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94 Cards in this Set
- Front
- Back
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three things that identiy neuroendocrine cells
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1. neuron specific enolas 2. chromogranin 3. synaptophysin
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what can you see with EM in neuroendocrine cells
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secretory granules
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place to normally find neuroendocrine cells
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gut, thyroid, pancreas, adrenal medulla, lung, (and elsewhere)
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examples of tumors to respective organs
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carcinoids of the gut, pancreatic islet cell tumor, pheochromocytoma, and neuroblastomas, carcinoids, and small cell ca of lung
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how can you ID a neuroendocrine cell from the gut
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look for brush border of microvilli and secrectory granules in the cells
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2 things secreted by pancreas
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enzymes and bicarbonate
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3 places with NE carcinoids
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gut, lung, pancreas
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islet cell tumors are from the _______________
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pancreas, DUH!
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NE (neuroendocrine) tumor of the skin
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Merkel cell
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malignant NE cell of the lung
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small cell ca
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another NE tumor of thelung
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large cell NE ca
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2 other kinds of NE ca's mentioned
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NE ca of the cervix and MEN I
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what is a feature of Merkel cell tumor
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bland eosinophilic spindle cells, also look for elongated nuclei with various sizes and shapes
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how can you tell an insulinoma from normal pancreatic islet cells on slides
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look for a gazillion nuclei and smaller islets
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how can you ID a slide of gastrinoma and duodenal ulcer (Zollinger-Ellison Syndrome)
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Dark area is ulcer with white necrosis
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what cell types gives rise to insulin and glucagon
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B and A
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Too much insulin and glucagon cause what conditions, respectively
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hypoglycemia and diabetes mellitus(and skin rash)
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What cell type causes somatostatin syndrome
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D
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what hormone and cell type cause Zollinger-Ellison Syndrome
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Gastrin, G
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pancreatic polypeptide hormone results from what cell type and causes what
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PP, PP-oma syndrome
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what rare AD disease results from clinical loss of K/ATP channel function
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persistent hyperinsulinemia of infancy
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Persistent hyperinsulinemia of infancy cuases what
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nesidioblastosis
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Verener-Morrision syndrome is cause by what hormone and cell type
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secretin, S
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what hormone and cell type cause WDHA and pancreatic cholera (with big time diarrhea)
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serotonin, EC
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too much ACTH/CRH causes______
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Cushings syndrome
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too much GHRH causes_______
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Acromegaly
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aside from looking like Andre the Giant, what happens with acromegaly
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hypertrophy of sweat/sebaceous glands, glactorrhea, sexual dysfunction, peripheral neuropathy, abnormal GTT/glucosuria/polyuria, visual field defects
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3 S/SX of cushings mentioned
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thin skin, polyuria, polydipsia????related to ACTH/ADH???
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what does a glucagonoma look like
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some nasty looking red marks called Necrolytic Migratory Erythema
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hormones released from a gland to itself are called__________
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eutopic
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Most important feature to determine malignancy
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metastasis-in most cases the only criterion
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how can you tell normal adrenal medulla from pheochromocytoma on slides
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in pheo there are lots of great big granules in the cells
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how can you tell its adrenal neuroblastoma on slides
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brown lines (look like little brown hairs or fibers) are stained nerve fibers
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how to tell neuroblastoma of slides
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cells of varying sizes and shapes, undifferentiated
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"What was the common denominator that characterised these slides?" in the handout
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They all had a pathological condition on them, after all, HE IS A PATHOLOGIST!
