20/21: Pathology of the Endocrine Pancreas - Fang Flashcards Preview

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Flashcards in 20/21: Pathology of the Endocrine Pancreas - Fang Deck (42):
1

"bronze diabetes"

hemochromatosis

due to hemosiderin deposition in pancreas

2

b-cell destruction leading to absolute insulin deficiency

type 1 DM

immune-mediated
idiopathic

3

insulin resistance with relative insulin deficiency

type 2 DM

4

MODY =

maturity onset diabetes of the young

genetic abnormalities which cause a primary defect in b-cell function

5

no obesity
no insulin resistance
no antibodies to gluatmic acid

MODY
-just a defect in b-cell function

6

normal blood glucose range

70-120

7

any one of four criteria for diabetes diagnosis :

1. A1c greater of equal to 6.5%
2. Fasting plasma glucose greater than 126 mg/dL
3. 2h plasma glucose greater than 200 mg/dL during an oral glucose tolerance test
4. random glucose greater than 200 in patient with symptoms

* in the absence of unequivocal hyperglycemia, criteria 1-3 should be confirmed

8

most common COD in pt with DM

MI

9

inflammation, degranulation of b-cells, and death of b-cells

acute islitis
early change in type I DM

following this acute inflammation, there will eventually be a reduction in number and size of islets; thus loss of b-cells. later will be hyalinized.

10

there is a _______ lack of insulin in type 2 DM

relative

normal levels of insulin re circulating but cells are not appropriately responding to the insulin

11

primary beta cell defect and peripheral tissue insulin resistance --> hyperglycemia ---> _______ ---> type 2 DM

beta cell exhaustion

12

insulin, abnormally packaged and secreted, accumulating outside beta cells

amylin (because resembles amyloid)

sign of type 2 DM

13

does early type 2 DM show insulinitis?

no insulinitis present

14

"glucose toxicity"

later stage of Type 2 DM

mild/moderate insulin deficency due to beta cell damage/exhaustion due to chronic hyperglycemia

15

amorphous "cracked plate glass"

histological type II DM

amylin

16

*******_____________ is the MOST common underlying cause in the pathogenesis of complications in DM

non-enzymatic glycosylation of extracellular matrix

17

4 pathogenic effects of AGEs

1. plasma prtns can bind to glycated BM
2. can induce cross linking in type IV collagen in BM
3. can trap LDL particles in artery walls
4. can bind to receptors on numerous cell types

18

AGEs =

advanced glycation end-products

19

AGEs binding to cell receptors can cause (4)

- release of cytokines and growth factors from macrophages
- increased endothelial permeability
- increased endothelial procoagulant activity
- increased extracellular matrix production by vascular smooth muscle cells as well as increased proliferation

20

AGEs play a role in damage of BM by (2)

- prtn accumulation thickening of BM
- trapping of LDL in artery wall, oxidation

21

most consistent morphologic feature of diabetes

diffuse thickening of BM

most evident in capillaries of retina and renal glomeruli

22

despite increase in thickness of BM, diabetic capillaries are _______ than normal to plasma prtns

more leaky

23

microangiopathy underlies the development of ...

diabetic nephropathy
diabetic retinopathy
some forms of neuropathy

24

thick, narrow, and leaky SMALL blood vessels

diabetic microangiopathy- especially in kidneys and eyes

due to glycosylation
BM damage leak
AGE deposition

25

how would you describe peripheral neuropathy caused by DM nerve damage?

symmetric , bilateral
progressive, irreversible
paraesthesia
pain
muscle atrophy

26

damage to blood vessels in eyes is described as

exudative and proliferative retinopathy

27

diabetic nephrosclerosis =

nodular kimmelstiel-wilson glomerulopathy

28

gram negative bacilli -->
staphylocci -->

pyelonephritis
cortical infection

29

what are some effects of visceral neuropathy?

CN - diplopia, bell palsy
GIT - constipation, diarrhea
CVS- orthostatic hypotension

30

diabetic macroangiopathy =

accelerated atherosclerosis

(due to nonenzymatic glycosylation of lipoprtns)

31

ischemia due to microangiopathy and atherosceleroiss serves as a stimulus for neovascular proliferation

diabetic retinopathy

32

3 changes in retina with diabetic retinopathy

edema
hemorrhagic foci
neovascularization

33

no insulinitis
yes amyoid

type 2 DM

34

more concordance in twins

type 2 DM

35

2 pancreatic neuroendocrine tumors NETs

-insulinoma
- zollinger-ellison syndrome
- wermer syndrome

36

hyperinsulinism NET

insulinoma

most common pancreatic NET

37

hypergastrinemia NET

zollinger-ellison syndrome

38

MEN1 syndrome NET

wermer syndrome

39

****Whipple triad of hypoglycemia

- blood glucose less than 45 mg/dL
- CNS confusion/stupor
- precipitated by fasting or exercise and relieved by food

40

describe insulinomas

- benign
-solitary
-small
- encapsulated
- "giant islets"
- amyloid can be found
- 10% carcinomas

41

multiple peptic ulcerations in stomach, duodenum and even jejunum --->

suspect zollinger-ellison syndrome

result of elevated gastric acid secretion caused by a gastrinoma

42

risks of zollinger-ellison syndrome

- 1/2 metastasized at time of diagnosis
- 25% associated with other endocrine tumors (MEN1 syndrome)