Unit 6: Endocrine & Urinary system

Endocrine System structure

* Pituitary gland
* Thyroid gland
* Parathyroid
* Adrenal glands
* Pancreas
* Pineal and thymus glands
* Ovaries and testes

Functions of Endocrine System

* Consisting of endocrine (ductless) glands
* Secretion of chemicals called hormones directly into the bloodstream
* Control and integration of many bodily functions
* Action of hormones on target organs to increase or decrease the target’s activity level
* Monitoring and interpretation of and reaction to changes in the body and external environment to maintain homeostasis

Pituitary gland

* Tiny, pea-shaped structure at the base of the brain
* Consists of an anterior and posterior lobe
* Known as the “master gland” of the body
* Regulation of many body activities
* Stimulation of other glands to secrete their own specific hormones
* Effects of its hormones felt throughout the body

Pituitary gland - Anterior lobe

secretion of six hormones

Pituitary gland : Anterior lobe- Adrenocorticotropic hormone (ACTH)

regulates the production of steroid hormones by the adrenal gland

Pituitary gland: Anterior lobe - Follicle

stimulates hormone (FSH), which stimulates egg production in the ovaries or sperm production in the testes

Pituitary gland: Anterior lobe - Growth hormone (GH) (*somatotropin)*

regulates growth of bones and other tissues

Pituitary gland: Anterior lobe - Luteinizing hormone (LH)

stimulates production of sex hormones by the ovaries or testes

Pituitary gland: Anterior lobe - Prolactin

stimulates growth of breast tissue and milk production in females

Pituitary gland: Anterior lobe - Thyroid

stimulating hormone (TSH), which regulates activity of the thyroid gland

Pituitary gland: posterior lobe - Antidiuretic hormone (ADH) (*vasopressin)*

* Regulation of urinary output
* Role in blood pressure regulation

Pituitary gland: posterior lobe - Oxytocin

* Inducement of labor in pregnant women by stimulating contractions in the uterus
* Promotion of milk secretion from the mammary glands

Thyroid gland

* Two lobes on either side of the trachea
* Secretion of three hormones

Calcitonin

regulates normal blood levels of calcium and phosphate (in conjunction with parathyroid hormone)

Triiodothyronine (T3)

increases the rate of cellular metabolism

Thyroxine (T4)

increases the rate of cellular metabolism after being converted to T3 in the tissues

Parathyroid gland

* Two pairs of pea-shaped organs located on the underside of the thyroid gland
* Secretion of parathyroid hormone (PTH)

Parathyroid gland - parathyroid hormone (PTH)

Regulation of normal blood levels of calcium and phosphate (in conjunction with calcitonin)

Pancreas

* Elongated organ located just below the stomach in back of the abdomen
* Secretion of two hormones

Pancreas - Insulin

removes glucose from the blood by promoting storage in tissues as carbohydrates when blood glucose levels are high

Pancreas - Glucagon

stimulates the release of sugar from storage sites in the liver when blood glucose levels are low

Pineal gland

* Small, pinecone–shaped organ located deep within the brain just behind the thalamus
* Secretion of melatonin, which influences the maturation of sexual organs during puberty

Thymus gland -Thymosin

plays a role in development of the immune response in infants

Thymus gland

* Butterfly-shaped organ located between the lungs
* Withering away during puberty, leaving adults with fat and connective tissue in its place
* Secretion of thymosin

Ovaries

* Functioning in the female reproductive and endocrine systems
* Secretion of two female sex hormones

Ovaries - Estrogen (Estradiol)

stimulates development of ova (eggs) and secondary sex characteristics

Ovaries - Progesterone

prepares and maintains the uterus in pregnancy

Testes

* Functioning in the male reproductive and endocrine systems
* Secretion of male sex hormone testosterone

Testes - Testosterone

* Responsible for the development of secondary sex characteristics and sex drive
* Necessary for sperm production
* Maintenance of the reproductive organs in adult males

Graves disease

* Most common form of hyperthyroidism
* Caused by over secretion of hormones (T4 and T3) by the thyroid gland, in which elevated levels produce profound changes in the body’s physiological processes
* More common in women than men

