Pancreas Flashcards
What is the structure of the pancreas in which active endocrine cells of the pancreas are located?
Islet of Langerhans
Which cells of the pancreas release insulin
B-cells
which cell of the pancreas release glucagon
a-cells
What are the 5 steps of the regulation of insulin release
- GLUT-2 takes glucose into B-cell
- Glucose metabolism generates ATP
- ATP inhibits the membrane K+ channel
- Depolarization results in Ca influx
- Ca influx releases insulin
what cleavage product is left over from endogenous insulin?
C-peptide
If a type-1 diabetic comes in and you suspect insulin overdose, what marker can you NOT use
C-peptide, differentiate natural and pharmaceutical insulin
what are the effects of insulin on fat tissue
Increase glucose uptake and lipogenesis
Decrease lipolysis
What is the effect of insulin on striated muscle
Increase glucose uptake, glycogen synthesis, and protein synthesis
What is the effect of insulin on the liver
Increase Glycogen synthesis and Lipogenesis
Decrease gluconeogenesis
how does insulin move glucose into cells
results in the ascension of GLUT-4 into the cell membrane
What degrades incretins?
DPP-4
What would occur if you blocked DPP-4
Persistence of active incretins which would increase the action of insulin
What is the leading cause of T1DM
Autoimmune antibody generation and lack of self tolerance by T-cells
HLA gene cluster on what chromosome is responsible for 50% of T1DM
6p21
Someone has symptomatic T1DM, what percentage of islet cells would you suspect have been damaged
At least 90%
What is the cause of T2DM
Insulin insensitivity at target organs which leads to B-cell hypertrophy then failure
MODY (maturity-onset diabetes of the young) resembles which form of DM and what causes it
Resembled type 2 and is caused by mutation in glucokinase
What is the classic triad of T1DM
Polyphagia
Polydipsia
Polyuria
What is the triad of DKA and which form of DM does it predominate
predominated T1
Triad: Hyperglycemia, Ketonemia, Metabolic acidosis
What type of respiratory issue can arise out of DKA, what is it called
Kussmaul respiration
Describe Hyperglycemic Hyperosmotic Syndrome
acute hyperglycemic crisis in T2DM
NO KETONES
Which of the following, DKA or HHS will have a normal bicarb and extremely elevated glucose
HHS
Glucose is >600 compared to DKA (>250)
What is the target A1C of a diabetic
6.5-7
What is the most common cause of death in diabetics
MI
What is the screen for Diabetic Nephropathy
Albumin:creatinine ratio
What are the three primary pathologic lesions of Diabetic nephropathy
Glomerular sclerosis
Renal Vascular Lesions
Pyelonephritis
What does microalbuminuria mean?
there is 30-300 mg/g of NORMAL albumin in the urine
*she made a point to emphasize that micro and macroalbuminuria are about amount, not SIZE
What are some ocular problems associated with uncontrolled DM
Hemorrhage
Blindness
Cataracts
Glaucoma
What are features of a pancreatic neuroendocrine tumor
solid-tan yellow
well-differentiated
What can happen with an insulinoma
transient hypoglycemia
elevated C-peptide
Amyloid is common
What is the gastrinoma triad
Islet cell tumor
Gastric Acid Hypersecretion
Peptic Ulceration
Ulcers are REFRACTORY
What are common findings with Somatostatinoma
Diabetes, cholelithiasis, steatorrhea
Inhibitory effects
- decreased insulin
- reduced gallbladder motility
- Reduced exocrine pancreas
What are the findings of a glucagonoma
Mild diabetes
-Rash: Necrolytic Migratory erythema
What are the 4 Ds of glucagonoma
Diabetes
Dermatitis
Depression
DVTs
What can occur with a VIPoma
Vasoactive peptide tumor (D1 cells)
WDAH syndrome
- Watery Diarrhea
- Hypokalemia
- Achlorhydria
