Case 2: When Life Is Too Sweet

Question 1

What do the letters of PITCHIN stand for and what does each one do?

Answer 1

Phagocytes: WBC that engulf phagocytose pathogens
InTerferons: small proteins released by virus-infected cells to increase macrophage activity
Complement: proteins that attract phagocytes to foreign bacteria
Histamines: Inflammatory response, secreted (with heparin) by mast cells
Natural killer cells: lymphocytes that lyse infected foreign cells

Question 2

What two things cause issues with immunity?

Answer 2

excessive response (autoimmune)
inadequate response (immunodeficiency)

Question 3

What are the three stages of wound healing?

Answer 3

1. inflammation: fills with clot and cells (neutrophils first, mast, macrophage, etc)
2. tissue formation: increased macrophages and fibroblasts to make granulation tissue (increased keratinocytes)
3. tissue remodeling: re-epithelialization, decreased cellular density of granulation tissue, ECM remodeled, formation of scar

Question 4

What does the exocrine portion of the pancreas produce, how much of the pancreas does it make up and what cells secrete?

Answer 4

digestive enzymes (produced by acinar cells), bicarbonate ions to small intestine
99%

Question 5

What does the endocrine portion of the pancreas produce, how much of the pancreas does it make up and what cells secrete?

Answer 5

insulin (beta cells) and glucagon (alpha cells)
islets of Langerhans (also secrete somatostatins and pancreatic polypeptide)
1%

Question 6

What happens when you eat (hormone in response to glucose)? How much glucose is normally in blood 2 hours after meal?

Answer 6

increased blood glucose
detected by beta cells
beta cells secrete insulin
increased uptake of glucose from blood
8-10 mmol/L

Question 7

How does insulin work and what does it effect?

Answer 7

activates second messengers

change in metabolism and change in genes (growth)

Question 8

What does glucagon do?

Answer 8

low glucose = break down of glycogen

Question 9

How are AGEs formed? What is good for measuring hyperglyscaemia and T2DM?

Answer 9

when glucose binds to proteins or lipids (glycation)
in RBC, glucose to haemoglobin
HBA1c good for measuring hyperglycaemia and T2DM

Question 10

How are lipid intermediates formed?

Answer 10

decreased insulin = free fatty acids and LI

Question 11

What do the numbers in a blood pressure reading mean?

Answer 11

systolic: pressure as blood pushes through heart
dystolic: pressure maintained by arteries between heartbeats

Question 12

What causes T1DM?

Answer 12

autoimmune

destruction of islets of Langerhans so less insulin released

Question 13

Why are diabetic foot ulcers common?

Answer 13

decreased macrophages, slow collagen formation, decreased cell proliferation, decreased formation of new blood vessels

Question 14

What is happening with T2DM? And what can it cause?

Answer 14

insensitivity to insulin
nerve damage, insensitivity in limbs
damage to retinas, kidneys, liver, pancreas, stomach, muscle
increased amount of ADVANCED GLYCATION END PRODUCTS

Question 15

What is the cause of hyperglycaemia? What can it cause?

Answer 15

capacity of glucose transporters exceeded, some glucose remains in filtrate, less H2O reabsorbed (H2O goes from low concentration to high concentration)
dehydration

Question 16

In the nephron, glucose is cotransported on what molecule from what concentration to what concentration?

Answer 16

sodium

from high concentration in tubule to low concentration in cells lining nephron

Question 17

What does noradrenaline do?

Answer 17

constriction of kidney arterioles
decreased filtration and H2O secretion
constriction of vessels to increase BP

Question 18

What does ADH do? Where is it released from and what stimulates its release?

Answer 18

increase H2O reabsorption and constricts blood vessels (urine production decreases)
posterior pituitary
decreased BP and increased salt in blood

Question 19

What does renin-angiotensin aldosterone do?

Answer 19

increase salt and water absorption

Question 20

What substance does endothelium produce to increase blood flow?

Answer 20

nitric oxide

Question 21

What happens in atherosclerosis?

Answer 21

increased glucose and lipid intermediates damages endothelium
inflammatory response
increased glucose in blood, increased clotting
LDL (bad) cholesterol deposits on artery walls

Question 22

What are the three reasons insulin insensitivity occurs in T2DM?

Answer 22

decreased affinity between insulin and receptor
decreased number of receptors (receptor down regulation
decreased effectiveness of receptor

Question 23

What two medications decrease blood pressure and how?

Answer 23

diuretics: decrease reabsorption of NA+ and therefore water

calcium channel blockers: relaxation of smooth muscle

Question 24

How does obesity lead to insulin resistance?

Answer 24

obesity to increased free fatty acids and glucose to hyperinsulinaemia to insulin resistance

Question 25

What do biguanides (metformin) do?

Answer 25

prevent production of new insulin from liver and increase sensitivity

Question 26

What do SGLT2 inhibitors do?

Answer 26

decrease glucose reuptake from filtrate

Question 27

What do alpha-glucosidase inhibitors do?

Answer 27

competitive inhibitors of enzymes in small intestine where carbs are digested

Question 28

What do ACE inhibitors do?

Answer 28

decrease salt and water retention

INHIBIT PRODUCTION OF ANGIOTENSIN II

Question 29

What is ACE?

Answer 29

ANGIOTENSIN CONVERTING ENZYME

Question 30

What does angiotensin II cause?

Answer 30

aldosterone secretion in kidneys which leads to water retention and salt reaborption