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(OMS2) ENRP Exam 2 > Endocrine pancreas pathology > Flashcards

Endocrine pancreas pathology Flashcards

1
Q 
What do alpha cells secrete?
Beta cells?
Delta cells?
PP cell? 
D1 cell?
A
  1. glucagon
  2. insulin
  3. somatostatin
  4. pancreatic polypeptide
  5. VIP
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2
Q

What is the marker of endogenous insulin?

A

C peptide

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3
Q

What is glucose homeostasis regulated by?

A
  1. Hepatic release of glucose
  2. Tissue utilization of glucose
  3. Hormonal control of glucose by insulin and glucagon (amongst others)
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4
Q

Steps of insulin release

A
  1. GLUT-2 (glucose transporter) takes glucose into beta cells
  2. Glucose metabolism generates ATP
  3. ATP inhibits the membrane K+ channel
  4. Depolarization results in Ca2+ influx
  5. Ca2+ influx results in insulin release
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5
Q

Oral glucose stimulates release of what?

A

Incretins:
•Glucagon-like peptide-1 (GLP-1)
•Glucose-dependent insulin-releasing polypeptide (GIP)

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6
Q

MOA of incretins

A
  1. stimulate insulin release
  2. inhibit glucagon release

resulting in lower blood glucose

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7
Q

What are incretins inactivated by?

A

dipeptidyl peptidase-4 (DPP-4)

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8
Q

Describe diabetes mellitus

A

Impairment of normal glucose homeostasis resulting in hyperglycemia
◦ Defective insulin secretion
◦ Defective insulin effect

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9
Q

What is T1DM

A

Autoimmune disease due to failure of T-lymphocyte self tolerance

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10
Q

How many islet cells must be destroyed to give overt T1DM symptoms?

A

> 90%

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11
Q

What must be present for T2DM to manifest?

A

Beta cell dysfunction

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12
Q

Describe MODY: Maturity-onset diabetes of the young

A

Resembles T2DM clinically, but happens in youth!

Increased blood insulin
NO autoantibodies
Nonketotic

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13
Q

What is MODY most often caused by

A

Mutations resulting in loss of function of glucokinase

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14
Q

Risks to fetus of gestational diabetes

A

◦ Neonatal hypoglycemia –> seizures –> brain damage
◦ Macrosomia
◦ Congenital malformations
◦ Stillbirth

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15
Q

Classic triad of T1DM

A

◦ Polyphagia
◦ Polyuria
◦ Polydipsia

◦ Severe: Diabetic ketoacidosis

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16
Q

When is T2DM usually identified

A

On screening

-fatigue, vision changes

17
Q

4 T’s of T1DM

A

toilet
thirsty
tired
thinner

18
Q

HLA associated with T1DM

A

HLA DR/DQ on chr. 6

19
Q

Triad of DKA

A

◦ Hyperglycemia
◦ Ketonemia
◦ Metabolic acidosis

20
Q

What ketones accumulate and should be tested for in DKA

A

Acetoacetic acid

Beta-hydroxybutyrate

21
Q

What is Hyperglycemic hyperosmotic syndrome (HHS)

A

Acute hyperglycemic crisis in T2DM

Culmination of prolonged insulin deficiency
◦ Increased gluconeogenesis
◦ Decreased glucose uptake in peripheral tissues

22
Q

What are presenting signs/symptoms of HHS

A

◦ Glucose >600 mg/dL
◦ Severe dehydration
◦ Hyperosmolality (>350 mOsm/L) –> obtundation, coma
◦ Impaired renal function

NO KETONES

23
Q

What is a measure of long term diabetic control

A

Hgb A1c

24
Q

What is target A1c

A

6.5-7 or lower

25
Q

What is the most common cause of death in diabetics

A

Myocardial infarction

26
Q

Chronic hyperglycemia increases risk of

A

• Stroke
• Myocardial infarction (2x)
• Lower extremity
gangrene (100x)

27
Q

What is the gold standard for urine albumin testing?

To diagnose what

A

Urine Albumin:creatinine ratio (UACR)

Diabetic nephropathy

28
Q

What are the 3 primary pathologic lesions of diabetic nephropathy

A
  1. Glomerular sclerosis
  2. Renal vascular lesions
  3. Pyelonephritis
29
Q

pathogenesis of diabetic retinopathy

A

Neovascularization
◦ Hypoxia leads to VEGF overexpression
◦ Hemorrhage
◦ Blindness

30
Q

Unifying features of pancreatic neuroendocrine tumors

A

Gross appearance – solid, tan-yellow
Predilection for the pancreatic neck and tail
Histology – well-differentiated neuroendocrine tumors
EM – secretory granules

31
Q

What is an insulinoma

What is a common histiologic finding?

What can make the diagnosis?

A
  1. Small tumors (<2 cm) can produce episodes of symptomatic hypoglycemia
    ◦ (<50mg/dL)
  2. Amyloid
  3. C peptide
32
Q

What is the triad for a gastrinoma (zollinger ellison syndrome)

A

◦ Islet cell tumor
◦ Gastric acid hypersecretion
◦ Peptic ulceration

33
Q

Typical manifestations of a somatostatinoma

A

Somatostatin functions as a paracrine regulator, so manifestations are typically inhibitory

◦ Reduced insulin
◦ Reduced gallbladder motility
◦ Reduced exocrine pancreatic secretions

34
Q

What are the 4 D’s of a glucagonoma

A

Diabetes
Dermatitis
Depression
DVT’s

35
Q

What is the characteristic rash of a glucagonoma?

Location?

A

NECROLYTIC MIGRATORY ERYTHEMA

Groin, lower extremities

36
Q

How do VIPomas present?

A

WDHA syndrome
◦ Watery diarrhea
◦ Hypokalemia
◦ Achlorhydria

20% of pts will have flushing as well

37
Q

What does VIP do

A

Vasoactive intestinal Peptide: Secreted by D1 cells

◦ Intestinal fluid secretion

(OMS2) ENRP Exam 2 (9 decks)

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