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ENDOCRINE SYSTEM

Pancreas
 Functions
1. Excorine – lipase, amylase, protease
2. Endocrine
*the ff cells are located in islet of langerhans
 Alpha cells: glucagon
 B cells: insulin
 D cells: somatostatin

 DX:
1. (FBS) Fasting blood sugar
 NPO post midnight
 N: 70-110 mg/dL

*hypoglycemia: <50 mg/dL

“cold and clammy, HYPOGLY” -- “cold and clammy, give some CANDY”
“hot and dry, the sugar is HIGH”

2. (OGTT) Oral glucose tolerance test

 Preferred by OB in cases of GDM
 NPO post midnight. Lasts 2 to 3 hours.
 Go to lab then will be given IV fluid and will see if pt can tolerate glucose
THEN nurse will get glucose level again then will ingest fluid again and then
glucose level will be taken again.

 S/SX
1. Polyuria (osmotic diuresis)
2. Polyphagia
3. Polydypsia

 Complications
1. Diabetic retinopathy – MGT ophthalmologist annually.
2. Diabetic nephropathy – MGT prepare for HD. Visit nephrologist.
3. Diabetic neuropathy – MGT foot care. Visit podiatrist.
*Avoid wearing same shoes 2 days in a row.
*When buying shoes buy it in the afternoon because “feet expand” in the
afternoon.
*Avoid putting lotion in between the toes.
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TYPES
1. IDDM (insulin-dependent)
 Defect in B cells
 Common in children (juvenile
on set)
 Causes:
 Idiopathic
 Genetic
 Autoimmune
 Viral infection
 S/SX
 Muscle wasting b/c of
CHON use
 Complication: DKA
 Glucose level: 300-600
mg/dL
DKA “Di kataasan”
 D – ehydration b/c
glucose level is high
K – ussmaul’s breathing
(deep, rapid, labored
breathing)
A – cetone / fruity odor
of breath
 Metabolic acidosis,
Hyperkalemia – MGT is
INSULIN still
 Primary treatment: IV
FLUIDS
 INSULIN
 In ref, but never be frozen. +2 to +8
 Do NOT shake. Just roll between your palms.
 Discard in 28 days / 1 month
 Best site of injection: 2” from umbilicus.
**Do not use the same site consecutively because it can cause lipodystrophy.
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2. NIDDM (non-insulin dependent)
 Defect in insulin receptors
 Common in adults (senile on
set)
 Causes:
 >45, stress
 Sedentary lifestyle
 Fat intake
 Alcohol, smoking
 Complication: HHNK
(Hyperosmolar, hyperosmotic,
non-ketotic syndrome)
*(+) glucose in cell and serum,
but no breakdown of fats
because (+) glucose in cells
*In layman’s term, (+) glucose
but not enough
 >600mg/dL
HHNKS “High na High
nakaka-seizure”
 DOC: Oral hypoglycemic
drug
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Rapid acting o Onset: 5-15 mins

 Insulin lispro o Peak: 1 hour
 Insulin aspart o Duration: 2 to 4 hrs

*When do you check for hypoglycemic

reaction if you gave insulin lispro at 7am?
--- 8 am
Regular (short acting) o Onset: 30 mins
 Humulin R o Peak: 2-3 hrs
o Duration: 3 to 6 hrs
Intermediate acting (NPH) o Onset: 2 to 4 hrs
 Humulin N o Peak: 4 to 12 hrs
o Duration: 12 to 18 hours
Long acting o Onset: 1 to 1 ½ hours
 Glargine (Lantus) – La “Long o Peak: 5 hrs
acting” o Duration: 24 hrs
ULTRA long acting o Onset: 6 hrs
 Glargine U-300 o No peak – usually given at night
so it’d take over the whole night
o Duration: 36 hrs
 1st inject of AIR: 1) NPH [intermediate acting/CLOUDY] 2) regular [short
acting/CLEAR]
 Withdraw/aspirate: 1) Regular/clear 2) NPH/cloudy

**Memorize the PEAK.

Dawn phenomenon Somogyi phenomenon

 Hormones!! Hyperglycemia!!
 Occurs at 5am-6am
 TX: Administer NPH at 10pm
 Rebound hyperglycemia
 Insulin at night, natulog, glucose
went down, liver will compensate
to release glycogen, (+)
hyperglycemia in the morning
 Tulog, baba sugar
 Gising, taas sugar

MGT:
 Decrease insulin dose at night
 Give midnight snack
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How to differentiate? GET GLUCOSE LEVEL AT 2AM - 3 AM.

Glucose level – Dawn phenomenon
Glucose level – Somogyi phenomenon

 Oral hypoglycemic drugs – will tell pancreas to increase insulin. Give BEFORE
meals.

