1. Pathology I Flashcards
Endocrine organs
• Secrete hormones to target cells and organs
• Peptides
• Steroids
• Amino acids and arachidonic acid analogs
– Catecholamines
• Regulation usually through ____ feedback
• Any organ that produces a hormone > endocrine ○ Kidney § EPO § Renin ○ Stomach § Digest and control appetite ○ Pituitary, hypothalamus, sex organs > ones that are initially thought about ○ Panc and parathyroids • Peptides = small \_\_\_\_ • Steroids ○ \_\_\_\_ ○ Estrogen • Adrenaline/noradrenaline (epi/noriepi) = \_\_\_\_ • Mechanism of regulation for most is negative feedback regulation ○ ACTH and cortisol from adrenal § Once ACTH > adrenal to produce corticos > ciruclation and threshold > if high enough > shuts down ACTH secretion from the pituitary □ Ngeative feedbcak regulation
negative
proteins
testosterone
catecholamines
Pancreas
• ____ and endocrine gland
• Excretes digestive juices
• Secretes – Insulin – \_\_\_\_ – Somatostatin – \_\_\_\_
• Can't live w/o a pancreas • Exocrine ○ Producing substance that exit into the environment § Salivary gland is also an exocrine § Here producing enzymes and lubricant that goes into the \_\_\_\_ to neutralize stomach acid contents • Endocrine ○ Produces insulin, glucagon, somatostatin and panc polypeptide
exocrine
glucagon
pancreatic polypeptide
duodenum
Endocrine pancreas Islets of Langerhans 1 – 3 million islets in human pancreas – Most found in \_\_\_\_ Up to 3000 cells per islet \_\_\_\_-staining cells
• Small component of the actual pancreas • Purple = serous acini (the \_\_\_\_ portion) ○ Produces digestive enzymes and juices • Arrows highlight the \_\_\_\_ portion > characterized by pale-staining islets of langs • Most of the hormone is produced in the tail region of the pancreas • The islets are smalled copared to what's next to it
tail
pale
exocrine
endocrine
Endocrine pancreas • α (A) cells (15-20%) – Glucagon • β (B) cells (\_\_\_\_%) – Insulin • δ (D) cells (5-10%) – Somatostatin • F cells (< 1%) – Pancreatic polypeptide
• B cells far outnumber the alpha cells ○ Don't see delta or F cells here
60-70
Insulin – activated by blood glucose > ____ mg / 100 mL
- Decreases blood glucose levels
- Promotes uptake of glucose
- Glucose storage via ____
- Glucose utilization via ____
- ____ breakdown
- ____ synthesis in skeletal muscle cells and hepatocytes
• Glycogenesis occurs in the liver • Lipoproteins = chylomicron ○ Contain \_\_\_\_ cholesterol and protein ○ Insulin breaks these down for energy • Start as \_\_\_\_/pre-hormones before getting metabolized into the functional product
70 glycogenesis glycolysis chylomicron protein synthesis TG pre-peptide
Glucagon
• Blood glucose < ____ mg / 100 mL stimulates release
• Increases blood glucose levels
• Reciprocal action to insulin
Somatostatin
• Inhibits ____ and glucagon secretion
• Suppresses ____ function
Pancreatic polypeptide
• Suppresses ____ function
• Inhibits gastrointestinal ____
• Controls ____ and weight
• Somatostatin ○ Regulates dig enzymes from the pancreas ○ Regulates appetide by reducing the digestive enzymes > not eating > don't need more digestion into th duodenum • Panc polypep ○ \_\_\_\_ suppressor § Regualtes in similar way to somato > suppresses exocrine function of panc § Limits ability of GI tract to move • Panc polypep expression is NOT related to \_\_\_\_ ○ The other three ARE § Once normalized > no reason to further produce insulin, glucagon or somatostatin
70
insulin
exocrine
exocrine
motility
satiety
appetite
sugar
Diabetes mellitus
• Prevalence across the world is increasing > more obese > more likely they'll develop type 2 diabetes ○ Type 1 is \_\_\_\_ § Young people § Diff mech from type 2 § Inability fi panc to produce \_\_\_\_ □ Autoimmune destructino of b-cells > dec insulin production from the panc □ No insulin > no glucose being taken up by the cells > become hyperglyc ○ Type 2 Is not \_\_\_\_ § Multifactorial in development § Result of 1 and/or 2 things: □ Cells are \_\_\_\_ to glucose ® Receptors are defective (glucose trasnproters) □ \_\_\_\_ produces less insulin ○ Irrespective of type; DM > glucose accum in BS and urine > hyperglycemic > serious complications • Most expensive disease in this country ○ 1 or 3 $ is involved in treating DM and complics: § \_\_\_\_ § Athersclerosis § \_\_\_\_ (cerebrovascular accidents)kidney dysfunction § \_\_\_\_/infections § Dementia
autoimmune insulin autoimmune insensitive panc HTN CVA amputations
Diabetes mellitus – Diagnostic criteria
• Fasting plasma glucose > ____ mg/dL
• Typical signs and symptoms of hyperglycemia and
random plasma glucose ≥ ____ mg/dL
• Plasma glucose ≥ ____ mg/dL two hours after oral glucose tolerance test
• Glycated hemoglobin (HbA1C) ≥ ____%
