Your Daily Meds - 6 April, 2022
Good morning and welcome to your Wednesday dose of Your Daily Meds.
News: The little Ward Call Course I made is now available. It maps out an Evening Ward Call shift and covers a bunch of common tasks that you may need to do, like:
Deteriorating Patients
Heparin Infusions
Fluid Orders
Electrolyte Replacement
Difficult patients - Discharge Against Medical Advice, Ryan’s Rule
End of Life etc
You can find the course page HERE.
It’s free and always will be. Let me know what you think.
Bonus Review: How does ADH act on the kidney?
Answer: ADH does a few nice things
ADH affects the cells of the medullary and cortical collecting ducts
In this part of the tubule, the major cell types are
Principal cells - responsible for
Water absorption
Sodium reabsorption
Potassium excretion
Intercalated cells - responsible for
Hydrogen ion secretion
ADH combines with V2 receptor on basolateral membrane of principal cells in collecting duct
= activation of adenyl cyclase —> cyclic AMP is formed as second messenger
End result = vesicles in principal cell sytoplasm move to and fuse with luminal membrane
Water channels (aquaporin 2) present in those vesicles get incorporated into the luminal membrane
Then water can now be reabsorbed down an osmotic gradient
Of course, when ADH is not present, the luminal membrane is impermeable to water
Query:
Which of the following correctly describes the normal venous drainage of the adrenal glands?
Left via the left renal vein; right via the inferior vena cava
Left via the left phrenic vein; right via the inferior vena cava
Right via the right renal vein; left via the left renal vein
Right via the right renal vein; left via the inferior vena cava
Right via the right gonadal vein; left via the inferior vena cava
Have a think.
Scroll for the chat.
Question:
Secondary amenorrhoea is most likely to originate from which of the following sites?
Hypothalamic-pituitary
Ovary
Endometrium
Lower genital tract
Iatrogenic cause
Have a think.
Scroll for the chat.
Anatomical:
Righto, so - left adrenal gland via the left renal vein; right via the inferior vena cava.
See the image below for the normal venous drainage of the adrenal glands:
Cessated:
Secondary amenorrhoea involves the cessation of menstruation for 6 or more months in those with previously regular periods. This is contrasted to primary amenorrhoea, the failure to commence menstruation.
Normal menstrual function requires a functional hypothalamic-pituitary-ovarian axis, functional uterine endometrium and normal lower genital tract. Secondary amenorrhoea can be considered based on the level at which the pathology occurs. Central causes (hypothalamic-pituitary dysfunction) are more likely to have low levels of follicle-stimulating hormone (FSH) or luteinising hormone (LH) being released from the hypothalamus. Peripheral causes, as with dysfunction of the ovaries or endometrium, are more likely to have high levels of FSH and LH.
The origin of secondary amenorrhoea is hypothalamic-pituitary in approximately 85% of cases.
Bonus: What is lymph?
Answer in tomorrow’s dose.
Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.
Just credit us where credit is due.
As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!
Luke.