Pancreas Path Flashcards
what are the 4 main types of cells found in th eislets of langerhans
beta, alpha, delta and pancreatic polypeptide cells
what cells produce insulin
beta cells in the iselts of langerhan
what cells secrete glucagon
alpha cells
role of glucagon
to stimulate glycogenolysis and increase blood suga
what cells secrete somatostatin
delta
role of somatostatin
suppresses insulin and glucagon release
What is role of pancreatic polypeptide
stimulates secretion of gastric and intestinal enzymes and inhibits intestinal motility
what are the 2 rare cell types in the islets of langerhans
D1 cells and enterochromaffin cells
What do D1 cells do
elaborate vasoactive intestinal polypeptide that induces glycogenolysis and hyperglycemia
also stimulates GI fluid secretion and causes secretory diarrhea
Enterochromaffin cells do what
synthesize serotonin and are source of pancreatic tumors that cause the carcinoid syndrome
halo around cell on electron microscopy indicates what
beta cells in islets of langerhans
leading cause of end stage renal disease in US
DM
what is the normal range for blood glucose
70-120mg/dL
what is Dx of DM based on fasting plasma glucose? based on random plasma glucose?
fasting- >126 mg/dL
random- >200 mg/dL
during an oral glucose tolerance test with loading of 75 gm what is Dx of DM
2 hour plasma glucose >200 mg/dL
what is normal limit for glycated HbA1c
6.5%
what are the plasma glucose levels for prediabetes
fasting between 100 and 125
2 hour plasma glucose 140 and 199
glycated Hb between 5.7 and 6.4
what is DM I
autoimmune
destruction pancreatic beta cells
absolute deficiency of insulin
what is DM II
combination of peripheral R to insulin action and inadequate secretory response by beta cells
weight differences of DM I and DM II patients
DM I weight loss preceding Dx,
DM II obese
what islet Ab circulate in DM I
anti insulin, anti-GAD and anti-ICA512
without Tx what can occur in DM I
diabetic ketoacidosis in absence of insulin
without Tx what can occur in DM II
nonketotic hyperosmolar coma
which DM more likely to have insulitis? beta cell depletion? amyloid deposition?
DM I- insulitis and beta cell depletion
DM II- amyloid
what immune cell has the problem in DM I
T cells
why are the insulin requirements minimal in first 1-2 years of DM I
ongoing endogenous insulin secretion
“honeymoon period”
what are some cc before Dx DM II
unexplained fatigue, dizziness, blurred vision
classic triad DM I
polyuria, polydipsia, polyphagia
morbidity of longterm DM is due to
diabetic macro and microvascular disease from chronic hyperglycemia
macrovascular disease in DM increases risk for
MI, stroke, lower extremity ischemia
microvascular disease is seen where in DM
diabetic retinopathy, nephropathy, neuropathy
reduction in nu,ber and size of islets
DM I
leukocytic infiltration of iselts
DM I
amyloid in islets
DM II
increas in number and size of islets
nondiabetic newborns of DM mothers
most common cause death in DM
MI from atherosclerosis
what occurs in kidneys in DM
renal hyaline arteriosclerosis
what is included in diabetic nephropathy
glomerular lesions(nodular sclerosis), renal vascular lesions, pyelonephritis and necrotizing papillae
what occurs to BM of glomeruli in DM
thickening because very leaky
what type of neuropathy occurs in DM
distal extremities, motor and sensory
what type of genetic abnormalities occur with DM
defects in beta cell dysfunction and also abnormalities of the insulin R signaling
what 4 pathways are assoc with long term complications of DM
advanced glycation end products
activation PKC
increase in oxidative stress
overload of hexosamine pathway
term for pancreatic islet cell tumor
pancreatic neuroendocrine tumor
criteria for malignancy of pancreatic neuroendocrin tumor
mets, vascular invasion, local infiltration
90% insulin producing tumors are malignant or benign
benign
3 most common functional syndromes assoc with pancreatic neuroendocrine tumor
hyperinsulinism
hypergastrinemia (zollinger ellison)
MEN multiple endocrine neoplasia
insulinomas present how
hypoglycemic episodes when blood glucose is below 50 mg/dL
confusion, stupor, loss of consciousness
if a tumor is around the pancreas, not in it. is it morelikley ot be benign or malignant
malignant
deposition of amyloid is characteristic of what pancreatic endocrine tumor
insulinoma
lab finding for insulinoma
high circulating insulin and high insulin:glucose ratio
Tx insulinoma
removal tumor
where do gastrinomas arise
duodenum and peripancreatic soft tissues
intractable jejunal ulcer found
zollinger ellison
are gastrin producing tumors locally invasive
yes
many have mets by time of Dx
presenting Sx in gastrinomas
diarrhea
Tx zolinger ellison
H K pump inhibitors and excision of neoplasm
what can cause mild DM with migratory erythema rash and anemia
alpha cell tumors (glucagonomas)
whats req for Dx delta cell tumor (somatostainomas)
high levels of somatostatin
Sx VIPoma
watery diarrhea, hypokalemia, achlorhydria or WDHA syndrome
