Pathology of the Pancreas Flashcards by Matt Stanton

acinar cells

exocrine pancreas

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cell types in islets of langerhans

alpha
beta
delta
PP

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insulin production

beta cells

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glucagon production

alpha cells

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somatostatin production

delta cells

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pancreatic polypeptide production

PP cells

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insulin

reduce blood sugar levels

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glucagon

increase blood sugar levels

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somatostatin

suppress insulin and glucagon release

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pancreatic polypeptide

GI effects

-stimulates secretion of gastric and intestinal enzymes and inhibition of intestinal motility

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D1 cells

in pancreas

elaborate vasoactive intestinal polypeptide

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enterochromaffin cells

in pancreas

induce glycogenolysis and hyperglycemia

synthesize serotonin

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carcinoid syndrome

pancreatic tumor - of enterochromaffin cells

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predominant cell type in pancreas islet

beta cells - insulin

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leading cause of ESRD, blindness, and amputations

diabetes mellitus

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normal blood glucose

70-120 mg/dL

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diagnosis of diabetes

fasting plasma glucose >126

random plasma glucose >200

2 hour plasma glucose >200 after oral glucose tolerance test

HbA1C level > 6.5%

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pre-diabetes

fasting plasma glucose 100-125

2 hour plasma glucose 140-199 after oral glucose tolerance test

HbA1C 5.7-6.4%

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DM I

autoimmune

beta cell destruction

insulin deficiency

patient younger than 20

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DM II

peripheral resistance to insulin action and inadequate secretory response

majority of DM patients** 95%

older and obese**

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increasing rate of obesity

more DM II in children an adolescents

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nonketotic hyperosmolar coma

DM II

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ketotic episodes

DM I

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islet autoantibodies

anti-insulin
anti-GAD
anti-ICA512

DM I

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GLA linkage

DM I

insulitis

inflammatory infiltrate of T cells and macrophages beta cell depletion islet atrophy in DM I**

amyloid deposition in islets

DM II - chronic inflammation

lymphocytes in islets

DM I

honeymoon period

destruction beta cells during asymptomatic period don't notice until 90% destroyed

unexplained fatigue, dizziness, blurred vision in obese patient

DM II

most frequent diagnosis of DM II

routine blood testing in asymptomatic person

polyuria, polyphagia, polydipsia

3 Ps of diabetes

metabolic derangement in diabetes

ketoacidosis hyperglycemia > polyuria volume depletion

diabetic coma

volume depletion and ketoacidosis

vascular disease in diabetes

macrovascular - MI, stroke, lower extremity ischemia microvascular - diabetic retinopathy, nephropathy, neuropathy

atherogenic profile

in hypothyroidism

increased number and size of islets in pancreas

nondiabetic newborns of diabetic mothers islet hyperplasia - response to maternal hyperglycemia

amyloid

extracellular in DM II

most common cause of death in diabetes

myocardial infarction atherosclerosis of coronary arteries

hyaline arteriosclerosis

in glomerulus | -diabetic microangiopathy

35yo obese male, BUN/Cr elevation

most likely DM II

diabetic nephropathy

glomerulosclerosis arteriosclerosis of renal vasculature pyelonephritis

glomerular BM in diabetes

normal 200-300nm diabetic 600nm late stage 1200nm

cataract

diabetes - hyperglycemia - opacification of lens

chronic diabetes clinical

MI, renal vascular insufficiency, CVAs diabetic nephropathy visual impairment distal symmetric polyneuropathy enhanced susceptibility to infections

pancreatic neuroendocrine tumor

PanNETs islet cell tumor

most common islet cell tumor

beta cell | -insulinoma

insulinoma prognosis

90% benign

second most common pancreatic tumor

zollinger ellison syndrome | -gastrinoma

nonfunctional islet cell tumor

more likely malignant

functional pancreatic endocrine neoplasms

hyperinsulinism hypergastrinemia (ZES) MEN - multiple endocrine neoplasia

hypoglycemia episodes, confusion, stupor, loss of consciousness precipitated by fasting or exercise and relieved by feeding

with insulinoma

tumor in pancreas

insulinoma

tumor around pancreas

malignant - gastrinoma

45yo M exercises and faints, blood sugar low

insulinoma

amyloid

seen in insulinomas

insulinoma lab findings

high levels of insulin high insulin:glucose ratio

diarrhea, stomach pain, H2 blockers don't get better, and multiple ulcers

ZES - gastrinoma

most common ulcer in ZES

duodenum

single gastrinoma

sporadic

multifocal gastrinomas

familial - MEN-1

jejunal ulcer

think ZES

tx of ZES

H/K ATPase inhibitors and excision of neoplasm (whipple procedure)

alpha cell tumor

glucagonoma increased serum glucagon

somatostatinomas

delta cell tumor high plasma somatostatin

VIPoma

watery diarrhea, hypokalemia, achlorhydria WDHA syndrome VIP assay - all patients with severe secretory diarrhae

serotonin producing tumor

pancreatic carcinoid tumor