Sulfanylureas Glipizide
Glyburide
Meglitinides Repaglinide
Biguanides Metformin
Rosiglitiazone
*tells liver to release glycogen
*hepatotoxic so monitor liver function
test
a-glucosidase inhibitos Precose
Acarbose
*will delay breakdown of simple sugar
in your mouth
*take it WITH FIRST BITE of the meal

DOC for acromegaly / gigantism: (Ocreotide acetate) Sandostatin “Hindi

na kasya ang sando kasi lumaki”

Antidiuretic hormone (ADH) – anti “ihi” hormone

SIADH Diabetes Insipidus
“sobrang increase ADH” “D- down ang ADH”
“DI – dami ihi, dami inom”
Urine Urine
 High specific gravity (N 1.010-  Hallmark: Very low specific gravity
1.025)  Low osmolality
 High osmolality
Blood
Blood  Hypokalemia
 Hyponatremia
 Hyperkalemia
(+) Dehydration – "Diiiii-hydrated”
(+) water intoxication *everything is DOWN except output
*everything is UP except output MGT: Desmopressin, Vasopressin
MGT: Diuretic
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THYROID DISORDERS
1. T3 “Triiodothyronine”
2. T4 “Tetraiodothyronine/thyroxine”
*T3 and T4 regulate basal metabolic rate. They are molecules connected to TG.
3. Calcitonin – gives Ca to bone

 DX:
 RAIU (radioactive iodine uptake)
 Sodium iodide 131 is given.
 Ask the ff:
Diet: Did you eat seafood the night before?
Dx procedure: Did you undergo any diagnostic procedure recently?
 MGT: Flush the toilet several times b/c it’s radioactive.
**PTH – gives Ca to serum :P
**Calcitonin – gives Ca to bone :P

Thyroid
Hyperthyroidism Hypothyroidism
*everything is UP except TSH, weight *everything is DOWN except TSH,
and menstruation weight, and menstruation

 S/SX VS  Complications
Diaphoresis  Child: Cretinism
Heat intolerance  Adult: Myxedema coma
Diarrhea How to know if there’s myxedema
Insomnia coma? VS is LOW + LOC
Nervousness
Weight loss  S/SX VS
Amenorrhea Cold intolerance
Somnolent
 Hallmark: Exopthalmus Weight gain
 WOF: Seizure Menorrhagia

 Complication: Thyroid storm /  Hallmark:

Thyrotoxicosis Facial edema
Fatigue
How to know if there’s a Forgetfulness
complication? HIGH VS
-- “TH”YROID (temp and HR) MGT: Levothyroxine (Synthroid)
 s/e insomnia
MGT for fever: Bromochriptine  give in the morning (AM)
(Parlodel)
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MGT: Prophylthiouracil (PTU)

Methimazole
Tapazole

2nd choice: Radiation therapy

Last resort: Thyroidectomy
 Preop drugs:
1. Lugol’s solution
 7-14 days before surgery
 Causes staining of teeth so
administer VIA STRAW and
citrus juice

Good to know:
 4 Medications to be taken
via straw: Lugol’s, Iron,
Tetracycline,
Nitrofurantoin (drug of
choice for pyelonephritis)

POST-OP:
1. Laryngospasm – respiratory
obstruction
+ Bedside tracheostomy set
2. Hypocalcemia – HypoPTH
Hyperphosphatemia
+ Airway, tracheostomy set
+ Ca gluconate

*How to know if there’s HYPOcalcemia?

(+) Chvostek’s sign – Facial twitching
(+) Trousseau’s sign – BP cuff inflate, (+)
carpal spasm
(+) Tetany – muscle numbness

3. WOF hemorrhage
+ Check for bleeding at site or
back of neck
4. Aphonia – absence of voice
+ Report to AP
**Hoarseness: side effect of
surgery
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PARATHYROID GLANDS
Hypocalcemia: muscle spasm
Hypercalcemia: muscle weakness
At risk for Fracture
Normal Ca: 9-10.5 mg/dL
Normal Phosphorus: 3-4.5mg/dL

HYPOPARATHYROIDISM HYPERPARATHYRODISM
Ca PO4 Ca PO4

Hypocalcemia Hypercalcemia
 Tingling sensation around lips  Fractures
 Chovstek’s Sign  Renal stone formation
 Trousseau Sign
Hypophosphatemia
Hyperphosphatemia  Complication: Renal stone
 Complications: Laryngeal spasm  Priority: Fluids
 Priority: Airway

KIDNEY STONES
Acid Alkaline
 Uric acid  Oxalate
 Cysteine
Acid – ASH diet
Alkaline – ASH diet o Cranberry
o Corn
o Prune
o Plum

*Dried fruits are high in K.