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what is the hidden organ
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pancreas
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where can pancreatic cells be located
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anywhere in the peritoneum
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how much does the pancreas secrete
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one liter/day
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in the childish picture used in the handout, what distinguishes the Golgi from the RER
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ribosomes, you know, the little round balls on the ovals
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2 problems with pancratic diseases
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silent, cannot palpate
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sthe most common endocrine syndrome
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diabetes mellitus 1,2
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1st sympotom of pancreatic cancer is often_____________
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pain
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__________pancreatitis is usually benign
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acute
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who has chronic pancreatitis
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alcoholics after bouts of acute pancreatitis
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2 blood findings with chronic pancreatitis
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hypercalcemia, hyperlipidemia
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in alcoholics with lobule fibrosis, sq. metaplasia
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common chronic calcifying pancreatitis
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proteinplugs in ducts that cause gallstones
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chronic obstructive pancreatitis
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secretes many enzymes and proteases, can progress to hemorrhagic necrosis, has acinar cell injury, is self limiting and mild
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acute pancreatitis--this slide looks #ucked up, its on page 10
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sings/symptoms of pancreatitis
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back pain,, jaundice, glycosuria, hypercalcemia from fat necrosis
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what can precipitate pancreatitis
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large fatty meals
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tumor duct epithelium 4% pancreas cells, highly malignant, poor prognosis, caused by smoking, diet, chemicals in 60-70yo, dx via CT and needle biopsy
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pancreatic adenocarcinoma
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from diagnosis to death in pancreatic adenocarcinoma
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6-12 months
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screwed up gene in pnacreatic cancer and pancreatitis
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K-ras mutation, an oncogene
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best chemo drug for pancreatic cancer
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gemcitabine
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other drug for pancreatic cancer
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5-FU (fluorouracil)
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in DM II, patients produce______but don't ______
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insulin, respond
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TX for DM I
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insulin
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TX for DM II
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diet and exercise
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new name for DM II
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insulin independent DM
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DM increase in incidence with _____and _____ sex
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age, male
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% of DM in US attributable to weight gain
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>80%
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cardiovascular disease triad in DM
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cerebrovascular disease, coronary heart disease, peripheral vascular disease
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__________>glucosuria>polyuria>dehyrdration>polydypsia
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hyperglycemia
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_______>acetonuria>acidosis>coma>death
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ketosis (from FA oxidation)
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blutbahn translates from Deutsch as ___________
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blood vessel (literally blood highway or path)
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most common DM lesion
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microangiopathy
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what causes the microangiopathy
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AGE
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important thing about gestational DM
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you'll never have it! no really, it is only temporary and in pregnancy
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nesidioblastosis is normal in _____________
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infants
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mnesidioblastosis in abnormal in _________
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everyone else
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hyperinsulinsism + insulinoma= triad of hypoglycemia, which are...
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<50mg/dl serum glucose, CNS changes like stupor or LOC, and precipitating factors like fasting or exercise
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what gives immediate relief form hypoglycemia
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feeding or IV glucose
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what is Zollinger-Ellsion syndrome
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MEN I, hypergastrinemia and gastrinoma, usually a pancreatic Islet cell tumor
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insulinoma are single adenomas __________% of the time
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70%
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Nesidioblastosis is
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a controversial medical term for hyperinsulinemic hypoglycemia attributed to excessive function of pancreatic beta cells with an abnormal microscopic appearance. wiki
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nesidioblastosis is now referred to as congenital hyperinsulinism However, the term has been resurrected in recent years to describe
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a form of acquired hyperinsulinism with beta cell hyperplasia found in adults, especially after gastrointestinal surgery. wiki
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diffuse islet cell hyperplasia is associated with
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infants of diabetic mothers
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Nesidioblastosis is associated with
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infants with hypoglycemia, no diabetic mother and adults with hypoglycemia. straight from notes
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islet cell hyperplasia on slides looks
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lighter that surrounding islet or brown is using neuron specific enolase
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other causes of hypoglycemia
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insulin sensitivity, diffuse liver disease, ectopic insulin, tumors, retroperitoneal fibrosarcoma
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Where are ulcers in Zollinger-Ellison syn
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gastric, duodenal, ileal and usually multiple ulcers
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duodenal ulcers:gatric ulcers in ZE syn
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6:1
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frequent symptom of ZE syn
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diarrhea in 50% cases
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other sources of hypergastrinemia
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duodenum, stomach, G-cell hyperplasia, small gastrinomas
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what can you give to increase gastrin secretion or test for ZE
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secretin, normals don't respond
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causes mild DM, migratory necrotizing dermatitis, anemia
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glucagonoma
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causes vasoactive polypeptides, watery diarrhea, hypokalemia, achlorhydria
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VIPOMA
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causes DM, cholelithiasis, steatorrhea, hypocclorhydria
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somatostatinoma
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releases pancratic polypeptide
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PPOMA
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where are most pancreatic tumors
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head
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types of MEN I
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non-beta cell gastrin secreting islet cell tumor, insulinomas, parathyroid hyperplasia, pituitary adenomas (maybe functional), thyroid adenomas, adrenal cortical hyperplasia and adenoma
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most malignant pancratic MEN I
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gastrinomas
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the pancreas looks like a_______,______, ____ ____ in the last few photos
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boneless, skinless, chicken breast
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what was the professor doing before the lecture
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smoking crack in his pipe
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