NCMP119: Endocrine System and Hepatic Encephalopathy - Practice Flashcards

Flashcards cover endocrine system anatomy, hormone function, regulation, thyroid/parathyroid/adrenal/pancreatic systems, and hepatic encephalopathy concepts, diagnostics, management, and nursing care.

What is an acute biological crisis as described in the notes?

A condition that may result in patient mortality if left unattended for a brief period and requires immediate attention to reverse the disease process and prevent further morbidity or mortality.

What is the endocrine system and what is its primary role?

A network of glands that produce, store, and secrete hormones to regulate metabolism, growth and development, tissue function, and mood, working with the nervous system to maintain homeostasis.

List the general effects of hormone action.

Regulate metabolic rate and energy storage/conversion; regulate fluid and electrolyte balance; initiate coping responses to stress; regulate growth and development; regulate reproduction.

How is hormone secretion typically regulated?

Primarily by a negative feedback system, where a fall in hormone concentration triggers release by a regulator gland, and elevations inhibit further secretion.

Differentiate primary, secondary, and tertiary endocrine disorders.

Primary: disease in the secreting gland itself; Secondary: disease in a regulator gland (e.g., pituitary) causing abnormal hormone release; Tertiary: hypothalamic dysfunction leading to abnormal stimulation by the pituitary.

What is an adenoma in endocrinology?

A hormone-producing tumor located at a remote site that can cause inappropriate hormone production.

Name the major endocrine glands listed in the notes.

Hypothalamus, pituitary, pineal, thyroid, parathyroids, thymus, adrenals, pancreas, ovaries, and testes.

How do endocrine glands differ from exocrine glands?

Endocrine glands secrete hormones directly into the bloodstream; exocrine glands secrete through ducts onto surfaces or into the GI tract.

What role does the hypothalamus play in endocrine regulation?

It produces releasing hormones (e.g., GHRH, TRH, GnRH, CRH) that control the pituitary and regulate multiple endocrine functions.

Which gland sits below the hypothalamus and influences growth and reproduction?

The pituitary gland.

What is the function of ADH (vasopressin) and which gland releases it?

ADH increases water retention in the kidneys and helps regulate blood pressure; released by the posterior pituitary.

What does growth hormone (GH) do?

Affects growth and development, stimulates protein production, and influences fat distribution.

What is the role of LH and FSH?

Control production of sex hormones and the production of eggs and sperm.

What does oxytocin do in the body?

Stimulates uterine contractions and milk duct contraction in the breast.

What is the function of prolactin?

Initiates and maintains milk production in the breasts and can impact sex hormone levels.

What is the role of TSH?

Stimulates the production and secretion of thyroid hormones (T3 and T4).

What hormones are produced by the kidneys relevant to endocrine regulation?

Renin (and angiotensin) regulating blood pressure; erythropoietin affecting red blood cell production.

What are the pancreatic endocrine hormones and their actions?

Glucagon raises blood glucose; insulin lowers blood glucose and influences metabolism of glucose, protein, and fat.

What hormones do the ovaries produce and what are their roles?

Estrogen – development of female characteristics and reproductive function; progesterone – prepares the uterine lining for implantation and breast preparation for lactation.

What is the function of parathyroid hormone (PTH)?

The most important regulator of blood calcium levels.

What is the function of thyroid hormone?

Controls metabolism, and influences growth, maturation, and nervous system activity.

What is the primary action of testosterone?

Develops and maintains male sexual characteristics and maturation.

What hormone does the pineal gland secrete and what is its function?

Melatonin; regulates sleep-wake cycles.

What releasing hormones does the hypothalamus produce to regulate the pituitary?

Growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone (GnRH), and corticotropin-releasing hormone (CRH).

What is the thymus’ primary endocrine function?

Produces hormones important for the development of a type of white blood cell called T cells.

What are common silent signs of thyroid dysfunction?

Unexplained weight changes, fatigue/weakness, hair and skin changes, cold or heat intolerance, and mood changes.

List common signs of diabetes mellitus as noted.

Increased thirst and urination (polydipsia and polyuria); blurred vision; slow-healing sores; recurrent infections; numbness or tingling (neuropathy).

What are common signs of adrenal dysfunction?

Weight gain (especially in abdomen and face), fatigue and muscle weakness, skin hyperpigmentation, salt cravings, and low blood pressure.

What does a high vs. low TSH indicate?

High TSH suggests hypothyroidism; low TSH suggests hyperthyroidism; T4 levels help distinguish the condition.

What is the role of T3 and T4?

T3 is the more active thyroid hormone affecting metabolism and development; T4 is a precursor that is converted to T3 in tissues.

What is the Bethesda system in thyroid cytology and what do Categories III and IV represent?

Category III AUS/FLUS: Atypia of undetermined significance/Follicular Lesion of Undetermined Significance with 10–30% risk of malignancy; Category IV FN/SFN: Follicular neoplasm or suspicious for follicular neoplasm, risk ~25–40%.

What imaging tests are used to localize parathyroid glands before surgery?

Neck ultrasound, Sestamibi scan (Technetium-99m), 4D CT scan; MRI in some cases.

What laboratory tests assess parathyroid function?

Serum calcium, parathyroid hormone (PTH), serum phosphate, 25-hydroxyvitamin D, magnesium, creatinine/eGFR, alkaline phosphatase; 24-hour urinary calcium.

What adrenal function tests are commonly used?

Serum cortisol, ACTH, plasma aldosterone concentration (PAC), plasma renin activity (PRA), DHEA-S, plasma catecholamines, and electrolytes.

What are stimulation and suppression tests used in adrenal assessment?

ACTH stimulation test; dexamethasone suppression test; insulin tolerance test; salt-loading test.

Describe the dual roles of the pancreas.

Exocrine function: digestive enzymes and bicarbonate; Endocrine function: islets of Langerhans producing insulin and glucagon to regulate blood glucose.

What are key tests to assess pancreatic endocrine function?

Serum amylase and lipase (pancreatitis), blood glucose, HbA1c, OGTT, fasting blood sugar (FBS).

What is hepatic encephalopathy (HE) and its basic pathophysiology?

A life-threatening neuropsychiatric complication of liver failure caused by ammonia and other toxins accumulating in the blood, leading to brain dysfunction.

What are precipitating factors for hepatic encephalopathy?

GI bleeding, high-protein diet, infections, uremia, dehydration, diuresis, certain medications, electrolyte disturbances, renal dysfunction.

What are early vs. advanced clinical manifestations of hepatic encephalopathy?

Early: mild mental changes, mood alterations, sleep pattern changes; Advanced: confusion, lethargy, disorientation, asterixis, constructional apraxia, coma.

What is fetor hepaticus and its significance?

A sweet, musty breath odor associated with advanced hepatic encephalopathy and portal-systemic shunting.

What is lactulose used for in HE and how does it work?

Lactulose reduces serum ammonia by acidifying the colon to trap ammonia, increasing stool frequency, and altering gut flora; typically 2–3 soft stools daily indicates effectiveness.

What are key nursing and management goals for hepatic encephalopathy?

Treat/remove the underlying cause; monitor neurologic status and ammonia levels; manage fluids/electrolytes; avoid sedatives; infection surveillance; educate family.

What dietary management is used during acute HE and during recovery/home care?

Acute: protein restricted to 0.8–1.0 g/kg/day; recovery/home: low-protein, high-calorie diet with gradual reintroduction of protein in 10 g increments; vegetable protein may be preferred if tolerance is low.

What is the typical prognosis for hepatic encephalopathy in cirrhosis?

Approximately 35% of patients with cirrhosis die in hepatic coma.