Chapter 17: Diseases of Pancreas Flashcards
What are the levels of glucose controlled by?
the opposing effects of insulin and glucagon
High blood glucose levels cause increased pancreatic secretion of what?
insulin
Low blood glucose levels cause increased pancreatic secretion of what?
Glucagon
Glucagon stimulates what?
the liver to convert stored glycogen to glucose
Which pancreatic islet of Langerhans produces what?
○ Beta cells: Insulin
○ Alpha cells: Glucagon
When does pancreatic enzymes digestion occur?
duodenum
Acute pancreatitis
○ Is acute inflammation of the pancreas
○ sudden and painful
* can be a catastrophic medical emergency associated with shock and death
Chronic pancreatitis
○ repeated episodes of acute pancreatitis that destroys and scars the pancreas
○ less dramatic, less painful, and less dangerous
What conditions is associated with acute pancreatitis?
○ Gallstones: half of the patients with acute pancreatitis have gallstones
○ Alcoholism: 2/3 of the cases are associated
○ Unknown (idiopathic): 10% of the cases
○ Other: virus infections, high levels of calcium
What are symptoms for people with gallstones? How is it discovered?
○ never had any symptoms, though larger stones may have a cramping pain in the middle to right upper abdomen (biliary colic)
○ discovered when having a routine x ray, abdominal surgery, or other medical procedure
What are some symptoms that may occur with pancreatitis?
○ Pain in the right upper or middle upper abdomen, that may go away and come back
○ Fever
○ Yellowing of skin and whites of the eyes (jaundice)
Tests used to detect gallstones or gallbladder inflammation
○ Abdominal ultrasound
○ Abdominal CT scan
○ (ERCP)
○ radionuclide scan
○ Endoscopic ultrasound
○ (MRCP
○ (PTCA
Blood tests for gallstones or gallbladder inflammation
○ Bilirubin
○ Liver function tests (LFTs)
○ Pancreatic enzymes
List out LFT’s (Liver function tests)
○ Albumin
○ Alpha-1 antitrypsin
○ ALP
○ ALT
○ AST
○ Gamma-glutamyl transpeptidase (GGT)
○ Prothrombin time
○ Serum bilirubin
○ Urine bilirubin
Large amounts of bilirubin in the blood can lead to what?
○ Jaundice
○ a yellow color in the skin, mucus membranes, or eyes
What aren’t a part of LFTs
amylase and lipase
What happens to amylase and lipase during acute pancreatitis?
○ amylase levels rise and fall quickly after injury
○ lipase levels rise more slowly and stay elevated longer
What is the most common cause of chronic pancreatitis?
alcohol abuse
What is the least common cancer type in males and females?
Cancers of the pancreas
What is often a sign of Pancreatic Carcinoma?
Upper abdominal pain or back pain usually is the first symptom
if the tumor obstructs the common bile duct…
Painless jaundice may be the initial sign
How many patients survive pancreatic carcinoma? For how long?
○ Only about 1% of patients with pancreatic carcinoma survive five years
Beta cell tumors (insulinomas)
○ Usually a benign mass secreting insulin
○ Causing hypoglycemia
○ Glucose < 50mg/dl
○ Effects the ANS: Nervousness, sweating, irregular heartbeats, tremor, hunger
Zollinger-Ellison
○ results from gastrinomas
○ Causing stomach and duodenum ulcer
Diabetes Mellitus
○ A disorder of insulin action
○ results in high blood glucose (hyperglycemia)
What defines Diabetes mellitus?
○ fasting blood glucose level 126 mg/dl or more
○ blood glucose level 200 mg/dl on any occasion
Type 1 diabetes
the pancreas does not secret enough insulin
Types-2 diabetes
Insulin produced is not effective
What is Type-1 diabetes known as? What is it responsible for?
○ (juvenile diabetes
○ 10% of the diabetes
What type of diabetes is responsible for the remaining 90% of cases?
Type-2
Insulin deficiency that results from what?
autoimmune destruction of the islets by anti-islet antibodies
Pathogenesis of Type 1 Diabetes
○ A lifelong disorder
○ autoimmune disorder
○ Early on islets become infiltrated with T lymphocytes
○ Runs in families, however, more so in type 2
Pathogenesis of Type 2 Diabetes
○ target cell resistance to insulin
○ Majority have a parent or sibling with the disease
○ Peripheral tissue begins to resist insulin as much as 10 years before the diagnosis becomes apparent
○ Obesity is the cause of 80%
What are short term complications of Diabetes Mellitus?
○ Glycosuria- blood glucose raise above renal threshold (180 mg/dl), thus glucose in urine
○ Polyuria – frequency urination
○ Polydipsia – increased water intake
○ Polyphagia – increased appetite
○ The paradox: ravenous appetite and weight loss
Diabetic comas occur from what?
○ acidosis or severe dehydration
○ Acidosis occurs when insulin is lacking, with glucose unavailable, the body must burn fat for fuel
Diabetic ketoacidosis
Rapid, deep breathing as lungs labor to expel acid in the form of ketones and CO2
What does Diabetic ketoacidosis lead to?
○ Glycosuria – as blood glucose levels exceed the renal threshold – glucose spills into urine.
○ Acidosis – low blood pH owing to ketone buildup.
○ Ketonuria – excretion of ketones in urine.
○ Osmotic diuresis – high urine output as glucose in urine carries water with it.
○ Volume depletion – body loses water in urine
Acute Complications of Diabetes Mellitus
○ Hypoglycemia
○ Diabetic ketoacidosis
○ Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
○ Somogyi effect
○ Dawn phenomenon
Long-term Complications of Diabetes
○ Accelerated atherosclerosis
○ Myocardial infarction
○ Stroke
○ Peripheral vascular insufficiency & gangrene
○ Retinal disease (retinopathy)
○ Renal insufficiency
○ Peripheral nerve disease
