Class 4 Pancreas Flashcards
What 2 substances does the pancreas secrete? and what do they regulate?
- Insulin and glucagon
- Glucose, lipid and protein metabolism
What does the acini do?
-Secrete digestive juices
What is the islet of Langerhans?
-Region of pancreas that contain endocrine cells
What cells are part of the islet of Langerhans?*****
- Alpha
- Beta
- Delta
What cells secretes glucagon? *****
-Alpha
Beta cells secrete what?*****
-Insulin
Delta cells secrete what?*****
- Somatostatin
- Pancreatic polypeptide
What is insulin?
-Hormone associated with energy abundance and storage of excess energy
What does insulin do to carbs?
-Stores them as glycogen in muscle and liver
What does insulin do to fat?
-Stores them in adipose tissue
What happens to excess carbs that cannot be converted to glycogen?
-Converted to fat and stored in adipose tissue.
Insulin promotes ______ of amino acids and conversion to ______.
- Uptake
- Protein
Insulin is stimulated by what 7 things?*****
- Amino Acids
- Acetylcholine
- Beta keto acids
- High blood sugar
- Glucagon
- insulin resistance
- Sulfonylurea drugs
Insulin is inhibited by what 4 things?*****
- Low blood glucose
- Fasting
- Catecholamines**
- Somatostatin
Neurons***** in the _____ are permeable to glucose and do not require _______.
- Brain
- Receptors
Insulin facilitates entry of glucose into the cell EXCEPT in what 4 areas?
- Brain****
- Kidney tubules
- Intestinal mucosa
- RBC
How does insulin effect the liver?
- Increase hepatic uptake of glucose
- Increase lipogensis
- Increase protein synthesis
How does insulin effect fat?
- Increase fat synthesis and storage
- Inhibits fat breakdown
What effects does glucagon have?
- Opposite of insulin
- Increase blood sugar
Insulin is an ________ hormone, while glucose is a _______ hormone
- Anabolic
- Catabolic
What stimulates glucagon release?*****
- Hypoglycemia
- Amino acids
- Beta adrenergic stimulation
- Exercise
What inhibits glucagon*****
- Fatty acids
- Somatostatin
- high glucose
- insulin***
- ketones
The anabolic phase (postprandial) is mediated by what? When does it begin? and when does it peak?
- Insulin
- Insulin release begins at 100
- Peaks at 400-600
Catabolic phase (fasting) is mediated by what?
-Glucagon
during fasting phase, glucagon breaks down what? to form what?
- glycogen
- protein
- triglycerides
- Forms = Glucose and ketones
What is diabetes mellitus?
-Impaired metabolism of carbs, fat and protein
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
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
Low insulin leads to ______ catabolism, increased ______ catabolism and release of what?
- Muscle
- Fat
- Keto acids
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
What are the chronic symptoms of diabetes?
- decreased ability to fight infection
- Macrovascular disease (accelerated atheroclerosis)
- Microvascular disease
What does macrovascualar disease lead to in diabetes? (also perioperative implications)
- CAD
- PAD
- AMI
- CHF
- CVA
- HTN
What does the microvascular disease lead to in diabetes?
- Nephropathy
- Retinopathy
- Neuropathy
Autonomic neuropathy causes what problems?****
- Orthostatic hypotension
- Delayed GI emptying
- Post induction hypotension
- can’t compensate volume or tone
Type 1 diabetes is caused by what?
-Destruction of beta cells from autoimmune disorder** of viral infections** (heredity)
T/F plasma levels of insulin are elevated type 2 diabetes?
True
What is the normal Hgb A1C and what does it reflect?****
- 4-5.6%
- Avg. blood sugar over 3 months (life of RBC)
What 4 ways does better glycemic control improve outcomes?
- Decreased hospital stay
- Decreased infection
- better outcomes after CVA, MI
- Decreased mortality
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,
What is DKA? and what are the primary features?
- Type 1 diabetics with profoundly low insulin levels
- Dehydration, acidosis, electrolyte depletion (K)
Symptoms of DKA?
- N/V
- Poly: -uria, -dypsia, -phagia
- anorexia
- Kussmaul breathing
- acetone halitosis
What can precipitate DKA
- MI
- Trauma
- ETOH
- Infection
- Non compliance
DKA will present with DKA hyper or hypo kalemia?
Hyperkalemia in the face of total K depletion
What is the equivalent of DKA for type 2 diabetics? **
-Nonketotic hyperosmolar state
Symptoms of Nonketotic hyperosmolar state*****
- Thrombosis from hyperviscosity
- Focal neuro/reflex
- global neuro signs
- confusion seizures
- Coma
Insulin excess (hypoglycemia)
-Profound CNS response (confusion, convulsion, coma)
-
Body response to early, late and very late hypoglycemia?
- Early = liver glycogen breakdown
- Late = sympathetic stimulation (epi release)
- Very late = GH and cortisol
What is an insulinoma?
-Beta cell adenoma that produces insulin
When does hypoglycemic shock occur?
glucose range 20-50%
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
Neurons use what for fuel?****
Ketones
What happens during osmotic diuresis? *****
- Dehydration of 4-6L
- Loss of up to 10% body K
- Loss of Na, mag, cl, phos
hyperglycemia perioperative consequences*****
- CHF
- CVA
- increased mortality and length of stay
- Infection
- Sepsis
- ARF
- Neuropathy
- Poor fetal outcomes