Graves disease: signs and symptoms

* Exophthalmos
* Elevated metabolic rate
* Heat intolerance
* Weight loss, fatigue, and muscle weakness
* Enlarged thyroid (goiter)
* Thyrotoxic crisis
* Tachycardia
* Arrhythmias
* Heart murmurs
* Cardiomegaly

Graves disease: Treatment

* Antithyroid agents to block hormone synthesis within the thyroid gland
* Alteration in the structure of the thyroid gland through surgery or radioactive iodine therapy
* Beta blockers in combination with one of the treatments listed above

Cushing syndrome

* Caused by exposure to excess cortisol
* Adrenal or pituitary problem
* Long-term use of corticosteroids
* More common in females

Cushing syndrome: signs and symptoms

* Central obesity with thin arms and legs
* Fat pad on upper back (buffalo hump)
* Round, “moon-shaped” face with acne and facial hair
* Secondary diabetes due to insulin resistance
* Glucose intolerance due to stimulation of gluconeogenesis
* Muscle wasting and thin skin with purple striae as a result of cortisol’s catabolic effect on tissues
* Hypokalemia due to sodium retention and potassium loss in the urine
* Catabolic effects on bone leading to osteoporosis, pathological fractures, and back pain from compression fractures of the vertebrae
* Risk of infection due to anti-inflammatory and immunosuppressive actions of cortisol
* Mental status changes in about half of patients, from irritability to psychosis

Crushing syndrome treatment

restoring cortisol to normal levels, removal of a tumor, suppression of the adrenocorticotropic hormone

Growth Hormone (GH) Imbalance

hyper/hypo secretion of GH (responsible growth of bones, cartilage, and soft tissue)

signs of GH Imbalance

Acromegaly, Giantism= hypersecretion

Dwarfism= hyposecretion

GHI Treatment

drug therapy, surgery

Diabetes Mellitus

\n Metabolic diseases, high glucose, due to defects in insulin secretion/action

Type 1 Diabetes Mellitus

insulin dependant, hyperglycemia, occurs in children

Type 2 Diabetes Mellitus

non-insulin-dependant, middle age, high blood glucose

Type 1 symptoms

fatigue, polyphagia/uria/dipsia, unplanned weight loss, blurred vision, loss of metabolic control

Type 2 symptoms

\n commonly asymptomatic

Type 1 treatment

\n diet, exercise, foot and eye care, medication

Type 2 treatment

diet, exercise, oral drugs, insulin injections

Insulin injection

rotation of multiple daily injections to several sites

glucose testing

using a glucometer, monitoring test of glucose levels in blood

insulin delivery

using an insulin pump, delivers subcutaneous insulin

Hypophysectomy

minimally invasive endoscopic surgery to excise the pituitary gland, possible transfrontal craniotomy to remove tumor

FBG

Fasting blood glucose

GTT

Glucose tolerance test

RAIU

Radioactive iodine upake test

TFT

Thyroid Function Test

HRT

Hormone replacement therapy

Kidney

Bean-shaped organ located in the lumbar region of the back

Renal Cortex

outer region of the kidney

Renal Medulla

inner region of the kidney

Nephron

Microscopic functional unit of the kidney

\- Forms urine in renal corpuscles and tubules by process of filtration, reabsorption, and secretion

Renal corpuscle

contains glomerulus and bowman's capsule

Glomerulus

transportation of waste products for filtration

Bowman capsule

\n beginning of waste removal

Nephrin - Renal tubule

\n End of urine formation and transportation of urine to renal pelvis

Nephron - Collecting tubules

leading to and terminating at the renal pelvis

Ureters

\n Vessels for carrying urine in peristaltic waves from the kidneys to the urinary bladder

Bladder

Hollow, muscular sac; Temporary reservoir for urine

Urethra

Tube that carries urine from the urinary bladder to outside the body in a process called *urination* or *voiding*

