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Endocrine Pathophysiology > Pathophysiology of the Endocrine Pancreas > Flashcards

Pathophysiology of the Endocrine Pancreas Flashcards

1
Q

what do beta cells secrete?

A

insulin
amylin

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2
Q

what percentage of the islet cells are beta cells?

A

60-70%

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3
Q

what do delta cells secrete?

A

somatostatin

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4
Q

what is the half-life of insulin?

A

3-5 minutes

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5
Q

insulin is secreted at a constant basal level, and in a __________________ in response to increased blood glucose levels

A

bolus or spike

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6
Q

what does insulin stimulate in hepatocytes?

A

glycogen storage

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7
Q

is insulin required for glucose uptake in hepatocytes?

A

no: primarily use GLUT2 transporter

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8
Q

where is somatostatin produced?

A

hypothalamus
stomach
intestine
pancreatic delta cells

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9
Q

what does gastrin stimulate?

A

production of hydrochloric acid by parietal cells

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10
Q

what is diabetes insipidus?

A

polyuria due to decreased ADH response or ADH deficiency

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11
Q

what percentage of beta cells must be lost for clinical diabetes mellitus?

A

> 90%

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12
Q

what does insulin resistance in the peripheral tissues cause?

A

decreased glucose uptake in response to insulin

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13
Q

what happens with beta cells in type II/non-insulin dependent diabetes mellitus?

A

may be abnormal: beta cell exhaustion
may be overcome to some extent by increased secretion of insulin

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14
Q

what are the clinical signs associated with diabetes mellitus?

A

polyuria/polydipsia
weight loss despite good appetite or polyphagia
hepatomegaly due to hepatic lipidosis
cataracts, more common in dogs than cats
dehydration
halitosis

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15
Q

what are the consistent laboratory findings with diabetes mellitus?

A

hyperglycemia: marked and persistent
glucosuria

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16
Q

what are some complications of diabetes mellitus?

A

ketoacidosis
cataract formation
hypokalemia/hyperkalemia
immune dysfunction
microvascular complications
urinary tract infections

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17
Q

what type of acidosis do increased ketones cause?

A

titration-type
high anion gap

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18
Q

______________ precedes ketonemia

A

ketonuria

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19
Q

intracellular _____________ causes water influx by osmotic effect in diabetic cataracts

A

sorbitol

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20
Q

chronic high levels of glucose lead to _________________________________________________

A

glycosylation of proteins in blood and tissues

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21
Q

what type of diabetes mellitus do most dogs with diabetes mellitus have?

A

type I/insulin dependent

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22
Q

what type of diabetes mellitus is usually the one in cats?

A

type II
~80%

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23
Q

which cats have a higher incidence of diabetes mellitus?

A

neutered males
burmese, russian blue, abyssinian, norwegian forest

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24
Q

what are some possible predisposing factors for feline diabetes mellitus?

A

glucose transport abnormalities
leptin resistance
reduced adiponectin
beta cell dysfunction
islet amyloidosis (not proven- only in humans)

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25
Q

obese cats have reduced expression of _________ in muscle and adipose tissue

A

GLUT4

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26
Q

what is leptin secreted by?

A

adipose tissue

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27
Q

with positive energy balance, melanocortin 4 receptor (MC4R) is stimulated by alpha-melanocyte stimulating hormone (alpha-MSH), _______________________

A

increasing satiety

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28
Q

what is acromegaly caused by?

A

hypersomatotropism
excess growth hormone

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29
Q

what does increased growth hormone case with insulin?

A

insulin resistance

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30
Q

is diabetes mellitus common in ferrets?

A

no, uncommon

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31
Q

what does cortisol cause in skeletal muscle?

A

insulin resistance

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32
Q

what does cortisol cause in adipose tissue?

A

increased insulin sensitivity

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33
Q

who is gestational diabetes described in?

A

dogs

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34
Q

what causes gestational diabetes?

A

increased progesterone and growth hormone secreted in pregnancy or diestrus

35
Q

the amount of glycosylated protein can be measured to evaluate ___________________________

A

long-term blood glucose levels

36
Q

type II (insulin resistance) in horses may occur with ________________________________________

A

pituitary pars intermedia dysfunction (PPID)

37
Q

what do horses with equine metabolic syndrome have an increased tendency for?

A

obesity
laminitis

38
Q

what happens in equine metabolic syndrome with adipose tissue?

A

obesity or accumulation of fat in focal areas

39
Q

true/false: glucose is usually within reference interval with equine metabolic syndrome

40
Q

in equine metabolic syndrome, what are the insulin and glucose levels?

A

high insulin
normal or slightly elevated blood glucose

41
Q

equine metabolic syndrome horses exhibit an __________________ insulin response to carbohydrates

A

exaggerated

42
Q

avian diabetes mellitus may be secondary to increased _____________

43
Q

do birds usually have higher baseline glucose than mammals?

44
Q

what are some more common differentials for hypoglycemia?

A

excess insulin
malabsorption
artifactual/maldigestion

45
Q

what does the exocrine pancreas do?

