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D&T3 Exam 1 > Pancreas-Graffeo > Flashcards

Pancreas-Graffeo Flashcards

1
Q

Complications

Nonenzymatic glycosylation

A

Glucose chemically attaches to amino group of proteins without enzymes

Directly related to level of glucose in blood

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2
Q

Type 1

Role of viruses

A

Release of sequestered ag

Or

Molecular mimicry: viral protein share sequences with beta cell (GAD shares sequences with coxsackie)

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3
Q

Nesidioblastosis

Cause

A

Islet cell hyperplasia

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4
Q

Type 2

Common presentation

A

May present with polyuria and polydipsia

Asymptomatic

Easier to control

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5
Q

Necrolytic migratory erythema ass with

A

Glucagonoma

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6
Q

DM

A

Chronic disorder of CHO, fat and protein metabolism

Common feature among all of groups: hyperglycemia

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7
Q

Insulinoma

Malignancy

A

90% benign

Can only determine malignancy if pt has invasion and mets

Form solitary aggregations of cell which look like giant islets

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8
Q

Ketoacidosis

Role of glucagon

A

Glucagon accelerates oxidation of free fatty acids

Ketones in blood and urine

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9
Q

D1 cells

Secrete

A

Vasoactive intestinal peptide

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10
Q

Type 1 vs type 2

Type 1

A

Onset <20

Normal wt

Dec blood insulin

Anti islet cell ab

Ketoacidosis common

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11
Q

Type 2

Insulin resistance

A

Reduced responsiveness of peripheral tissues to insulin

Seen in pregnancy and obesity

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12
Q

Type 1 vs type 2

Pathology

Type 2

A

Insulin resistance
Relative insulin deficiency

islet cells:
Focal atrophy and amyloid

Mild beta cell depletion

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13
Q

Genetic differences in type 1 vs 2

Type 1

A

30-70% concordance in twins

HLA-DR3 and/or DR4

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14
Q

Alpha cells

A

Glucagon

Induces hyperglycemia

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15
Q

Diabetic wound complications

A

Inc risk of infxn

Delayed healing

Monitor pts

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16
Q

Advanced glycosylation end products (AGE)

A

Form from glycosylation products which bind to long-live proteins

Inc deposition of LDLs on vessel wall

Lead to BM thickening in kidney

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17
Q

Laboratory DX

Criteria

Random glucose

A

> 200 mg/dl

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18
Q

Type 1

Islet cell abs

Role

A

Not causative

Marker of disease

Detected before clinical disease

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19
Q

Complications

Vascular system

A

Accelerated atherosclerosis in all vessels

MI: most common cause of death

Gangrene of vessels in lower extremities (causes morbidity)

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20
Q

Differential for hypoglycemia

A

Islet cell tumors

Insulin sensitivity

Liver disease

Xs production of glycogen

Ectopic production by certain sarcomas

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21
Q

Type 2

Role of obesity

A

80% of type 2 diabetics are obese

Abdominal obesity is highest ass

Weight loss and exercise can reverse

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22
Q

Type 1

Environmental factors

A

Viruses (coxsackie b)
Drugs
Chemical toxins

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23
Q

Type 1

Genetic susceptibility

A

Northern European descent

HLA-DR3 and/or DR4 (although most do not develop)

Alter recognition by T-cell receptor or ag presentation

Ass with DQ allele:: HLA-DQA1301-HLA-DQB10302

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24
Q

DM

Type 2

A

Non-insulin dependent

Previously adult onset (80-90% of cases)

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25
Q

Diabetic kidney problems

Nodular glomeruloneprhosclerosis

A

Characteristic kidney lesion

Peripheral glomerular nodules present (made of mucopolysaccharides)

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26
Q

Type 2

Deranged beta cell secretion

A

Changes with disease course

Insulin secretion normal early

No reduction in insulin levels

Mild insulin deficiency later

–chronic hyperglycemia may exhaust function of beta cells

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27
Q

D1 cells

A

Not in islets, but admixed with pancreatic exocrine cells

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28
Q

Free fatty acids metabolized by

A

Acetyl co-enzyme A in liver

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29
Q

DM

Type I

S&Sx

Polyuria and polydipsia mechanism

A

Dec insulin->glucose->polyuria (glucose, na, k, mg, po4-osmotic diuresis)->dec intracellular water-> trigger osmoreceptors of the thirst center in brain->
Polydipsia