 Surgery
1. Extracorporeal shockwave lithotripsy (ESL)
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ADRENAL GLANDS
 Adrenal medulla  cathecholamines: epi / norepi / adrenaline

1. “Pheochromocytoma” - tumor in medulla

 Paroxysmal headache
 Hypertension

 DX: VMA (vanillyl mandellic acid test) – 24 hr collection test

- Wants to check vanilla b/c it’s a byproduct of catecholamine
- Discard the 1st save the last!!
- Can put preservative para hindi mapanis
- DO NOT flush urine within 24 hrs kasi restart ulit
- No to vanilla containing food – no to cake, coffee, ice cream, hazelnut, mocha,
or toothpaste with vanilla

N vanilla in urine: 6mg / 24 hrs

 MGT:
a. Monitor BP
b. Maintain client in normotensive state

 Adrenal cortex  cortisol, corticosteroid

o Mineralocorticoid – Na
o Glucocorticoid – glucose
o Ketosteroid – androgen / Sex H

CUSHING’S SYNDROME ADDISON’S

 Hypernatremia  Hyponatremia
 Hypertension  Hypotension
 Hyperglycemia  Hypoglycemia
 Hypokalemia  Hyperkalemia

*everything is up except K *everything is down except K

 S/SX  S/SX
Trunchal obesity Bronze skin pigmentation
Buffalo hump Cyanosis – Shock!!! Addisonian
Striae in abdomen crisis!! – Antidote: Epinephrine
Edema
Hirsutism in females – extra hair MGT: Fluodrocortisone (Prednisone)
Gynecomastia (b/c of high sex H)  Avoid crowded areas.
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MGT: Mitotane (Lysodren)

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SKIN DISORDERS
1. Scabies
 Cause: Mites (surot) under skin
 S/SX: itching, presence of multiple straight or wavy, threadlike lines
beneath the skin
 Prevention: Wash and hot iron all materials
 Highly contagious

**Kuto – pediculosis
**Treat 1, treat all.

2. Ringworm
 Cause: Fungus
 S/SX: Scaly patch or bump w/c develops into itchy red rings w/ raised,
blistery, scaly borders
 TX: Antifungal creams “-azole”

3. Eczema (nagbabalat)
 Cause: Stress, irritants, climate-trigger flare-ups
 S/SX: Inflamed skin, red, dry, & itchy
 TX: Cortisone creams, pills, shots, antibiotics, antihistamines,
phototherapy, cold compress

4. Hives
 Cause: Allergy is pagkain, aspirin/penicillin, shellfish, strep throat, temp
extremes, nuts (has aflatoxin)
 S/SX: Itchy, stinging, burning sensation, DOB!!
 Prevention: Antihistamine. Epi if w/ DOB.

5. Psoriasis
 Cause: Unknown
 S/SX: Rash of thick red plaques covered with silvery scales
 TX: Steroid or retinoid creams, light therapy, and medications

6. Acne vulgaris
 S/SX: Circumscribed, solid elevation of skin
 Prevention: Keep oily areas clean, don’t squeeze pimples
 TX: 1) Benzoyl peroxide 2) Retinoids (don’t give vitamin A esp to preggy
women!) 3) Antibiotics
7. Cold sores (fever blisters) – “singaw”
 Cause: Herpes simplex, too much sun, stress
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 S/SX: Small, painful, fluid-filled blisters on mouth or nose

 TX: Antiviral pills or creams, doctor consultation if it contains pus

8. Warts
 Cause: HPV
 S/SX: Small, rough growth that can resemble a cauliflower or a solid
blister
 Prevention: Do not pick, cover w/ bandage, keep dry
 TX: Lasers, chemical wash

9. Chickenpox/varicella zoster
 S/SX: Maculopapular vesicular rash
 Recurrence: Herpes zoster / shingles, very painful, linear
 Prevention: Vaccine
 TX: Acyclovir

10. Heat rash / “prickly heat”

 Cause: Blocked sweat ducts, dresses baby too warmly
 S/SX: Pimple-like rash
 Prevention: Dress lightly!!
 TX: Topical antibacterial

11. Vitiligo / “anak araw”

 Cause: Hair loss on certain parts of body
 TX: Cortisone creams / light therapy
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BURNS
 Acute management of chemical burns (Lysol, muriatic acid – running water for 10
minutes)
1. Emergency therapy
2. History-taking: a) Name and b) concentration of chemical

 Classification of burns:

Thickness Degree Depth Characteristics

Superficial 1 Epidermis Pain, redness, mild
swelling
Superficial partial 2 Dermis BLISTERS, pain,
Papillary region severe swelling
Deep partial 3 Dermis PAINLESS, white,
Reticular region leathery
Full thickness 4 Hypodermis (SQ tissue), Charred, eschar
bones formation,
insensate

 MGT
 Grafting
a. Autograft – from you
b. Isograft – from twins
c. Homograft – same species (cadaver)
d. Heterograft – different species (pork, tilapia)

