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Assignment 2 Endocrine and Cardiovascular SystemsMs. J.S., a 52 yo white female with two children (16 and 14 yo) presents with history of fatigue, weight gain and muscle weakness over past two years.? She initially thought it was caused by work stress and busy family life but has also noticed that she bruises more easily than in the past. ?She also noted purple lines (stretch marks) that you identified as?striae.??All of the above symptoms have been getting worse.? Blood pressure is 170/110, respirations 12/min and some ankle edema (non-pitting) was noted.? The limbs seem relatively thin and the trunk thickened, especially between the upper shoulder blades. Diagnosis was made of Cushing disease/syndrome.? How could you differentiate between the two?? Elevated levels of cortisol has two effects of plasma leading to increased volume: 1) up-regulation of receptors for?aldosterone?and 2) an increased effectiveness of ADH (either by centrally increasing ADH release or peripherally by increasing the cellular responsiveness).?What effects would these two changes (increased responsiveness to aldosterone and ADH) have on Na+, K+ and water levels in the plasma? (Endocrine Mod 3: MO2, MO3, CO2, CO3, CO4)Increased responsiveness to aldosterone would have the effect of increased sodium and decreased potassium. According to Huether and McCane (2017) aldosterone conserves sodium by increasing the productiveness of the sodium pump of epithelial cells. Aldosterone maintains extracellular volume by acting on distal nephron epithelial cells to increase reabsorption of sodium and excrete excretes potassium and hydrogen. ADH on the other hand increases the permeability of the distal renal tubules and collecting ducts leading to water reabsorption. ADH has no direct effect on electrolyte levels but by increasing water levels dilutes the serum electrolyte concentrations leading to hyponatremia (Huether & McCane, 2017). Where does cortisol secretion occur, and thus is a potential site of an over-secreting tumor? How else could someone develop Cushing syndrome if not by a tumor in that area? (Endocrine Mod 3: MO1, MO2, MO3, CO1, CO2, CO3, CO4, CO5)According to Huether and McCane (2017) cortisol is released from the adrenal glands in response to stress. Cushing syndrome can develop from endogenous cause, such as an over-secreting tumor, but can also develop by exogenous cause. One example is taking oral corticosteroids, such as prednisone, or injectable corticosteroids at high doses for an extended period of time.Which of the following influences the secretion of ACTH? (Endocrine Mod 3: MO1, MO2, CO1, CO2, CO3)d)? ?All of the aboveWhat is the?most common cause of Cushing syndrome?in the United States? (Endocrine Mod 3: MO1, MO2, MO3, CO1, CO2, CO3, CO4, CO5)a)? Adrenal tumors? ? ? ? ??Mr. M.S., an overweight, 55 yo white male presents to your clinic with chest pains.? He has a history of hypertension, alcohol use and does not restrict his diet.? He is currently taking nitroglycerin tablets as needed for angina.? This pain is worse and is not controlled by nitroglycerin.? The pain is radiating down his left arm.? The pain in the chest feels like pressure or heartburn.? You hear inspiratory rales, consistent with pulmonary edema.? His blood pressure is 100/75.? He begins to have difficulty breathing, especially when lying down.? ?EKG and serum enzymes suggest a left ventricular wall myocardial infarction.? Cardiac catheterization reveals a pulmonary wedge pressure of 30 mm Hg (normal, 5 mm Hg) and two-dimensional echocardiography measured an ejection fraction of 0.35 (normal, 0.55).? In the Coronary ICU, he was treated with?thrombolytic agents?(tPA), digitalis (a positive inotropic agent) and furosemide (Lasix, a loop diuretic)What measures above helped you determine that the stroke volume was reduced and why they correlate to reduced stroke volume? (Cardiovascular Alterations Mod 5: MO7, MO9, MO10, MO12, MO17, CO2, CO3, CO4, CO5)It can be determined that the stroke volume was reduced due to the ejection fraction being reduced from normal. According to Huether and McCane (2017), ejection fraction is the result of stroke volume divided by the end diastolic volume. A reduced stroke volume will lead to a reduced ejection fraction. Pulmonary capillary wedge pressure?is used as an estimate for what chamber pressure (as it is almost equal to that pressure) and how is it measured? Provide source. (Cardiovascular Alterations Mod 5: MO13, MO17, CO3, CO4, CO5)Pulmonary capillary wedge pressure is used to estimate left atrial pressure. This PCWP can only be measured when anterograde flow is not present and is done so by inserting a catheter through the pulmonary veins and pulmonary capillary bed into the pulmonary artery. Pulmonary wedge pressure. (n.d.). Retrieved November 16, 2018, from does?digitalis (AKA Oubain) work at a molecular level?to increase contractility (positive inotrope)? Discuss the ion gradients, how they were created/maintained for a cell at resting membrane potential and the effects of this drug that lead to its action on muscle. (Cardiovascular Structure and Function Mod4: MO2, MO6, MO7, MO9, MO11, CO1, CO2, CO3)Inotropic agents are those that affect contractility. There are two type of inotropes, positive and negative. Positive inotropes, such as digitalis, strengthen the force of cardiac contractility while negative inotropes will decrease cardiac contractility. Digitalis works to strengthen contractility by increasing the amount of calcium in the heart’s cells. This works because calcium stimulates the heart to contract. When digitalis reaches the muscle, it binds to sodium and potassium receptors. These receptors control the amount of available potassium by preventing potassium from being released by the cell.Inotropic Agents (Inotropes). (n.d.). Retrieved November 16, 2018, from a sentence or two, explain why Mr. MS developed pulmonary edema by describing?Starling forces and how they were altered to promote edema formation. (Cardiovascular Structure and Function Mod4: MO1, MO2, MO7, MO8, CO1, CO2, CO3)According to Huether and McCane (2017), Starling forces are the four forces that act together to determine if fluid moves from the capillary and into the interstitial space, filtration, or if fluid moves back into the capillary from the interstitial space, reabsorption. Mr. MS developed pulmonary edema due to left sided heart ischemia and failure that has resulted in pulmonary vascular congestion and inadequate perfusion of the systemic circulation. This was done by increasing capillary hydrostatic pressure which prompted fluid to move from the capillary into the interstitial space (Huether & McCane, 2017). References Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology. St. Louis, MO: Elsevier.Inotropic Agents (Inotropes). (n.d.). Retrieved November 16, 2018, from wedge pressure. (n.d.). Retrieved November 16, 2018, from ................
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