*Chronic kidney disease*

* Progressive, irreversible decrease in renal function

\~Metabolic, fluid, & electrolyte imbalances

\~Uremia & nitrogenous waste products build-up in the blood

* Effects in every body system

Chronic Kidney Disease: signs/symptoms

\-Polyuria and oliguria \n -Edema of the extremities, sacral area, and abdomen \n -Hypertension \n -Weakness and fatigue \n -Nausea and vomiting \n -In later stages, yellowish pale skin that causes itching due to urea crystals on the skin

chronic kidney disease: Treatment

* Dietary restrictions
* Control of blood glucose levels and blood pressure
* Smoking cessation
* Prevention of further damage and end-stage renal disease

end-stage renal disease (ESRD)

* Inability of kidneys to sustain daily activity.
* Usually the result of chronic renal failure
* Toxic build-up of urea and creatinine in the blood
* Effects all systems, with dialysis or renal transplantation needed for survival

end-stage renal disease signs/symptoms

* Progressive, with varied severity depending on the extent of renal damage and remaining function
* Weakness
* Anorexia
* Diarrhea
* Pruritus
* Polyuria

end-stage renal disease: treatment

* Dietary restriction of protein,sodium, and potassium
* Antiemetics for nausea
* Control of hypertension
* Dialysis
* Renal transplantation

renal calculi

* Concentration of mineral salts in the renal pelvis or calyx
* Most common cause of urinary obstruction

Renal Calculi Signs/Symptoms

* Possibly asymptomatic for long periods
* Intense pain and urinary urgency if the calculus fragment lodges in a ureter
* Dull, constant pain if calculus is in the renal pelvis and calyx
* Back pain and severe abdominal pain
* Other signs and symptoms, including nausea, vomiting, chills and fever, hematuria, and abdominal distention

renal calculi - treatment

* Passage of small calculi without treatment
* Surgical excision (lithotomy) for larger calculi
* Extracorporeal shock-wave lithotripsy (ESWL) — powerful sound waves used to break up calculi
* Prevention of new calculus formation and enhanced elimination of calculi with increased fluid intake
* Antibiotics if build-up is due to bacterial infection
* Analgesics for relief of intense pain

hydronephrosis

\- Distention of the renal pelvis and calyces due to pressure from accumulating urine

\~Leading to impairment and, possibly, total interruption of kidney function

hydronephrosis - signs/symptoms

signs/symptoms

* Possibly asymptomatic for a long period if only one kidney is affected
* Intense pain, possibly including back and abdominal pain
* Nausea
* Vomiting
* Oliguria
* Anuria
* Hematuria

hydronephrosis - treatment

* Placement of stents and a nephrostomy tube
* Removal of obstruction, prevention of complications, and treatment of underlying disorders
* Catheterization for immediate relief of urinary pressure
* Analgesics if needed
* Antibiotics if infection occurs
* Surgery if needed to dilate a ureteral stricture

Catheterization

\n insertion of a slender tube into the bladder

Catheter function

to withdraw urine for diagnostic purposes or to introduce liquids

Hemodialysis

\n diversion of a patient’s blood into a machine for filtering, and then returned to the body

Peritoneal Dialysis

\n dialysis using the patient’s peritoneum

what are the 2 steps in Peritoneal dialysis

infusion of dialysis solution into the peritoneum, and removal of the fluid containing waste products

Extracorporeal shock-wave lithotripsy (ESWL)

use of powerful sound-wave vibrations to pulverize calculi in the kidney

Renal transplantation

diseased kidneys replaced by transplanted kidney

Bladder Scan

The use of sound-waves to estimate the amount of urine in the bladder (painless and non-invasive, no patient preparation required)

Cystoscopy

insertion of a cystoscope through the urethra and into the urinary bladder

What is a cystoscopy used for

examining the bladder, obtaining biopsies of tumors/growths, removing polyps

Blood urea nitrogen

measurement of the amount of urea (the major waste product), used to evaluate renal fluid, indication of impaired renal function (with high values)

pyelography/ intravenous pyelography (IVP)

radiographic procedure that evaluates the kidneys, renal pelvis, ureters, and bladder

Pharmacology

\n Antibiotics, antispasmodics, diuretics

azot/o

nitrogenous compounds

cyst/o, vesic/o

\n bladder

glomerul/o

glomerulus

hemat/o, hem/o

\n blood

hepat/o

liver

hydr/o

\n water

lith/o

stone, calculus

meat/o

opening, meatus

nephr/o, ren/o

\n kidney