• When he says Diabetes > means DM • >126 mg/dL> patient is DIABETIC; irrespective of type 1 or type 2 ○ No eating the night prior • Random blood glucose during the day > >200 mg/dL > diabetic ○ Doesn't matter if you eat, dirnk, etc. • GTT ○ Test where you fast over night > like you're going into GA ○ Blood drawn next morning > base line glucose > then give a \_\_\_\_g dose of sugar (orally) ○ Two hours > another blood draw > test blood glucose at that time § If at that point is >200 mg/dL > indicative of diabetes • A1C - isoform of HbA > glycoprotein that years ago they determined the level correlated w blood sugar ○ Hb is a reflection of blood cells ○ HbA1C reflects a number (average amount) over a \_\_\_\_ month period of time > blood cells have a 3 month period of life § Reflects average of blood sugar over 3 month period of time • All are measurements of diabetes ○ Can also be pre-diabetic § If the numbers are in the table > pre-diabetes □ Risk fo developing if not contorlling diet □ Fasting BG > \_\_\_\_ □ GTT > \_\_\_\_ □ A1C > \_\_\_\_
126
200
200
6.5
75 3 100-125 140-199 5.7-6.4
Type I Diabetes mellitus
• ____ destruction of β cells
• Viral infection trigger
– ____ mimicry
• ____-DR, -DQ, -DP
• Islet cell antibodies – \_\_\_\_ (IAA) – Glutamic acid decarboxylase (GAD) – \_\_\_\_ (ZnT8) – Tyrosine phosphatase-IA2 protein (IA2)
• Also called \_\_\_\_ diabetes • Autoimmune dx that if left unchecked > life threatening ○ Constantly measuring their blood ○ Taking care of their diet § Carry sugar packets in case they need it, bc at risk of hypoglycemia • Mutlficatorail - there is a \_\_\_\_ link, but not 1:1 (not AD, or AR) > storng genetic component > regulated nby the HLA molecules ○ DR, DQ, and DP inc the risk fo diabetes type I ○ \_\_\_\_ infection can trigger the dx § Molecular mimicry is the mechanism □ Strep infection causing systemic complications > RF and PSGM □ Same mechanisms play the role • Once dx triggered > autoab produced across array of antigens in the pancrease • Don't manifest w diabetes from time of birth, but rarely during their single digit years > more likely in adolescence and late-teens/early-adults ○ Takes \_\_\_\_ to manifest > takes a while for ab to damaged the panc to the extent of causing insulin deficiency
autoimmune molecular HLA insulin autoantibody b cell-zinc transporter
juvenile
genetic
viral
time
Type II Diabetes mellitus
• ____ pathogenesis
• ____ tissue resistance to insulin
• Insufficient ____ of insulin by β cells
• Not the result of AI-type dx • Mechanism results in: ○ Cells resistant to insulin § \_\_\_\_ receptor being mutated in those cells ○ Insufficient secretion of insulin § Iatrogenic □ Panc surgeyr > lose chunk of \_\_\_\_ > less insulin being secreted ® Presence of a tumor • Don't memorize the picture ○ Rare cases > b cell failure > insuffieicnt secretion
multifactorial
target
secretion
insulin
tail
• KNOW THE CHART
• Type 1
○ Juvenile diabetes
○ Age of onset = ____ (late childhood, adolescence, into teen)
§ Older people bc of a ____ trigger (RARE!)
○ Rather ____ onset
§ Kids start losing weight, fail to thrive properly, meet their growth thresholds, feeling run down and thirsty
○ No ____ link; the link is more so in risk
○ ____ destrucitno of beta cells is the mechanism
○ Test insulin levels > ____ to speak off
• Type 2 ○ Non-\_\_\_\_ dependent diabetes ○ \_\_\_\_ dx (more younger people are getting it now) ○ \_\_\_\_ onset (years!) § Stage of pre-diabetes (prolonged) before full blown diabetes ○ Far more \_\_\_\_ than type 1 ○ \_\_\_\_ genetic link; but not a direct gene-to-gene link § Parents are obese, if predisposed to weight gain > important risk factor ○ Insulin \_\_\_\_ and insuff \_\_\_\_ of insulin ○ Test insulin levels > initially \_\_\_\_ bc the target cells are not responding to insulin § Panc produces more and more insulin > early on in these patients > high insulin levels, eventually they drop > the target tissuesa ren't responding > circ at high levels > panc adapts > producing less insulin > what's in the circ will \_\_\_\_ off (due to the half-life)
• Nutritional status - ____ in younger, and in the olde rpop - overweight and obese
○ Houston has the highest rate in the country
young viral quick genetic AI none
insulin adult slower common stronger resistance secretion high die
undernourished
2018 Recommendations for type 2 diabetes testing in asymptomatic adults:
Overweight/obese with risk factors – \_\_\_\_-degree relative – High-risk ethnicity – History of \_\_\_\_ disease / hypertension – HDL < 35 mg/dL and/or triglycerides > 250 mg/dL – \_\_\_\_ inactivity Patients with \_\_\_\_ Women diagnosed with \_\_\_\_ diabetes Age > \_\_\_\_ years
2018 Recommendations for type 2 diabetes testing in under 18 years:
Overweight / obese with risk factors
