Endocrien Pancreas Flashcards

1
Q

Describe etiology of type I diabetes

A

Genetic factors, genes encoding class II MHC on 6p21 (HLA-D)
Environemental factors especially infections mumps, rubella, coxB, may be an initial trigger by antigenic mimcry

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2
Q

Mention the 2 two metabolic effects of type 2 diabetes with explanation

A
  1. Insulin resistance: obesity has a relation probably mediated by cytokines.
  2. B cell dysfunction: beta cell compensation becomes inadequate leading to hyperglycemia, this can lead to secretion of pro-inflammatory cytokines from beta cells into islets, ultimaletly leading to their death. Amyloid replacement is a chch finding in ling standing cases.
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3
Q

Describe diabetic morphological changes in:
1. Pancreas
2. Microvasculature

A
  1. Reduction in number & size of islets (type 1), leukocytic infiltration in islets in both types. Amyloid replacement is a chch finding in ling standing cases.
  2. Accelerated atherosclerosis affecting aorta & large & medium-sized arteries.
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4
Q

Describe pathogenesis of long term diabetes complications.

A
  1. Formation of AGEs: accelerate atherosclesis + basement membrane thicking leading to diabetic microangiopathy.
  2. Activation of intracellukar PKC: produce proangiogenic molecules as VEGF (retinopathy), & profibrogenic factors as TGFB.
  3. Disturbance in polyol pathway leading to oxidative stress.
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5
Q

Describe morphology & significance of diabetic microangiopathy

A

-Diffuse thickening of basement membranes either in capillaries or nonvascular structures. Basal lamina is thickened by concentric layers of hyaline material composed of collagen IV. Diabetic capillaries are leaky.
-This underlies diabetic nephropathy, retinopathy & some types of neuropathy.

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6
Q

List features of diabetic nephropathy

A
  1. Glomerulosclerosis (12 yrs or more, either diffuse or nodular called Kimmelsteil-Wilson lesion)
  2. Renal arteriosclerosis
  3. Pyelonephritis with necrotizing papillitis & papillary necrosis.
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7
Q

………..are the major contributor to mortality in diabetic

A

MI, renal vascular insufficiency & CVA

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8
Q

Describe features of eiabetic neuropathy

A
  1. “Glove & stocking” pattery of polyneuropathy
  2. Autonomic neuropathy of bowel or bladder or sexual impotency
  3. Mononeuropathy
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9
Q

…….are PanNETs with LEAST malignant potential.

A

Insulinomas

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10
Q

…..is the most common metastatic site for PanNETs

A

Liver

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11
Q

…….is one of the best correlates of outcome in PanNETs

A

Proliferative rate (measured by either mitotic counts or nuclear labeling with proliferator marker Ki-67)

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12
Q

Describe morphology of insulinoma

A

G: majority are solitary, small, localized to pancreas
M: benign tumors look like giant islets with preservation of regular cords of monotonous cells & their orientation to the vasculature. Not even malignant lesions present much evidence of anaplasia & they may be deceptively encapsulated. Deposition of amyloid in ECT.

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13
Q

List features of Zollinger-Ellison syndrome

A
  1. Pancreatic islet cell tumor “Gastrinoma”
  2. Gastric acid hypersecretion
  3. Peptic ulceration the stomach, duodenum & jejunum (multiple & unresponsive)
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14
Q

Describe morphology of gastrinoma

A

G: single in sporadic cases, multifocal in MEN1
M: bland looking cells, rare marked metaplasia

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15
Q

With respect diabetes, Genetic predisposition is stronger in……

A

Type 2

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16
Q

Describe presentation of type 1&2

A

1, acute onset with ketoacidosis as the 1st manifestation
2, early gradual hyperglycemiap passes unnoticed

17
Q

The most imp risk factors of type 1 DM

A

Early viral infection & the early introduction of cow’s milk or solid food for infants feeding

18
Q

Prediabetic glycated Hb value is…….

A

Between 5.7 & 6.4%

19
Q

Screening for DM is by…l..

A

Blood sugar testing (strip test)

20
Q

HbA1c measurement for diabetics is obtained……(frequency?)

A

Twice yearly