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ENRP Exam 2 > pathology of the endocrine pancreas - hillard > Flashcards

pathology of the endocrine pancreas - hillard Flashcards

1
Q

B cells secrete what?

what is its major effect

A

beta cells secrete insulin and the major effects are to lower blood glucose and increase glucose in tissues (fat and muscle)

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2
Q

a cells secrete what and what is its major effect

A

glucagon and its major effect is to increase blood glucose by glycogenolysis

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3
Q

delta cells secrete what cells and what is the major effect

A

somatostatin

and it causes decreased insulin and decreased glucagon

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4
Q

PP cells secrete

major effect

A

pancreatic polypeptide

decreased intestinal motility and increase intestinal enyzmes

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5
Q

D1 cells secrete what

major effect

A

increase blood glucose a lot and cause by glyconeogenosis

cause a watery diarrhea

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6
Q

enterochromaffin cells secrete what

major effects

A

serotonin

regulate mood/mental states
“carcinod syndrome- flushing, tachycardia, diarrhea)

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7
Q

diabetes is very common and affects the _ system the _, peripheral _ and kidney

it results in too much _ in the blood to due issues in insulin production or response

A

cardiovasculae

nerves

glucose

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8
Q

type 1 diabetes is more frequently seen in _ and is caused by _ descruction of pancreatic _ cells leading to hyperlgycemia, it often requires _ for treatment

A

children

autoimmune

beta

insulin

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9
Q

type 2 diabetes is seen in adults is caused by _ _ to insulin, it is most frequently seen in _ adults

A

peripheral resistance

obese

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10
Q

diabetes is present if

HbA1c=
fasting plasma glucose=
oral glucose tolerance test 2 hours=
randmon plasma glucose =

A

HbA1c=6.5
fasting plasma glucose= 126
oral glucose tolerance test 2 hours=200
randmon plasma glucose = 200**

all tests must be repeated a second time on a different day to confirm

2 times- expect random plasma glucose

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11
Q

hemoglobin A1c is used to determine _ blood glucose levels over the last _ months

HGBA1c

A

average

2-3

hemoglobin AB1c is the glycosylated form of hemoglobin becuase glucose binds to hemoglobin

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12
Q

type 1 diabetes is a type _ hypersentitivity reaction and is caused by a _ cell autoimmune reaction against _ cells

_ _ are created

A

type 4

T

Beta cells

islet autoantibodies

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13
Q

in type 1 diabetes T cells attack beta cell antigen: what antigens

A

insulin and glutamic acid decarboxylase

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14
Q

in order to diagnose type 1 diabetes you must test the presence of?

A

autoantibodies (islet)

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15
Q

what HLA types are associated with type 1 diabetes

A

HLADR3, 4, 8

breakdown in self tolerance to islet autoantigens

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16
Q

stages of type 1 diabetes

A

stepwise progression

presymptomatic normoglycemia

non-symptomatic elevated blood sugar levels

symptomatic diabetes

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17
Q

typw 2 diabetes pccurs due to _ resistance which prevents peripheral tissues from adequattely responding to insulin couples with _ cell dysfunctino

A

insulin

b cell

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18
Q

the most important risk factor for type 2 diabetes is?

A

obesity

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19
Q

how does obesity drive type 2 diabetes

A

it causes insulin resistance by increasing free fatty acids, inflammatory cytokines, and adipokines which inhibit peripheral response to insulin

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20
Q

what type of diabetes causes type 2 diabetes

A

central belly fat wrapped around abdomnial organs due to the portal vein being able to carrier free fatty acids to the liver causing insulin resistance in the liver and preventing glucose uptake

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21
Q

other than obesity what caused T2DM

A

sedentary lifestyle
genetics
high caloric intake
sleep disturbances

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22
Q

what adipokin is decreased in obesity

A

adiponectin

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23
Q

what is the purpose of adiponectin

A

it is beneficial in insulin utilization (it is decreased in obesity)

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24
Q

excess _ _ _ in obesity will inhbit the peripheral reponse to insulin but are also proinflammatory and secrete cytokines like _

