Endo 2: 2. Leech : Endocrine & Exocrine Pancreas

Front 1

What are the 6 cell types in the endocrine pancreas?

Back 1

Beta – 68% - insulin

Alpha – 20% - glucagon

Delta – 10% - somatostatin

PP – 2% - pancreatic polypeptide

D1 – vasoactive intestinal polypeptide (VIP)

Enterochromaffin cells – synthesize serotonin – carcinoid syndrome

Front 2

diagnosis of diabetes mellitus has to have fasting glucose > ?

Back 2

126 mg/dl on at least 2 separate occasions

Front 3

positive glucose tolerance test HbA1c equal to or > what shows diabetes mellitus?

Back 3

6.5%

Front 4

type I, juvenile onset diabetes, brittle diabetes are all what type of diabetes?

Back 4

Insulin-dependent diabetes mellitus (IDDM)

Front 5

which MHC II genes are associated with Insulin-dependent diabetes mellitus (IDDM)?

Back 5

HLA-DR3, DR4, and DQ

note also Northern European ancestry

Front 6

What is the pathogenesis of Insulin-dependent diabetes mellitus (IDDM)?

Back 6

Lack of insulin due to autoimmune destruction of B-cells

Absolutely dependent on insulin to prevent ketoacidosis and coma

Front 7

the etiology of Insulin-dependent diabetes mellitus (IDDM) is thought to be ...? triggered by?

Back 7

caused by an autoimmune reaction triggered by an infection (Coxsackie B virus) in a genetically susceptible individual

Front 8

3Ps of Insulin-dependent diabetes mellitus (IDDM)?

Back 8

Polydipsia, polyuria, and polyphagia

Front 9

type II, adult onset diabetes are all what kind of diabetes?

Back 9

Non-insulin-dependent diabetes mellitus (NIDDM)

Front 10

age generally effected in type 1 and 2 diabetes?

Back 10

1: young

2: over 30

Front 11

obesity, increasing age, and genetic predisposition are risk factors for what kind of diabetes?

Back 11

type 2 (NIDDM)

Front 12

Lymphocytic inflammation of the islets of Langerhans (insulitis)
Loss of B-cells
Fibrosis of the islets

are micro findings of what?

Back 12

Type I diabetes

Front 13

pathogenesis of disease in type 2?

Back 13

Relatively reduced insulin secretion

Peripheral insulin resistance: reduced tissue sensitivity to insulin due to decreased numbers of insulin receptors on the cell membranes

Front 14

Nonspecific changes
May have focal atrophy and amyloid deposition in islets (hyalinization)

are microfindings of what?

Back 14

type 2 diabetes

Front 15

most common cause of death in a diabetic pt?

**

Back 15

MI

Front 16

what are some of the vascular problems associated with diabetes?

Back 16

atherosclerosis

MI

Stroke

Peripheral Vascular Disease

Microvascular disease

Front 17

what type of infiltrate will you see in nodular glomerulosclerosis of diabetic nephropathy?

Back 17

Kimmelstiel-Wilson

Front 18

what are some of the neuropathy's seen in diabetes?

Back 18

A. Peripheral neuropathy
B. Neurogenic bladder
C. Sexual impotence

Front 19

tx for Type 1 diabetes?

Back 19

INSULIN

Front 20

this diabetes is due to peripheral insulin resistance and due more to lifestyle problems

Back 20

type II diabetes

Front 21

what is pancreas divisum?

Back 21

Persistence as dorsal & ventral pancreas

Front 22

what is annular pancreas?

Back 22

Pancreatic head encircles the duodenum
Risk of obstruction
Predisposes to recurrent pancreatitis

Front 23

what is aberrant pancreas?

Back 23

Locations: stomach, duodenum, jejunum, Mechel diverticulum, ileum
Single or multiple
3-4 cm
Typically submucosal

Front 24

what is the etiology of acute hemorrhagic pancreatits? Mechanism?

Back 24

Etiology: gallstones & alcohol – 80%; hypercalcemia; drugs; shock; infections; trauma; and scorpion stings.

Mechanism: Pancreatic acinar cell injury results in activation of pancreatic enzymes and enzymatic destruction of the pancreatic parenchyma.

Front 25

you are in Texas and a pt was recently stung by a scorpion. He now has stabbing epigastric abdominal pain radiating to the back. What is going on? what labs would you see elevated?

Back 25

acute hemorrhagic pancreatitis

elevation of serum amylase and lipase

Front 26

with diabetes, what would be a late finding (chronic or acute pancreatitis?)

Back 26

chronic pancreatitis

Front 27

most common type of islet cell tumor? what will the pt look like?

Back 27

Insulinoma (B cell tumor)

Hypoglycemia, sweating, hunger, confusion, insulin coma
Lab elevated insulin and C-peptides
Treatment: glucose

Front 28

pt has ulcer disease that just won't go away with normal tx. What do you start thinking?

Back 28

Zollinger-Ellison syndrome

Front 29

pt has Hyperglycemia (diabetes), anemia,and skin rash..if it were due to a tumor, what kind would it be?

Back 29

Glucagonoma (alpha-cell tumor)

Front 30

a gamma cell tumor would produce what? cause?

Back 30

Tumor produces somatostatin
Somatostatin inhibits
Insulin secretion --> diabetes
Gastrin secretion --> hypochlorhydria
Cholecystokinin secretion --> gallstones and steatorrhea

Front 31

a 65 year old smoker and recovering alcoholic presents to your office with abdominal pain, jaundice, and migratory thrombophlebitis (Trousseau sign)..what do they likely have?

Back 31

Pancreatic carcinoma

Most common between ages 60 and 80
Risk factor: smoking – ETOH – as well

Front 32

breakdown the site of pancreatic carcinomas from most common to least

Back 32

pancreatic head (60%), body (15%), and tail (5%),

note: diffuse (20%)

Front 33

describe MEN I (Wermer syndrome)..what is effected? population?

Back 33

abnormalitities of pituitary, parathyroids, and pancreas

(prolactinoma, hyper parathyroid, ZE/insulinomas)

seen in younger folk

symptoms normally due to pancreas

Front 34

Describe MEN IIA (Sipple syndrome)

Back 34

parathyroid hyperplasia

pheochromocytoma

Medullary ca of thyroid ***

Genetic mutation of RET proto-oncogene

Front 35

Describe MEN IIB

Back 35

Pheochromocytoma only

medullary thyroid ca is more aggressive

NO primary hyperparathyroidsim (like in MEN IIA)

also may have neuromas of skin, oral mucosa, eyes, respiratory tract/GI tract