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30
Q

Zollinger-Ellison Syndrome

Rx

A

H2 blockers-PPI

Resection of tumor

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31
Q

HBA1c

A

Glycosylated hemoglobin

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32
Q

Zollinger-Ellison Syndrome

Ulcer findings

A

Ulcers in 95% of pts

In unusual locations (like jejunum)

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33
Q

Type 2

A

Often older (>40) and frequently obese

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34
Q

Zollinger-Ellison Syndrome

When to consider

A

Pts with intractable jejunal ulcers

Also >50% of pts have diarrhea

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35
Q

Zollinger-Ellison Syndrome

Tumor characteristics

A

> 50% are malignant (may be multicentric)

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36
Q

Islet cell tumors

Functional

A

MC syndromes ass with functional tumors

Inc insulin

Inc gastrin

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37
Q

DM

Type I

S&Sx

Polyphagia mechanism

A

Dec insulin->catabolism of protein and fat->negative energy balance->polyphagia

Catabolic effects prevail leading to weight loss and mm weakness

THINK DIABETES IF YOU SEE THIS!!

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38
Q

Mucor in diabetic

A

Nonseptate fungi with right angle branching

39
Q

Delta cells

A

Somatostatin

40
Q

Beta cells

A

Insulin

41
Q

Nesidioblastosis

A

Congenital hyperinsulinism

Hypoglycemia in neonate and infants

42
Q

DM

Classification

A

Type I

Or

Type 2

43
Q

Most common cause of death in diabetics

A

MI

44
Q

Diabetic neuropathy

Most commonly affects

A

Lower extremities

45
Q

DM is leading cause of

A

ESRD

Adult onset blindness

Non-traumatic lower extremity amputation

46
Q

Type 1 vs type 2

Type 2

A

Onset >30 yr

Obese

Normal to inc blood

No abs

Ketoacidosis rare

47
Q

Sorbitol and fructose formed by…

A

With hyperglycemia, sorbitol formed through action of aldosterone redcutase. Then forms fructose

48
Q

Type 1

Islet cell antibodies

A

Abs agains glutamic acid decarboxylase (GAD)

Formed after T cell reaction

80% of pts

49
Q

Zollinger-Ellison Syndrome

Ass

A

MEN-1

50
Q

VIP-oma

A

Watery diarrhea, hypokalemia, achlorhydria, WDHA syndrome

51
Q

Nesidioblastosis

ass

A

Maternal diabetes

Usually transient

52
Q

Type 1

Pathogenesis

A

Severe absolute lack of insulin due to reduction in beta cells mass

Autoimmune

Genetic and environmental

53
Q

Diabetic neuropathy

A

Peripheral symmetric neuropathy

Affects both motor and sensory

54
Q

Insulinoma (beta cell tumor)

A

MC islet cell tumor

Pts present with hypoglycemia precipitated by exercise or fasting

Also nervousness and confusion

Whipped triad

55
Q

Type 1

Autoimmunity

A

Chronic autoimmune attack on beta cells for years

Insulitis early with CD8 and some CD4

Inc class 1 expression and aberrant class 2

Primary T Cell response

56
Q

Enterochromaffin cells

A

Not in islets

Source of pancreatic tumors that cause carcinoid syndrome

57
Q

Ketoacidosis

Which type

A

Almost exclusive to type I

58
Q

Type 2

Pathogenesis

A

No evidence for autoimmune

No HLA linkage

But high twin rate 80%

59
Q

Morphological changes seen in…

A

Arteries: atherosclerosis

BM of small vessels: microangiopathy

Kidneys

Retina

Nerves

60
Q

Glucagonoma

Presentation

A

Mild DM

Characteristic skin rash (necrolytic migratory erythema)

Normocytic Normochromic anemia

Female

61
Q

Diabetic kidney problems

Nodular glomerulonephrosclerosis

Aka

A

Kimmelsteil-Wilson disease

62
Q

Glucagonoma

Characteristics

A

Alpha cell tumor

High plasma glucagon levels

63
Q

Pyelonephritis

A

Inflammation in interstitium leading into tubules

64
Q

Free fatty acids metabolized to

A

Ketone bodies (acetoacetic acid and b hydroxybuteric acid)

