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ENRP Exam II > Endocrine Pancreas (Hillard) > Flashcards

Endocrine Pancreas (Hillard) Flashcards

1
Q

hormone secreted in D1 pancreatic cells

A

vasoactive intestinal peptide; causes glycogenolysis; in high concentrations can induce watery diarrhea

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2
Q

hormone secreted in pancreatic enterochromaffin cells

A

serotonin; regulates mood/mental states; elevated levels in carcinoid syndrome can cause facial flushing, diarrhea and tachycardia

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3
Q

hormone secreted by pancreatic PP cells

A

pancreatic polypeptide; inhibits intestinal motility

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4
Q

T1DM

A

5-10% of cases; adolescents and children; requires insulin

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5
Q

T2DM

A

90-95% of cases; adults; associated with obesity

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6
Q

Diagnostic criteria for DM

A

HbA1C >6.5% -glycated hemoglobin
fasting plasma glucose >126 mg/dL
oral glucose tolerance test > 200 mg/dL
random plasma glucose >200 mg/dL

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7
Q

Genetics associated with T1DM

A

HLA-DR3
HLA-DR4
HLA-DQ8

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8
Q

the presence of what antibodies are diagnostic for T1DM?

A

t cell autoimmune (type IV hypersensitivity) reaction against pancreatic beta cells; islet autoantibodies

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9
Q

What is a major risk factor for T2DM?

A

central, visceral obesity

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10
Q

Adiponectin

A

hormone created by fat cells; helps insulin utilization; its decrease in obesity leads to insulin resistance

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11
Q

Histological finding in T2DM

A

amyloid deposition in pancreatic islets

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12
Q

the 3 P’s in diabetes

A

Polyuria (osmotic diuresis)
Polydipsia (hyperosmolar)
Polyphagia (muscle and fat break down; unable to utilize glucose)

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13
Q

Complications of T1DM

A

severe dehydration and ketoacidosis (metabolic acidosis) decreased consciousness and coma

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14
Q

Lab test for DKA

A

test for ketones in the urine (urine nitroprusside test)
confirm w/ serum beta-hydroxybutyrate

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15
Q

Complications of T2DM

A

Hyperosmolar Hyperglycemic Syndrome (HHS); prolonged insulin deficiency; glucose >600 mg/dL; severe dehydration; NO KETONES

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16
Q

Most common cause of Maturity onset diabetes of the young (MODY)?

A

loss of function mutation in glucokinase in pancreatic beta cells

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17
Q

Results of gestational diabetes?

A

large infant (macrosomia)
difficult birth (c-section)
congenital malformations
stillbirth

18
Q

Pathogenesis of hyperglycemia

A

increased glucose leads to advanced glycation end products (AGEs) causing increased vascular damage and atherosclerosis

19
Q

the 4 pathways involved in hyperglycemia

A
  1. polypol pathway - loss of antioxidant protection
  2. Hexosamine pathway - increased oxidative stress
  3. PKC - increased GFs and procoagulant activity
  4. AGEs - increased vascular damage and atherosclerosis
20
Q

polypol pathway involvement in hyperglycemia

A

loss of antioxidant protection

21
Q

Hexosamine pathway involvement in hyperglycemia

A

increased oxidative stress

22
Q

activation of protein kinase C (PKC) involvement in hyperglycemia

A

increased GFs and procoagulant activity

23
Q

advanced glycation end products (AGEs) involvement in hyperglycemia

A

increased vascular damage and atherosclerosis

24
Q

major complications of diabetes

A

Macrovascular atherosclerotic disease
Retinopathy & Ocular pathology
Neuropathy
Nephropathy
Increased infection risk

25
Q

the most common cause of adult-onset vision loss

A

Diabetic retinopathy and ocular pathology

26
Q

Diabetic Peripheral Neuropathy

A

distal symmetric polyneuropathy; “glove and stocking” distribution numbness and loss of pain sensation

27
Q

“glove and stocking” distribution numbness and loss of pain sensation

A

seen as a complication of Diabetic Peripheral Neuropathy; ascending process (starts distal toes and fingertips and ascends more proximal)

28
Q

Foot complications to T2DM

A

loss of sensation can lead to diabetic foot
deformity of bones and joints can lead to charcot foot - midfoot collapse “rocker-bottom” foot

29
Q

Charot foot

A

foot complication to DM; deformity of bones and joints can lead to midfoot collapse also called “rocker-bottom” foot

30
Q

Diabetic chronic kidney disease

A

diabetes and HTN are the most common reasons for chronic kidney disease; extremity edema and pruritis

31
Q

Hyaline arteriolosclerosis

A

associated with chronic HTN and diabetes

32
Q

Pyelonephritis in diabetes

A

infection of the kidneys due to increased glucose and immune dysfunction; presents with fever, chills, flank pain and hematuria; increased risk of papillary necrosis

33
Q

The grade of a pancreatic neuroendocrine tumor is based on what?

A

mitotic index

34
Q

Insulinoma

A

neuroendocrine tumor of pancreatic beta cells; Whipple’s triad:
Hypoglycemic symptoms
Hypoglycemia
Reversal w/ increased glucose (rapid)**

35
Q

Histological feature of an insulimoa

A

deposition of amyloid; inappropriate high insulin during hypoglycemia can confirm diagnosis

36
Q

Confirmation of an insulinoma

A

inappropriate high insulin during hypoglycemia can confirm diagnosis

37
Q

Factitious hypoglycemia and c-peptide

A

hypoglycemia due to inappropriate insulin use; high insulin levels w/ low c-peptide

38
Q

Zollinger-Ellison syndrome

A

neuroendocrine tumor that secretes gastrin; found in gastrinoma triangle (Passaro’s triangle); increased gastrin leads to increased acid secretion and duodenal ulcers

39
Q

What should you consider if there are multiple or unusual ulcer locations in a patient?

A

Gastrinoma due to MEN 1 syndrome; elevated fasting serum gastrin and gastric pH <2 (very acidic)

40
Q

Glucagonoma

A

4D’s
dermatitis
diabetes
depression
DVT

41
Q

delta cell tumors

A

increased somatostatin; DM w/ decreased insulin, cholelithiasis and steatorrhea

42
Q

VIPoma

A

secretory diarrhea w/ hypokalemia; increase VIP

ENRP Exam II (10 decks)

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