnormal. Her vital signs are Pulse 130, RR 28, BP 86/42, SpO2 99%, Temp 103.1. You suspect:

      • d. Thyroid Storm

    • The patient is a 45-year-old female who is 3 weeks status post-surgery to remove a glioblastoma. She presents with tachypnea, tachycardia, and she is lying in a bed that is soaked with urine. The most likely etiology is:

      • c. Diabetes Insipidus

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    Description

    This quiz covers key concepts related to diabetes mellitus, thyroid disorders, and adrenal insufficiencies. It encompasses symptoms, physiological effects, and critical conditions such as myxedema coma and thyroid storm. Test your understanding of these important endocrine functions and pathologies.

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