 Parkland formula (Lactated Ringer’s is preferred)

TBSA burned (%) x wt (kg) x 4ml = fluid reqt

 1st 8 hours : ½ of fluid reqt, fast drip

 16 hrs : other ½ of fluid reqt

 Insert picture of Rule of Nines in adult and pedia

 Situation: If the victim is burnt with clothing, left the clothes on and immerse
patient in water
 Situation: In electrical burns, do NOT pull the victim away from electrical source,
switch off the electricity and push the victim away w/ wooden stick

 Hyperbaric oxygen therapy (HBOT) for wound healing <3

100 % oxygen, negative pressure
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 POST-BURN
 (1st 48 hrs) HYPERKALEMIA d/t K-release from damaged tissues
 Metabolic acidosis

 Wound healing
 Phases of wound healing
a. Inflammatory – vasodilation so blood supply can start WH
b. Proliferation – tissue granulation formation
c. Maturation – remodeling phase

1. Healing by first-intention – For clean and fresh wounds BQ !!!

Ex. Closing in surgery
2. Healing by second-intention – Contaminated or infected wounds
Ex. Nadapa ka sa street
3. Healing by third-intention – Too contaminated

 Wound Drainage
1. Serous – Coloress NORMAL
2. Sanguinous – Blood NORMAL
3. Serosanguinous – Pink
4. Purulent – Infection
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RENAL DISORDERS
 Nephrons – functional unit of kidney

 DX:
1. (IVP) Intravenous pyelogram
- w/ contrast medium
- w/ consent
- PRE: enema (better visualization), assess for allergy

2. (KUB) Kidney, ureter, bladder x-ray

- w/o contrast medium
*BUN N value – 10-20 mg/dL
*Creatinine – 0.5 – 1.5 mg/dL

ASSESSMENT FINDING INDICATION

Ecchymosis in the flank area Retroperitoneal bleeding
Severe colicky pain (flank, abdomen, Renal calculi
groin)
Hematuria AGN (acute glomerulonephritis)
Hypertension
Periorbital edema

NEPHRITIC SYNDROME NEPHROTIC SYNDROME

 Inflammation of kidneys  There’s a hole in nephrons so
semi-permeable membrane
 S/SX becomes fully permeable
Hematuria
Tea-colored urine  S/SX
Cola-colored urine Hyperalbuminemia
Hypertension Frothy urine – andun ang “froootin”
Hypernatremia Hypotension b/c of low albumin
Periorbital edema Periorbital edema

Edema w/ HYPERtension: Edema w/ HYPOtension :

nephritic nephrotic

 Subsides in a day  Progresses w/in a day

1. AGN
 Acquired
 Prior infection: GAHBSI (Grp A)
S ore throat
I mpetigo
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S carlet fever

2. ALPORT’S SYNDROME
 Genetic

 Types of kidney problems

(K) Pre-renal – prob w/ BEFORE kidney
(U) Intra-renal – damage inside of kidney
(B) Post-renal – problem w/ urether pababa; obstruction in urethra;

1. Acute pyelonephritis
 CVA tenderness
 Complication of a recurrent lower UTI
2. BPH
 Dribbling urine
 TX:
 TURP – transurethral resection of prostate
 Has CBI or continuous bladder irrigation using isotonic solution
3. Renal failure
 Acute – lasts days to weeks
 3 phases:
1. Oliguric – 8 to 14 days
*Oliguaria <400ml/day (N is 800ml/day)
*Anuria <50ml/ day
2. Diuretic – 2 to 6 weeks (10L/day)
3. Recovery – up to 6 months

 Chronic renal failure / ESRF (end-stage) – months to years

 Confusion
 Encephalopathy
 Seizures
 Fishy odor of breath
 Uremic crystals on skin (yellow-brown)
DIET: All renal diseases have LOW PROTEIN, LOW SODIUM, LOW POTASSIUM diet
except nephrotic syndrome + HD
MANAGEMENT:
 Dialysis
1. Peritoneal (w/o machine)
o Complication: Peritonitis
o CCPD – continuous cycle peritoneal dialysis (w/ machine when
draining)
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2. Hemodialysis
o Complication of HD: Disequilibrium syndrome, s/sx headache and
vomiting

 Kidney transplant
o Kidney rejection types
1. Hyperacute – few minutes
2. Acute – 1st week to 3 months
3. Chronic – years
Anti-rejection med: Cyclosporine. Do NOT take w/ grapefruit.

CONCEPTS
 Potassium is primarily excreted by kidneys by kidneys so hyperkalemia is an
indication for HD
 Complication of peritoneal dialysis: Peritonitis
 Complication of HD: Disequilibrium syndrome, s/sx headache and vomiting