65
Q

Laboratory DX

Criteria

Abnormal GTT

A

> 200 mg/dl

66
Q

Complications

Due to

A

Persistent hyperglycemia

67
Q

Type 2

Metabolic defects

A

Deranged beta cell secretion of insulin

Insulin resistance of peripheral tissues

68
Q

Diabetic neuropathy

Autonomic neuropathy

A

Gastric retention

Diarrhea

Impotence

69
Q

Whipple triad

A

See in insulinoma (Beta cell tumor)

Confusion, FBG<50, relief of sx with glucose

70
Q

Hyper-osmolar nonketotic coma

A

Can occur in type 2

Caused by sever dehydration from sustained hyperglycemia in pts who do NOT drink enough water

Can wait to long to seek medical attention

71
Q

Monitoring of glucose control in diabetics

A

Measurement of HBA1c

Best measure of long term control

Monitor disease cours

72
Q

Pyelonephritis

Can lead to

A

Necrotizing papillomas

73
Q

Ketoacidosis

Sx

A

N/v, breathing problems

74
Q

Nonseptate fungi with right angle branching

A

Mucor in diabetics

75
Q

Type 2

Insulin resistance

Results in

A

Inability of insulin to lower glucose

Persistent hyperglycemia

More prolonged stimulation of beta cells

76
Q

Laboratory DX

Criteria

Fasting blood sugar

A

<99: wnl

100-126: prediabetes

> 126: diabetes

77
Q

Common renal vascular lesions

A

Arteriosclerosis and hyaline arteriolosclerosis

78
Q

Diabetic ocular complications

Types

A

Retinopathy, proliferative and nonproliferative

Cataract formation

Glaucoma

4th leading cause of acq blindness

79
Q

Genetic differences in type 1 vs 2

Type 2

A

60-80% concordance in twins

No HLA ass: multiple genes involved

80
Q

Zollinger-Ellison Syndrome

Classic

A

Gastric secreting tumor in pancreas stimulates xs gastric acid, causing peptic ulcer

Tumors can also occur in duodenum

81
Q

DM

Type 1

S&Sx

A

Begin by 20

Polyuria

Polydipsia

Polyphagia

Ketoacidosis

82
Q

PP

A

Pancreatic polypeptide

Stimulates secretion of GI enzymes

83
Q

Diabetic kidney problems

Diffuse glomerulosclerosis

A

Diffuse inc in mesangial matrix and mesangial cell proliferation->BM thickening

Can lead to nephrotic syndrome

84
Q

DM

Long term complications affect

A

Blood vessels, kidneys, eyes, nerves

85
Q

Pancreas

Morphology

A

Type 2: no significant change. Can see amyloid

Type 1: see insulitis early the dec in islets

86
Q

Complications

Hyperglycemia results in

A

Nonenzymatic glycosylation

87
Q

Vasoactive intestinal peptide

A

From D1 cells

Induces glycogenolysis and hyperglycemia

Stimulates gastrointestinal fluid secretion and causes secretory diarrhea

88
Q

2nd MC cause of death in diabetics

A

Kidney problems

89
Q

Sorbitol and fructose cause

A

Influx of H2O, cell injury

Eye complications such as cataracts and retinopathy

90
Q

DM

Type I

A

Insulin-dependent, previously juvenile-onset diabetes (10% all cases)

91
Q

Ketoacidosis

Due to…

A

Sever insulin deficiency

Insulin->excessive breakdown of fat->free fatty acids

Then go to liver and oxidized by ACETYL CO-ENZYME A to ketone bodies (acetoacetic acid and b hydroxybbuteric acid)

92
Q

Type 1 vs type 2

Pathology

Type 1

A

Autoimmunity sever insulin deficiency

Islet cells:
Early insulitis

Marked atrophy

Beta cells depleted

93
Q

MC islet cell tumor

A

Insulinoma (Beta cell tumor)

94
Q

Necrolytic migratory erythema

A

On legs, perineum and groin

Starts as erythema

Progresses to superficial blisters

Spreads with central clearing

Heals without scarring but with hyperpigmentation in 7-14 days

D&T3 Exam 1 (19 decks)

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