Lab Med 3 Pancreatic

Front 1

Fluids tested for pancreatic test

Back 1

Blood
Duodenal contents
Feces
Urine

Front 2

Disorders of endocrine pancreas

Back 2

DM
Islet cell tumor

Front 3

Endocrine pancreas hormones (3)

Back 3

Glucagon
Insulin
Gastrin

Front 4

Glucagon fxn

Back 4

Promotes Glycogenolysis (breakdown of glycogen to glucose in the liver)

Front 5

Insulin fxn

Back 5

facilitates glucose transfer acress cell membrane into cells

Front 6

Gastrin fxn

Back 6

Stimulates secreation of gastric acid, also produced by stomach acid

Front 7

4 most important cell types of Islets of Langerhans (microscopic units of endocrine panc)

Back 7

B
A
D
PP (pancreatic polypeptide)

Front 8

B cells

Back 8

70% of panc, contain insuline

Front 9

A cells

Back 9

Glucagon

Front 10

D

Back 10

Somatostatin

Front 11

PP

Back 11

u/k fxn

Front 12

Exocrine pancreas disorders

Back 12

Acute/chronic pancreatitis
Carcinoma of pancreas

Front 13

Exocrine juices

Back 13

Proteolytic
Lipolytic
Amylolytic

Front 14

exocrine means

Back 14

glands that secrete their products through ducts opening onto an epithelium rather than directly into the bloodstream

Front 15

Exocrine fxn tests

Back 15

Secretin/CCK, fatty meal

Front 16

3 categories of pancreatic problems

Back 16

Inflammation
Insufficiency
Excess

Front 17

Pancreatic insufficiency - endocrine

Back 17

DM

Front 18

Pancreatic insufficiency - exocrine

Back 18

Cystic fibrosis
Steatorrhea

Front 19

Cystic fibrosis s/s

Back 19

Thick mucus instead of thin/watery

Front 20

Lab tests for pancreatic insufficiency

Back 20

-Stool fat (Sudan stain)
-Liver enzymes, esp Alk phos
--LDH, SGOT
-Glucose

Front 21

If stool fat is present, what exocrine fxn is absent

Back 21

Lipase or pt on fat substitute (olestra, ALI)

Front 22

Pancreatic excess disorders (2)- endocrine

Back 22

1 Insulinoma - insulin secreting adeoma
2 Zollinger Ellison Syndrome - gastrin producing adenoma

Front 23

Microvascualr complications of DM appear when?

Back 23

10-15 yrs after onset

Front 24

Reasons for accelerated atherosclerosis of DM

Back 24

Elevated blood lipid
Qualitative changes in lipoproteins *low HDL, high LDL
^PLT adesive to vessels

Front 25

Insulin is a ___ bolic hormone
Fxn:

Back 25

Anabolic
Glucose and AA into cells
Glycogen formation in liver/m.
Glucose to triglycerides
Nucleic acid/protein synthesis

Front 26

Counter regulatory hormones of metabolism

Back 26

Glucagon
Epinephrin
Cortisol
GH

Front 27

Glucagon
-released from, acts on
-Fxn

Back 27

From panc a cells, acts on liver
^ gluconeo & glycogenolysis

Front 28

Epinephrine
-acts on
-Fxn

Back 28

Liver, m, fat
^ glycogenolysis, lipolysis

Front 29

Cortisol
-acts on
-Fxn

Back 29

Liver, m, fat
^gluconeo, protein breakdown
v m glucose uptake

Front 30

GH
-Fxn

Back 30

^lipolysis
v m glucose uptake

Front 31

Dx of diabetes
-Random plasma glucose >
-Fasting >
-75 g oggt 2 hr >

Back 31

200
126
200

Front 32

Impaired glucose tolerance level
-Fasting & ogtt

Back 32

<126; 150-200

Front 33

Impaired fasting glucose =

Back 33

110--126

Front 34

NL plasma glucose level
Fasting
OGTT

Back 34

Fasting <100
2 h OGTT <150

Front 35

Gestational DM dx

Back 35

Single screen > 200

Front 36

Insulin = ____ - _____

Back 36

Proinsulin - c peptide

Front 37

NL HA1c

Back 37

<6.5

Front 38

Intense acute abd, upper back radiation, PV collapse, shock, Nausea, sitting forward =

Back 38

Pancreatitis

Front 39

Common sequela of pancreatitis

Back 39

Sterile pancreatic abscess from liqueficaiton of tissue & pancreatic pseudocyst from aberrent drainage of panc secretions

