chapter 20 Flashcards
Pancreas: Different cells
-________: stimulate the release of glucagon and glycogen stores & promote gluconeogenesis
alpha cells
Pancreas: Different cells
_______: stimulate he release of insulin and lower blood glucose levels
beta cells
Pancreas: Different cells
_______: inhibit glucagon and insulin secetion
delta cell
inflammation and hemorrhage of the pancreas due to auto digestion of pancreatic ________ by pancreatic enzymes
- premature activation of _____ leads to activation of other pancreatic enzymes
- results in ________ hemorrhagic
- mostt commonly due to _____ and ____; other causes include trauma
-epigastric abdominal pain radiates to the ____
-nausea and vomiting. elevated serum ____ and _____; _____ is more specific for pancreatic damage
-_________(calcium is consumed during saponification in fat necrosis)
-complications
____________ - formed by fibrous tissue surrounding liquefaction necrosis and pancreatic enzymes
-pancreatic abscess - often due to _____
acute pancreatitis parenchyma trypsin liquefactive alcohol gallstones back lipase, amylase lipase hypocalcemia pancreatic pseudocyst E.coli
fibrosis of pancreatic parenchyma, most often secondary to recurrent acute pancreatitis
causes include _____ (adults) and ______ (children), some are idiopathic
clinical features: epigastric abdominal pain radiating to the ____, pancreatic insufficiency: results in malabsorption with _____ and ______ vitamin deficincies.
_______ calcification on x-ray and contrast studies reveal a ________ pattern due to _____ of pancreatic ducts
-increased risk for _________
chronic pancreatitis alcohol cystic fibrosis back steatorrhea fat soluble dystrophic chain of lakes dilatation pancreatic carcinoma
adenocarcinoma arising from the pancreatic ducts
most commonly seen in the elderly (average age is __ years). major risk factors are ______ and _________
clinical symptoms: epigastric abdominal pain and _____, _____ jaundice with pale stools and palpable ______; associated with tumors that arise in the ____ of the pancreas (most common location), tumors associated in the body or tail cause secondary _______, ______ (gallbladder distention)
-diagnosis: serum tumor marker is ____
treatment: includes surgical resection involves of removal of ___ and ___ of pancreas, proximal _____, and ______ (_______ procedure)
-very poor prognosis and 1 year survival is
adenocarcinoma of the pancreas 70 smoking chronic pancreatitis weight loss obstructive gallbladder head diabetes mellitus Courvoisier's sign CA 199 head, neck duodenum gallbladder Whipple 10%
Zollinger-Ellison syndrome with multiple ulcers unresponsive to medical therapy; may be part of ____(____________)
gastrinoma
MEN1
multiple endocrine neoplasia
insulin deficiency leading to a metabolic disorder characterized by hyperglycemia. due to autoimmune destruction of ___ cells by ______.
characteristics by inflammation of ____, linked with HLA ____ and ____, auto antibodies against insulin are often present and may be seen years before clinical disease develops
-symptoms of untreated disease include (__ + _____) _____, _____, __-_, weight loss and weakness
-untreated patients may progress to ______ and diabetic _________
-weight loss and low muscle mass will induce __________, _________ and _____ via glucagon which can induce hyperglycemia
-polyuria, polydipsia and hyperglycemia exceeds renal ability to resorb _____ resulting in excess filtered glucose leading to osmotic ____
treatment: lifelong _____
diabetes mellitus: Type 1 (IDDM) beta cells T lymphocytes islets DR3, DR4 3P's glucosuria polydipsia polyuria polyphagia ketosis ketoacidosis gluconeogenesis, glycogenolysis, lipolysis glucose diuresis insulin
end organ insulin resistance leading to a metabolic disorder characterized by hyperglycemia. mostly in _____, obese adults. obesity leads to decreased numbers of ____ receptors
-insulin levels are increased early in disease but insulin deficiency develops due to ___ cell exhaustion and evidence of ____ deposition in the islets in latter stages
-clinical features include ____, ____, _____ (same as IDDM)
-hyperglycemic __________ acidosis
diagnosis: made by measuring glucose levels (normal is __-__ mg/dL)
diagnosis: random glucose >___ mg/dL, fasting glucose >126 mg/dL (two times)
glucose tolerance test with a serum glucose level >__ mg/dL two hours after glucose loading
-managed with ____ changes and ___ drugs to stimulate insulin production and increase receptor effectiveness
diabetes mellitus type (I (NIDDM) middle aged insulin beta amyloid polyuria, polydipsia, hyperosmolar non-ketotic 70-120 200 200 dietary, oral
diabetic emergencies for type 1
(pathogenesis): results from the body’s change to fat metabolism and continuous buildup of ketones produces significant acidosis
signs and symptoms: results in hyperglycemia (> 300 mg/dL), ______ metabolic acidosis, and _______
presents with ________ respirations, ______, nausea, vomiting, _______ changes and ____ smelling breath due to _____
treatment: ____ (corrects dehydration from polyuria), ____, and replacement of _______(potassium)
diabetic ketoacidosis anion gap hyperkalemia Kussmaul dehydration mental status fruity smelling breath acetone fluids insulin electrolytes
diabetic emergies for type 2
found in type II diabetics, high glucose (>500 mg/dL) leads to life threatening dieresis with _____ and ____
-____ are absent due to small amounts of circulating insulin
-sustained hyperglycemia results in marked ______
treatment: ___ (corrects dehydration from polyuria) and ____
hyperglycemia hyperosmolar non-ketotic coma (HHNC): pathogenesis hypotension coma ketones dehydration fluids insulin
true hypoglycemia defined as blood sugar
hypoglycemia: insulin shock 60 glucose stores kidney
treatment of hypoglycemia
- ______ glucose
- only if intact _____, awake and able to sit up
- 15gm-30gm of packaged ______, or
- may use ___ containing drink or food
- oral route often _____
- _______ glucose
- adult: Dextrose __% (D50) 25gms IV in patent, free flowing vein, may repeat
- children: Dextrose __ % (D25) @ 2 - 4 cc/kg (0.5 - 1 gm/kg)
- infants: may choose Dextrose __% @ 0.5 - 1 gm/kg or 5 - 10 cc/kg]
oral gag reflex glucose sugar slower 50 25 10
complications of diabetes mellitus -Cardiovascular - \_\_\_\_\_\_\_\_ of extremities -\_\_\_\_\_\_\_\_\_\_ (damage to arteries) - Kidney - \_\_\_\_\_ - \_\_\_\_\_ -Eye \_\_\_\_\_\_ \_\_\_\_\_\_\_\_ - Nervous system - \_\_\_\_\_\_\_\_\_ disease - \_\_\_\_\_\_ neuropathy
gangrene arteriolosclerosis infection damage retinopathy cataracts cerebrovascular peripheral
