pancreatic Disorders Flashcards
The pancreas exocrine function
consist of glands which produce pancreatic juice
duct system carries pancreatic juice to small intestine
the pancreas endocrine function
islets of langherans - pancreatic islets where hormones are produced
Glucagon
secreted by Alpha cells, acts to raise blood glucose levels
Stimulates liver to release glucose stores from glycogen and other storage sites
Stimulates glucogenogensis by breaking down fats and fatty acids
Insulin
secreted by B cells acts to lower blood glucose levels increases glucose transportation into cells increases glucose metabolism by cells increases liver glycogen stores
Somatostatin
produced by the delta cells
regulates cells of the pancreatic islet
inhibits the secretion of insulin and glucagon
also inhibits the release of GH from the pituitary gland
Carbs
converted to simple sugar molecules for cellular metabolism
excess CHO are stored in the liver and muscle as glycogen, available for short term energy needs
additional CHO is converted to fat for intermediate and long term energy needs
Fats
When no insulin is available to enable glucose transport into cells, fatty acids stored in the liver can be broken down for energy - this leads to the production of acetate and ketone bodies
Protein
in the absence of insulin, muscle protein breakdown occurs
circulating amino acids are then directly used for energy
loss of protein leads to muscle wasting and organ dysfunction
Type 1 Diabetes
characterised by a deficiency in insulin secretion resulting in hyperglycaemia
disorder of CHO, fat and protein metabolism
T1D caused by
destruction of B cellsin the pancreas
autoimmune mediated
combination of hereditary factors, environmental factors and precipitating events
signs and symptoms of T1DM
develop quickly in the absence of insulin
polyuria, polydispia (increased thirst), dry mouth, lethargy, polyphagia (increased hunger), rapid weight loss, diabetic ketoacidosis
type 2 diabetes
characterised by hyperglycaemia, lack of insulin secretion and/or insulin resistance
insufficient insulin secretion from B cells in pancreas leading to lower levels of circulating insulin and hyperglycaemia
insulin resistance on cells in muscles, liver and fat tissue
causes of T2DM
obesity, lack of exercise, genetic component, medications including glucocorticoids, thiazines, beta blockers, previous gestational diabetes, testosterone deficiency
Signs and symptoms of T2DM
polyuria polydipsia polyphagia weight loss blurred vision peripheral neuropathy fatigue recurrent infection
treatment of T2DM
focus on lifestyl intervention manage concurrent health concerns such as HT and hyperlipidaemia dietary changes and increase exercise oral anti-diabetic agents weight loss surgery
Gestational Diabetes
high blood glucose levels during pregnancy in women who have nil Phx of diabetes
cause of gestational diabetes
likely due to pregnancy related factors which decreases insulin resistance
risk factors for gestational diabetes
polycystic ovary syndrome, previous gestational diabetes, family Hx, increased maternal age, obesity, ethnicity, maternal smoking
complications of gestational diabetes
growth abnormalities of the foetus difficulties with delivery neonatal hypoglycaemia resp distress syndrome of the neonate pre-eclampsia
treatment of gestational diabetes
dietary change and exercise
anti-diabetic drug therapy
Acute complications hypoglycaemia
reduction of BGL
causes of hypoglycaemia
admin of too much insulin, increased activity level, decreased food intake, lcohol intake in diabetic pts, illness/infection
signs and symptoms of hypoglycaemia
shaking, tachycardia, palpitations, diaphoresis, pallor, headache, hunger, impaired judgement, confusion, irritability, parasthesia, slurred speech, fatigue, ataxia, seizures, coma
treatment of hypoglycaemia
conscious pts: oral admin of 15g CHO
unconscious: IV dextrose, IM glucagon injection
Acute complications diabetic ketoacidosis
precipitated by a shortage of insluin
counter-regulatory hormones such as glucagon and adrenaline are released
causes acidosis
signs and symptoms of ketoacidosis
n + v, dehydration, tachycardia, hT, polydipsia, polyuria, abdo pain, hyperglycaemia, confusion, lethargy, increased resps, ketotic odour on breath, cerebral odema
treatment of ketoacidosis
fluid replacement therapy
insulin bolus and infusion
potassium infusion
IV mannitol and hypertonic saline
hyperosmolar hyperglycaemic state
hyperglycaemic state resulting in osmotic diuresis, but in the absence of ketone bodies
usually occurs in T2DM pts who will secrete enough insulin to mitigate the formation of ketone bodies
signs and symptoms of hyperosmolar hyperglycaemia state
hyperglyaemia polyuria dehydration minimal - no ketone bodies present sensory and motor impairment hyperviscosity of blood seizure coma death
treatment of hyperosmolar hyperglycaemic state
IV fluid admin
electrolyte replacement
insulin infusion to obtain normoglycaemia
Chronic complications
hyperglycaemia leads to damage of blood vessels
Diabetic retinopathy
damage to the retina with prolonged hyperglycaemia or poorly controlled BGLs in the diabetic pt
can lead to blindness
diabetic neuropathy
nerve damage secondary to poorly controlled diabetes
thought to be a result of poor vascular supply to nerve endings
can affect all peripheral nerves
signs and symptoms of diabetic neuropathy
parasthesia dizziness muscle weakness dysphagia nerve pain sexual dysfunction speech impairment
Diabetic nephropathy
progressive renal impairment caused by damage to the blood vessels in the glomeruli
results in diffuse scarring of the glomeruli
late signs of nephropathy
tiredness, headache, nausea and vomiting, frequent urination, lower limb oedema
diabetic cardiomyopathy
ventricular dilation, enlargement of heart cells, decreased systolic function and interstitial fibrosis
causes of diabetic cardiomyopathy
vascular disease
neuropathy
metabolic alteration and alterations in ion homeostasis