– ____ history of diabetes during pregnancy
– ____ history
– High-risk ____
• Memorize all of these • Advocating screening for at risk children (for the first time) • High risk ethinicty > Hispanic and \_\_\_\_ and NA • Obsese and atherosclerosis • Higher the HDL level > the \_\_\_\_ it is ○ High TG or low HDL > risk factor that warrants screening • Screened every \_\_\_\_ years for diabetes once you're prediabetic • Even if you're \_\_\_\_, once over 45 you're screened
first cardiovascular physical prediabetes gestational 45
maternal
family
ethnicity
AA
better
3
healthy
• Part of screening includes a ____ history
○ Includes a visit to the dentist
• Advocate a dental examination as part of that process
dental
Acute clinical complications
• Hyperglycemia
– Glycosuria causes osmotic ____
– Induces ____ and ____
– ____
• Diabetic ketoacidosis
– ____ breathing
• Hyperglycemia can be life threatening ○ First sign is the 3 P's: polyuria, polydipsia and polyphagia § Pee a lot, very thirsty and very hungry □ Glucose in the urine > creates an osmotic gradient that forces the urine to become even more diluted □ Peeing more > losing more H2o > more thirsty □ Cells aren't eating enough > body senses you have to eat more > become more hungry • Seen commonly w \_\_\_\_ > weight loss ○ Kids and young adults > first signs that something is wrong in that patient > start losing weight rather rapidly • Diabetic ketoacidosis ○ \_\_\_\_ balance is out of wack > significant complication that one sees in DM > extrmeely high \_\_\_\_ levels (>200 mg/threshold; have 500-700 mg/dL) > more likely that they're hyperglycemic, and using it in weird ways > formatino of \_\_\_\_ bodies that end up in the circulation (urine) > gives breath that smells like \_\_\_\_ ○ Most commonly seen in \_\_\_\_ § Body produces more HCO3 > converted to CO2 > expelled through the lungs ○ Have a unique breathing pattern > kussmaul breathing pattern
diuresis
polyuria
polydipsia
polyphagia
kussmaul
type 1 acid base sugar ketone acetone
type 1
Acute clinical complications
Hyperosmolar coma in ____ diabetes
– No ____
Extremely high levels of plasma glucose – > ____ mg/dL
____ onset than ketoacidosis
High risk of mortality
• Another rcomplication seen in type iI > hyperosmolar coma > comatose from high sugar levels > don't get KETOSIS ○ Ketones found in type I and not \_\_\_\_ diabetes ○ For the coma to occur > levels of glucose must be sky high > blood congealed bc of the glucose sitting in the circ § Complication occurs slower than ketoacidosis; with coma > may get death • Know the text in this photo
type 2
ketosis
600
slower
type 2
Acute clinical complications
____ resulting from treatment
Develops during ____, fasting or stress
Treat with ____ or intramuscular glucagon
• Some patients w diabetes may experience hypoglycemia ○ Can occur thorugh treatment > do not \_\_\_\_ properly > hypoglycemic state > insulin levels being regulated in dramatic fashion > and then glucagon secreted instread of insulin ○ Patients tend to be ones w high preference for \_\_\_\_, fast or get stressed out > metabolic imbalance > hypoglycemia in some patients § Treatment > w glucose to counterbalance that fast and dramatic reduction; and glucagon to release glucose from the system
hypoglycemia
exercise
glucose
titrate
exercise
• Standard of care in a dental office > patient may become hypoglycemic
• Patients put in ____, and given a ____ packet to restore sugar levels
○ Know the diagram
trendelenburg
sugar
Chronic clinical complications
____ disease
\_\_\_\_ disease – Retinopathy – Neuropathy – Nephropathy • End stage renal disease
Diabetic ____ ulcers
• Infections
• From type II standpoint > patient at risk for developing severe and morbid, chronic complications > most impt: macrovascualr disease ○ Implies large artery disease > \_\_\_\_ § Risk for developing MI, severe HTN, kidney failure and for a CVA (stroke) § Blood flow is much \_\_\_\_ > more cxn w sugar > blood flows less rapidly > will settle in and carry the plaque/chol in the BS > deposit on BV walls bc flow is so slow □ Patients at risk for microvascualr dx > smaller vessels in the peripehry > eyes, fingertips, lower extemeites, brain, kdiney ® Patients may become \_\_\_\_ ® May dvelop \_\_\_\_ ® May develop peripheral \_\_\_\_ ® Or \_\_\_\_ > may result in end stage renal dx > complete kidney failure □ Explains why skin breaks down in the perpihery > feet ® Foot ulcers are common (furthest from heart), and patients are at risk for infection > slower BF > bacteria have higher propensity to aggregate ina. Specific site ® Single most common cause of below knee amputation is \_\_\_\_
macrovascular
microvascular
foot
atherosclerosis slower blind dementia neuropathy nephropathy
diabetes
