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endo II exam1 > Pancreas Path > Flashcards

Pancreas Path Flashcards

1
Q

what are the 4 main types of cells found in th eislets of langerhans

A

beta, alpha, delta and pancreatic polypeptide cells

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2
Q

what cells produce insulin

A

beta cells in the iselts of langerhan

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3
Q

what cells secrete glucagon

A

alpha cells

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4
Q

role of glucagon

A

to stimulate glycogenolysis and increase blood suga

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5
Q

what cells secrete somatostatin

A

delta

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6
Q

role of somatostatin

A

suppresses insulin and glucagon release

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7
Q

What is role of pancreatic polypeptide

A

stimulates secretion of gastric and intestinal enzymes and inhibits intestinal motility

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8
Q

what are the 2 rare cell types in the islets of langerhans

A

D1 cells and enterochromaffin cells

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9
Q

What do D1 cells do

A

elaborate vasoactive intestinal polypeptide that induces glycogenolysis and hyperglycemia
also stimulates GI fluid secretion and causes secretory diarrhea

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10
Q

Enterochromaffin cells do what

A

synthesize serotonin and are source of pancreatic tumors that cause the carcinoid syndrome

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11
Q

halo around cell on electron microscopy indicates what

A

beta cells in islets of langerhans

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12
Q

leading cause of end stage renal disease in US

A

DM

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13
Q

what is the normal range for blood glucose

A

70-120mg/dL

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14
Q

what is Dx of DM based on fasting plasma glucose? based on random plasma glucose?

A

fasting- >126 mg/dL

random- >200 mg/dL

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15
Q

during an oral glucose tolerance test with loading of 75 gm what is Dx of DM

A

2 hour plasma glucose >200 mg/dL

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16
Q

what is normal limit for glycated HbA1c

A

6.5%

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17
Q

what are the plasma glucose levels for prediabetes

A

fasting between 100 and 125
2 hour plasma glucose 140 and 199
glycated Hb between 5.7 and 6.4

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18
Q

what is DM I

A

autoimmune
destruction pancreatic beta cells
absolute deficiency of insulin

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19
Q

what is DM II

A

combination of peripheral R to insulin action and inadequate secretory response by beta cells

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20
Q

weight differences of DM I and DM II patients

A

DM I weight loss preceding Dx,

DM II obese

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21
Q

what islet Ab circulate in DM I

A

anti insulin, anti-GAD and anti-ICA512

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22
Q

without Tx what can occur in DM I

A

diabetic ketoacidosis in absence of insulin

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23
Q

without Tx what can occur in DM II

A

nonketotic hyperosmolar coma

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24
Q

which DM more likely to have insulitis? beta cell depletion? amyloid deposition?

A

DM I- insulitis and beta cell depletion

DM II- amyloid

25
Q

what immune cell has the problem in DM I

A

T cells

26
Q

why are the insulin requirements minimal in first 1-2 years of DM I

A

ongoing endogenous insulin secretion

“honeymoon period”

27
Q

what are some cc before Dx DM II

A

unexplained fatigue, dizziness, blurred vision

28
Q

classic triad DM I

A

polyuria, polydipsia, polyphagia

29
Q

morbidity of longterm DM is due to

A

diabetic macro and microvascular disease from chronic hyperglycemia

30
Q

macrovascular disease in DM increases risk for

A

MI, stroke, lower extremity ischemia

31
Q

microvascular disease is seen where in DM

A

diabetic retinopathy, nephropathy, neuropathy

32
Q

reduction in nu,ber and size of islets

A

DM I

33
Q

leukocytic infiltration of iselts

A

DM I

34
Q

amyloid in islets

A

DM II

35
Q

increas in number and size of islets

A

nondiabetic newborns of DM mothers

36
Q

most common cause death in DM

A

MI from atherosclerosis

37
Q

what occurs in kidneys in DM

A

renal hyaline arteriosclerosis

38
Q

what is included in diabetic nephropathy

A

glomerular lesions(nodular sclerosis), renal vascular lesions, pyelonephritis and necrotizing papillae

39
Q

what occurs to BM of glomeruli in DM

A

thickening because very leaky

40
Q

what type of neuropathy occurs in DM

A

distal extremities, motor and sensory

41
Q

what type of genetic abnormalities occur with DM

A

defects in beta cell dysfunction and also abnormalities of the insulin R signaling

42
Q

what 4 pathways are assoc with long term complications of DM

A

advanced glycation end products
activation PKC
increase in oxidative stress
overload of hexosamine pathway

43
Q

term for pancreatic islet cell tumor

A

pancreatic neuroendocrine tumor

44
Q

criteria for malignancy of pancreatic neuroendocrin tumor

A

mets, vascular invasion, local infiltration

45
Q

90% insulin producing tumors are malignant or benign

A

benign

46
Q

3 most common functional syndromes assoc with pancreatic neuroendocrine tumor

A

hyperinsulinism
hypergastrinemia (zollinger ellison)
MEN multiple endocrine neoplasia

47
Q

insulinomas present how

A

hypoglycemic episodes when blood glucose is below 50 mg/dL

confusion, stupor, loss of consciousness

48
Q

if a tumor is around the pancreas, not in it. is it morelikley ot be benign or malignant

A

malignant

49
Q

deposition of amyloid is characteristic of what pancreatic endocrine tumor

A

insulinoma

50
Q

lab finding for insulinoma

A

high circulating insulin and high insulin:glucose ratio

51
Q

Tx insulinoma

A

removal tumor

52
Q

where do gastrinomas arise

A

duodenum and peripancreatic soft tissues

53
Q

intractable jejunal ulcer found

A

zollinger ellison

54
Q

are gastrin producing tumors locally invasive

A

yes

many have mets by time of Dx

55
Q

presenting Sx in gastrinomas

A

diarrhea

56
Q

Tx zolinger ellison

A

H K pump inhibitors and excision of neoplasm

57
Q

what can cause mild DM with migratory erythema rash and anemia

A

alpha cell tumors (glucagonomas)

58
Q

whats req for Dx delta cell tumor (somatostainomas)

A

high levels of somatostatin

59
Q

Sx VIPoma

A

watery diarrhea, hypokalemia, achlorhydria or WDHA syndrome

endo II exam1 (14 decks)

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