Front 40

Causes of pancreatitis (4)

Back 40

Alcohol
Biliary obstruction
Hypertriglyceridemia
Idiopathic

Front 41

Pancreatic alterations of pancreatitis

Back 41

Leakage of vasculature --> edema
Necrosis of regional fat (lipolytic)
Acut inflammation
Proteolytic destruciton of panc substance
Destruct blood vessels --> interstitial hemorrhage

Front 42

Labs of Pancreatitis
-Amylase
-Lipase

Back 42

-Elevated amylase
-Elevated lipase
-Leukocytosis, ^ triglycerides, Ca

Front 43

Higher amylase levels correlated to specific cause
-<300 =
- 300-800
- 500-10,000 =

Back 43

-Bowel wall (won't be more than 2X upper limit of NL)
-Sialadentitis (salivary)
-Pancreatic

Front 44

___ ratio is more specific than raw amylase

Back 44

Amylase/creatinine clearance

Front 45

Amylase/creatinine clearance ratio

Back 45

(Uamylase/SerAmyl) X (SerCreat /UCreat) X 100

Front 46

Does amylase or lipase rise first?
& time frame

Back 46

Amylase w/in 24 hr
Lipase 72-96 hr

Front 47

Specificity of lipase to pancreas
Sensitivity

Back 47

VERY - lipase only produced from pancreas
Lower

Front 48

____ criteria used to assess severity of acute pancreatitis

Back 48

Ranson's

Front 49

Ranson's Criteria - 3 or more of:
1 Age
2 WBC
3 Glucose
4 Base def
5 LDH
6 AST

Back 49

1 >55
2 >16K
3 >200
4 >4
5 >350
6 >250

Front 50

Mortality ^ if the following develop w/in 48 hours
-Hgb
-BUN
-Arterial PO2
-Calcium
-Fluid sequestration

Back 50

- Decr >10%
- Incr >5
- <60
- < 8 (Ca inflames panc, panc takes it out)
-> 6 L

Front 51

Abd pain, painless jaundice, weight loss, malabsorption, depression

Back 51

Pancreatic CA

Front 52

Types of pancreatic CA

Back 52

Ductal
Insulinoma
Gastrinoma
Carcinoma

Front 53

Carcinoma of pancreas
-Endo or exo?

Back 53

Exo

Front 54

Dx of pancreatic adenocarcinoma
-Tumor markers
-Radiology
-Tissue

Back 54

Tumor markers
-CEA
-CA19-9, 125
Radiology
-CT
Tissue ERCP

Front 55

2 common hx seen w/ pancreatic CA

Back 55

New onset painless jaundice (2/3)
1-2 mo abd pain, releived by sitting hunched

Front 56

PE findings panc CA

Back 56

? mass, liver enlargement, jaundice, weight loss

Front 57

Lab findings of pancreatic CA
Blocked bile duct
-Bilirubin
-Alk phos
Other
-Amylase
-Tumor marker

Back 57

Elevated bili & alk phose
elevated amylase, Ca-19-9

Front 58

Why low pH in diabetic ketoacid?

Back 58

Triglyc + H2O --> FA + glycerol + H; lipase catalyzes

Front 59

Tx diabetic ketoacid
1
2
Send them to:
Monitor:
Can die from

Back 59

Regular insulin bolus
IV saline
-1-3 L first hour, back off switch to D5/4.5% when sugar <300
K
Cerebral edema

Front 60

Levels of ketoacidosis
Sugar
pH

Back 60

>450
<7.25

Front 61

levels in HONK
Sugar
Osm
Ketones
Coma

Back 61

>700 - >1100
>325
None
No coma at first, then confused/sleepy

Front 62

HONK has increased risk of ____
Tx

Back 62

Thrombosis
Rehydrate

Front 63

Why C pep over insulin to distinguish Type 2 & 2

Back 63

Distinguish type 1 & type 2 .
C-peptide instead of insulin bc insulin in portal vein ranges from two to ten times higher than in the peripheral circulation.
The liver extracts about half the insulin reaching it in the plasma, but this varies with the nutritional state.
The pancreas of patients with type 1 diabetes is unable to produce insulin, and, therefore, they will usually have a decreased level of C-peptide, whereas C-peptide levels in type 2 patients are normal or higher than normal. Measuring C-peptide in patients injecting synthetic insulin can help to determine how much of their own natural insulin these patients are still producing, or if they produce any at all.

Front 64

Renal threshold for glucose

Back 64

>220

Front 65

Cigarrettes don't taste good

Back 65

Pancreatic CA