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34 Cards in this Set

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  • Back
he rate of ADH released into the bloodstream is directly related to the _____
osmolality of the ECF
what triggers the release of ADH into the circulation?
a severe decrease in vascular volume and other stesses such as pain
an increase in ECF osmolality is corrected by...
ingesting water and adding it to the ECF
a decrease in ECF osmolality is corrected by...
excreting water and removing it from the ECF
ECF osmolality (and hence sodium concentration) is regulated by....
ADH
ADH regulates....
ECF osm and hence sodium concentration
ADH is synthesized in the....
paraventricular and supraoptic nuclei of the hypothalamus
ADH is transported in the axoplasmic fluid of the hypothalmic-hypophyseal nerves to storage sites in nerve terminals of the....
posterior pituitary (neurohypophysis)
What stimulates the release of ADH from the posterior pituitary?
nerve action potentials
What is the neurohypophysis?
posterior pitiuitary
what is the adenohypophysis?
anterior pituitary
Which is the more potent vasoconstrictor, ADH or angiotensen II?
ADH
The paraventricular and supraoptic stimuli are more sensitive to changes in ______ than any other stimulus.
changes in ECF osmolality
What is the most powerful stimulus triggering the release of ADH?
an increase in ECF osmolality
ADH location of action?

effect?
distal tubule and collecting duct

increased absorption of water leading to a small amount of dilute urine
In the absence of ADH, the distal tubule and collectin gduct are ___ to water.
impermeable, leading to a large amount of dilute urine.
any stress (trauma, hypotension, emotional, pain, hypovolemia) leads to .....
an increase in the release of ADH.
what effect does ADH have on the permeability to water of the distal and collecting ducts?
increases the premeability
causes of DI?
failure of ADH synthesis or ADH release (most common)

insensitivity of the dital tubules and collecting ducts to ADH (nephrogenic)
SIADH as a result of surgery from...[5]
intercranial tumors, hypothyroidism, porphyoria, small oat's Ca of lung
diagnostic findings with SIADH?
inappropriate increased urine sodium concentration and urine osm in the presense of hyponatremia and decreased plasma Osm.
What is the major determinant of ECF volume?
TOTAL BODY SODIUM (content-load)
What is the most important hormone is regulating ECF volume?
aldosterone
ANP does what?
released from right atrium and acts on the kidney to increase sodium excretion
sodium excretion increases when GFR ______
increases and vice versa.
3 determinants of Na excretions.
GFR
aldosterone
ANP
aldosterone's effect on sodium excretion?

on K excretion?
aldosterone leads to sodium retention (decresed excretion)

leads to K excretion
aldosterone site of action...
late distal tubule, PRIMARILY the collecting duct
A pheochromocytoma is a tumor of the _____ or ______ of the _______ that has excessive catecholamine secretion. (norepi)
adrenal medulla or chromaffin tissue of the paravertebral sympathetic chain
pheocromocytoma originate in the ______ and are found in the ______.
adrenal medulla [90%]

abdominal cavity [95%]
MANIFESTIONS of pheocromocytoma...

The diagnostic triad is....
paroxysmal HTN
sweating
tremulousness
tachycardia

as well as HA, palpitaions, orthostatic hypotension


triad is diaphoresis, tachycardia, HA
pheocromocytoma patients ussually die from [3]
CHF
MI
intracerebral bleed
pheocromocytoma treatment?
alpha adrenergic blockade
-phenoxybenxamine
-prazosin

beta block
-for tachycardia

-correct hypovolemia (may need neo to support BP)
pheocromocytoma anesthetic concerns?
-do not stimulate sympathetic NS
-sedate well during line placement, etc....
-deep anesthesia
-control tachycardia (esmolol, etc)