A

FFA

IL-1

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25
in T2DM the initial reposne to an increased peripheral resistance is beta cells _ insulin production but eventually there is beta cell _ and ultimately failure
increase dysfunction ## Footnote failure= T2DM
26
histologically _ deposition is seen in T2DM as a result of _ secretion
amyloid amylin
27
what is amylin
this is a amyloid polypeptide that is released from beta cells along with insulin and help to inhibit glucagon secretion and delay gastic eating
28
histology of type 1 diabetes
insulitis (infiltrate of T cells in the islet)
29
describe the effects of insulin on adipose tissue striated muscle liver
increase in glucose uptake in striated muscle like the heaty and in adipose tissue increases protein sythesis increases fat synthesis (lipogenlysis) glcogen synthesis decreases gluconeogensis in the liver
30
insulin is an _ hormone
anabolic ## Footnote causes complex molecules to form from simpler ones
31
what type of fat is associated with obesity
white adipose ## Footnote brown adipose increases glucose uptake/utilization
32
what are the 3 p's of diabetes how do they occur
polyuria- glucose in pee, water follows it creating an osmotic diuresis polydipsia- urine water loss + increased blood glucose depeltes intracellular water and triggers thrist receptors polyphagia- type 1 and later type 2; no insulin and there is fat/muscle breakdown
33
diabetic ketoacidosis is seen in _ and is severe _ def
type 1 diabetes insulin
34
what causes DKA what is released? what does this do
stress like infection or trauma epinephrine is release and increased glucagon and blcoks insulin action
35
pathogensis of DKA
no insulin causes peripheral glucose to not be utilized liver breaks down glycogen to create more glucose **fat is broken down to FFA and are metabolized by the liver to form acidotic ketone bodies** ketones and glucose spill into the urine and cause osmotic diuresis causing severe dhydration and ketocidosis
36
symptoms of DKA
fatigue, can lead to coma, fruity breath, deep labored breathing
37
what causes the fruity breath in DKA
ketone metabolism and acetone formation
38
ketones end up in the urine and a _ test can detect them, confirmatory tests involve checking the urine for?
nitroprusside beta-hydroxyurea
39
what causes kussmal breathing in DKA
the body attempts to neutralize the metabolic acidosis by exhaling off CO2
40
what is hyperosmolar nonketotic hyperglycemic syndrome
this is a complication of type 2 diabetes especially in the elderly where there is prolonged insulin deficiency this causes increased hepatic gluconeogenis, and glycogenolysis causing really high glucose glucose greater than 600 no ketone bodies and severe dehydration can cause AMS and coma
41
what is matuirty-onset diabetes of the young (MODY) what does it resemble
this is a monogenic diabetes that affects glucokinase of the beta cell it resembles T2DM ## Footnote there are no autoantiboies and is nonketotic
42
what is glucosekinase
a rate limiting enxyme in oxidative glucose metabolism that leads to the secretion of insulin
43
during pregnancy early on there is an increase in _ sensitivity that allows for a reservoir of energy supply. Later on _ _ block the effects of insulin and create insulin resistance this is because they want glucose in the blood to be able to cross over to the baby
insulin placental hormones
44
in pregnancy maternal weight gain or underlying risk factors can cause insulin resistance to precipiate a state of?
gestational diabetes
45
how does th ebaby appear in a person with gestational diabetes
macrosomia difficult birth (shoulder dystocia_ c section congenital malformations (still birth)
46
describe the pathogensis of hyperglycemia
glucose causes advanced glycation of end products. End products have a vast majority of effects that cause the endothelium to become activated and allow for athersclerosis and vascular damage to occur
47
what other pathways contibute to hyperglycemia effects other than the glycationof end products
polyol pathway- loss of antioxidant production hexosamine pathway- increase in oxidative stress activation of protein kinase c (PKC) - increases growth factors and procoagulant activity
48
advanced glycation end products produces
vascular damage and athersclerosis
49
major complications of diabetes
athersclerotic disease (MI, cerebral infacrt, PVD-->gangrene) retinopathy/ocular neuropathy/peripheral neuropathy nephropathy- ateriorsclerosis, pyelonephritis infections- UTI, dental carries, candida
50
what fungal infection is common in diabetes
candida
51
describe the macrovascular athersclerotic disease in diabetes brain kidney bowel heart peripherally
brain: can cause hemmorage or stroke kidney: can cause renal artery stenosis and activation of the RAS system bowel: can cause mesenteric ischemia heart: chronic heart disease, MI peripherally: claudication and ganreenoug necrosis
52
diabetic retinopathy and occular pathology is common and causes _ loss and diminished _ it can be divided into proliferative and nonproliferative: what are these it can also cause _ and _ (end stages)
vision sight proliferative: formation of new vessels on the retina non proliferative: anurysems in small vells and microhemorrhage; lipid leak cataracts and glaucoma
53
diabetic peripheral neuropathy is a _ , _ , _neuropthy
distal symmetric polyneuropathy
54
symptoms of diabeteic peripheral neuropathy
numbness loss of pain sensation
55
diabetic peripheral neuropathy is in a _ and _ distibution
glove and stocking
56
one of thedirect affects of peripheral neuropathy is injury to the _
foot
57
loss of sensation in the foot can lead to _ and infection
trauma
58
peripheral vascular disease in the foot leads to decreased _ and a _ foot (ulceration)
healing diabetic
59
inflammationof the bones of the foot in diabetic neuropathy can lead to severe deformity of _ and joint and leads to a _ foot ( midfoot collapse/rocker bottom)
bones charcot foot
60
diabetes can cause _ kidney disease
chronic
61
symptoms of chronic kidney disease
extermity edema, puritis, hypertension, bone fractures ( decresed calcitriol) and hypocalcemia encephalopathy
62
what are the three principal vascular lesions in diabetic kidney nephropathy? in diabetes
renal vascular lesions pyelonephritis golmerular lesions
63
what are the renal vascular lesions in diabetic kidney nephropathy
athersclerosis thar causes renal atery stenosis and hypertension hyaline ateriorsclerosis: from chronic hypertension and diabetes ( nephroclerosis of the kidney giving a grnaular nodular apperance)
64
what infection is increased in the kidney in a diabetic patient
pyelonephritis **fevers, chills, flank pain, hematuria
65
_ _ is strongly associated with diabetic induced pyelonephritis
papillary necrosis
66
what does a diabetic glomerulus look like?
diffuse mesanglial slcerosis (increase in mesangium) capillary basement membrane thickening and PAS stained nodules (large) kimmelstiel wilson

ENRP Exam 2 (13 decks)

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