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Personal Endo > Class 4 Pancreas > Flashcards

Class 4 Pancreas Flashcards

1
Q

What 2 substances does the pancreas secrete? and what do they regulate?

A
  • Insulin and glucagon

- Glucose, lipid and protein metabolism

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2
Q

What does the acini do?

A

-Secrete digestive juices

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3
Q

What is the islet of Langerhans?

A

-Region of pancreas that contain endocrine cells

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4
Q

What cells are part of the islet of Langerhans?*****

A
  • Alpha
  • Beta
  • Delta
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5
Q

What cells secretes glucagon? *****

A

-Alpha

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6
Q

Beta cells secrete what?*****

A

-Insulin

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7
Q

Delta cells secrete what?*****

A
  • Somatostatin

- Pancreatic polypeptide

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8
Q

What is insulin?

A

-Hormone associated with energy abundance and storage of excess energy

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9
Q

What does insulin do to carbs?

A

-Stores them as glycogen in muscle and liver

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10
Q

What does insulin do to fat?

A

-Stores them in adipose tissue

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11
Q

What happens to excess carbs that cannot be converted to glycogen?

A

-Converted to fat and stored in adipose tissue.

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12
Q

Insulin promotes ______ of amino acids and conversion to ______.

A
  • Uptake

- Protein

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13
Q

Insulin is stimulated by what 7 things?*****

A
  • Amino Acids
  • Acetylcholine
  • Beta keto acids
  • High blood sugar
  • Glucagon
  • insulin resistance
  • Sulfonylurea drugs
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14
Q

Insulin is inhibited by what 4 things?*****

A
  • Low blood glucose
  • Fasting
  • Catecholamines**
  • Somatostatin
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15
Q

Neurons***** in the _____ are permeable to glucose and do not require _______.

A
  • Brain

- Receptors

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16
Q

Insulin facilitates entry of glucose into the cell EXCEPT in what 4 areas?

A
  • Brain****
  • Kidney tubules
  • Intestinal mucosa
  • RBC
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17
Q

How does insulin effect the liver?

A
  • Increase hepatic uptake of glucose
  • Increase lipogensis
  • Increase protein synthesis
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18
Q

How does insulin effect fat?

A
  • Increase fat synthesis and storage

- Inhibits fat breakdown

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19
Q

What effects does glucagon have?

A
  • Opposite of insulin

- Increase blood sugar

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20
Q

Insulin is an ________ hormone, while glucose is a _______ hormone

A
  • Anabolic

- Catabolic

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21
Q

What stimulates glucagon release?*****

A
  • Hypoglycemia
  • Amino acids
  • Beta adrenergic stimulation
  • Exercise
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22
Q

What inhibits glucagon*****

A
  • Fatty acids
  • Somatostatin
  • high glucose
  • insulin***
  • ketones
23
Q

The anabolic phase (postprandial) is mediated by what? When does it begin? and when does it peak?

A
  • Insulin
  • Insulin release begins at 100
  • Peaks at 400-600
24
Q

Catabolic phase (fasting) is mediated by what?

25
during fasting phase, glucagon breaks down what? to form what?
- glycogen - protein - triglycerides - Forms = Glucose and ketones
26
What is diabetes mellitus?
-Impaired metabolism of carbs, fat and protein
27
What is the difference between type 1 and type 2 diabetes?******
- Type 1 = lack of insulin | - Type 2 = decreased sensitivity of tissue to insulin effects
28
Glucose is reabsorbed by the kidney until about ______? After that the kidney is overwhelmed and leads to what
- 180 - Diuresis - Loss of Na and K - Glucosuria - hypovolemic hypotension - Dehydration - Poly: uria,dipsia.phagia
29
Low insulin leads to ______ catabolism, increased ______ catabolism and release of what?
- Muscle - Fat - Keto acids
30
Acute symptoms of diabetes are the 3 P's?****** and 2 other problems?
- Polyuria = osmotic diuresis****** - Polydipsia = Volume depletion - Polyphagia = protein catabolism - CNS irritability/confusion - Visual disturbances
31
What are the chronic symptoms of diabetes?
- decreased ability to fight infection - Macrovascular disease (accelerated atheroclerosis) - Microvascular disease
32
What does macrovascualar disease lead to in diabetes? (also perioperative implications)
- CAD - PAD - AMI - CHF - CVA - HTN
33
What does the microvascular disease lead to in diabetes?
- Nephropathy - Retinopathy - Neuropathy
34
Autonomic neuropathy causes what problems?******
- Orthostatic hypotension - Delayed GI emptying - Post induction hypotension - can't compensate volume or tone
35
Type 1 diabetes is caused by what?
-Destruction of beta cells from autoimmune disorder****** of viral infections****** (heredity)
36
T/F plasma levels of insulin are elevated type 2 diabetes?
True
37
What is the normal Hgb A1C and what does it reflect?******
- 4-5.6% | - Avg. blood sugar over 3 months (life of RBC)
38
What 4 ways does better glycemic control improve outcomes?
- Decreased hospital stay - Decreased infection - better outcomes after CVA, MI - Decreased mortality
39
Guidelines for perioperative diabetic surgery.
- 1st case of day - Hold oral hypoglycemics - balance control w/o hypoglycemia - type 1 should continue basal insulin - insulin pump OK for short procedures,
40
What is DKA? and what are the primary features?
- Type 1 diabetics with profoundly low insulin levels | - Dehydration, acidosis, electrolyte depletion (K)
41
Symptoms of DKA?
- N/V - Poly: -uria, -dypsia, -phagia - anorexia - Kussmaul breathing - acetone halitosis
42
What can precipitate DKA
- MI - Trauma - ETOH - Infection - Non compliance
43
DKA will present with DKA hyper or hypo kalemia?
Hyperkalemia in the face of total K depletion
44
What is the equivalent of DKA for type 2 diabetics? ****
-Nonketotic hyperosmolar state
45
Symptoms of Nonketotic hyperosmolar state*****
- Thrombosis from hyperviscosity - Focal neuro/reflex - global neuro signs - confusion seizures - Coma
46
Insulin excess (hypoglycemia)
-Profound CNS response (confusion, convulsion, coma) | -
47
Body response to early, late and very late hypoglycemia?
- Early = liver glycogen breakdown - Late = sympathetic stimulation (epi release) - Very late = GH and cortisol
48
What is an insulinoma?
-Beta cell adenoma that produces insulin
49
When does hypoglycemic shock occur?
glucose range 20-50%
50
What is glycogensis? Glycogenolysis? gluconeogensis?********
- Glycogensis = formation of glycogen (storage form of glucose) from glucose - Glycogenolysis = breakdown of glycogen - Gluconeogensis = production of glucose w/o carbs
51
Neurons use what for fuel?******
Ketones
52
What happens during osmotic diuresis? *****
- Dehydration of 4-6L - Loss of up to 10% body K - Loss of Na, mag, cl, phos
53
hyperglycemia perioperative consequences*****
- CHF - CVA - increased mortality and length of stay - Infection - Sepsis - ARF - Neuropathy - Poor fetal outcomes

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