A

produces digestive enzymes
secrete into the intestinal lumen via pancreatic duct

46
Q

what do F (PP) cells secrete?

A

pancreatic polypeptide

47
Q

what do epsilon cells secrete?

48
Q

what degrades insulin?

A

insulinase
insulysin
liver and kidneys

49
Q

what is removed to make active insulin?

50
Q

what might C peptide do?

A

activation of Na/K ATPase and nitric oxide synthase
may be used to evaluate endogenous insulin secretion

51
Q

what does increased intracellular glucose concentration of glucose in the beta cells cause?

A

membrane depolarization and influx of extracellular calcium and exoxytosis of insulin containing granules
diffuses in through GLUT2

52
Q

where does insulin bind to?

A

insulin receptor-kinases and insulin receptor substrate proteins

53
Q

where are Na/glucose cotransporters found?

A

enterocytes and renal tubules
use Na gradient created by Na/K ATPase

54
Q

where are GLUT1 transporters found?

A

most cells
red blood cells

55
Q

where are GLUT2 transporters found?

A

high expression liver, renal tubules, small intestine, beta cells

56
Q

where are GLUT3 transporters found?

A

neurons/brain

57
Q

where are GLUT4 transporters found?

A

striated and cardiac muscle and adipose tissue
regulated by insulin

58
Q

what are the effects of amylin?

A

decrease glucagon secretion
decreases gastric emptying
increases satiety

59
Q

what does pancreatic polypeptide do?

A

inhibits gall bladder contraction and exocrine pancreatic enzyme secretion
acts to antagonize cholecystokinin
may act as satiety factor

60
Q

what does somatostatin act to inhibit the release of?

A

growth hormone
thyroid-stimulating hormone
insulin
glucagon
gastrin
vasoactive intestinal peptide
exocrine pancreatic enzymes
prolactin

61
Q

gastrin is not normally secreted by the endocrine pancreas, but may be secreted by ____________________

A

islet neoplasia

62
Q

what are some diseases of the pancreatic islets?

A

metabolic disease
neoplasia

63
Q

what might lesions in the pancreas manifest histologically as with type one diabetes mellitus?

A

inflammatory infiltrates in islets
lack of visible islets
islet cell degeneration/vacuolation

64
Q

what are some causes of diabetes-like syndrome (damage pancreas or induce insulin resistant due to another disease)?

A

diabetogenic hormones or drugs
pancreatitis or pancreatic neoplasia

65
Q

what are some microvascular complications of diabetes mellitus?

A

diabetic retinopathy
neuropathy
nephropathy

66
Q

how are ketones formed?

A

fatty acids being broken down produce acetyl CoA
insufficient Kreb’s cycle intermediates so don’t use up
acetyl CoA forms ketones

67
Q

what can be measured to evaluate chronic hyperglycemia?

A

fructosamine
glycosylated Hb measurement`

68
Q

what might glycosylation do?

A

interfere with antibody-antigen binding
development of microvascular disease and neuropathy

69
Q

what dog breeds are more likely to get canine diabetes mellitus?

A

australian terrier
miniature and standard schnauzer
samoyed
bichon frise
fox terrier
beagle
miniature and toy poodles
keeshond

70
Q

what do obese cats have reduced expression of?

A

GLUT4 in muscle and adipose tissue

71
Q

where is the melanocortin 4 receptor mainly expressed?

A

hypothalamus

72
Q

what does adiponectin do with insulin?

A

enhances sensitivity

73
Q

how can chronic high glucose levels reduce the number of beta cells?

A

overstimulation
induction of apoptosis and inflammation
amyloidosis may occur

74
Q

what are some other endocrinopathies that may present like diabetes mellitus in cats?

A

hypersomatrotropism/acromegaly
hyperadrenocorticism

75
Q

what does hypersomatotropism/acromegaly cause with glucose?

A

glucosuria and hyperglycemia

76
Q

production of insulin-like growth factor-1 is increased by _____________________________

A

high growth hormone levels

77
Q

what are the effects of cortisol on glycemia?

A

insulin resistance in skeletal muscle tissue
increased insulin sensitivity in adipose tissue
liver: increases gluconeogenesis
pancreas: stimulates glucagon release and inhibits insulin releease

78
Q

does a urine ketone dipstick detect beta-hydroxybutyrate?

79
Q

what happens in equine metabolic syndrome with insulin?

A

resistance/dysregulation

80
Q

where do horses accumulate fat with equine metabolic syndrome?

A

nuchal ligament
behind shoulders
tail base
prepuce or mammary gland

81
Q

what are the clinical findings with equine metabolic syndrome?

A

hypertriglyceridemia
increased insulin levels
hyperleptinemia/leptin resistance

82
Q

what response to equine metabolic disease horses have to carbohydrates?

A

exaggerated

83
Q

what might avian diabetes mellitus be due to?

A

increased glucagon production
type 1 with chronic pancreatitis

84
Q

what is the most common islet cell neoplasm in veterinary medicine?

A

insulinoma

Endocrine Pathophysiology (6 decks)

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