endocrine Flashcards
pancreas structure and function
Has both endocrine and exocrine functions
Endocrine: secretes hormones such as insulin, glucagon, somatostatin and pancreatic polypeptide
Exocrine: acinar cells secret enzymes and networks of ducts that secret alkaline fluids important for digestive functions
exocrine digestive functions
Aqueous secretions contain potassium, sodium, bicarbonate and chloride
Alkaline pancreatic juice neutralizes the acidic chime that enters the duodenum from the stomach and provides the medium for actions of digestive enzymes and intestinal absorption of fat.
Pancreatic enzymes hydrolyze proteins (proteases), carbohydrates (amylases), and fats (lipases)
Secretion of pancreatic juice is controlled by hormonal and vagal stimuli
Secretin stimulates the acinar and duct cells to secrete the bicarbonate rich fluid that neutralizes chime and prepares for digestion
Enzymatic secretion follows and stimulated by cholecystokinin and acetylcholine
acute pancreatitis risk factors
Risk factors include: obstructive biliary tract disease (particularly cholelithiasis), alcoholism, obesity, peptic ulcers, trauma, hyperlipidemia, hypercalcemia, smoking, certain drugs and genetic factors
acute pancreatitis patho
Usually mild but can lead to necrotizing or hemorrhagic
Develops due to an obstruction of the outflow of pancreatic digestive enzymes caused by bile and pancreatic duct obstruction (i.e.: gallstones)
Leads to autodigestion of pancreatic cells vascular damage, coagulation necrosis, fat necrosis and edema
ETOH acinar cell metabolizes ethanol with toxic metabolites which in turn injure pancreatic acinar cells, causing a release of activated enzymes
Chronic ETOH use causes formation of protein plugs in pancreatic ducts and spasm of the sphincter of Oddi, resulting in obstruction release of activated enzymes, inflammation and pancreatitis
Severe acute pancreatitis, proinflammatory cytokines activate leukocytes, cause injury the vessel walls and abnormal coagulation in the lungs and kidneys paralytic ileus and GIB can occur bacteria in the bloodstream may cause peritonitis or sepsis vasoactive peptides cause vasodilation, hypotension, and shock ARDS, renal failure and Systemic inflammatory Response syndrome (SIRS) EMERGENCY!
acute pancreatitis clinical manifestations
Mid-epigastric or LUQ pain, nausea and vomiting (paralytic ileus), jaundice, fever and leukocytosis, abdominal distention, hypovolemia, hypotension, tachycardia, myocardial insufficiency and shock.
Severe acute pancreatitis tachypnea and hypoxemia due to pulmonary edema, atelectasis or pleural effusions, hypovolemia, renal failure (ATN), tetany due to hypocalemia, transient hyperglycemia, multi-system organ failure
nursing assessment of acute pancreatitis
I-PAP
GI Assessment: bowel sounds, distention, nausea and vomiting, guarding
Respiratory
Cardiovascular
Renal
Hyperlipidemia, hyperglycemia, hypocalcemia
Lab Values: Lipase and Amylase (may be 3x normal), WBC, Bilirubin, Sodium, Potassium, Creatinine, BUN, Lipids (TC, TG, HDL, LDL), Calcium, Troponin, ABG’s
diagnosing prediabetes
Prediabetes is the presence of an impaired fasting glucose and/or impaired glucose tolerance on two separate testing occasions
types of diabetes
Type 1
Type 2
Other
Gestational
type 1 diabetes
encompasses diabetes that is primarily a result of pancreatic beta cell destruction with consequent insulin deficiency, which is prone to ketoacidosis. This form includes cases due to an autoimmune process and those for which the etiology of beta cell destruction is unknown.
∗ Includes latent autoimmune diabetes in adults (LADA); the term used to describe the small number of people with apparent type 2 diabetes who appear to have immune-mediated loss of pancreatic beta cells
type 2 diabetes
may range from predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance. Ketosis is not as common.
gestational diabetes
refers to glucose intolerance with onset or first recognition during pregnancy.
other diabetes
specific types include a wide variety of relatively uncommon conditions, primarily specific genetically defined forms of diabetes or diabetes associated with other diseases or drug use (see Appendix 2. Etiologic Classification of Diabetes Mellitus).
type 1 vs type 2 diabetes
type 1
Pancreas does not produce any insulin
Complete loss of beta cell function
Unknown etiology but may be autoimmune or idiopathic
Requires exogenous insulin
Occurs in 10% of population
type 2
Pancreas does not produce enough insulin or insulin resistance
Usually diagnosed as an adult but more children are being diagnosed
Progressive loss of beta cell function as the patient gets older
Occurs in 90% of population
other types of diabetes vs gestational
other
Genetic defects of beta-cell function
Genetic defects in insulin action
Diseases of exocrine pancreas
Endocrinopathies
Drug-or-chemical-induced beta cell dysfunction
Infections
Uncommon forms of immune-mediated DM
Other genetic syndromes associated with DM
gestational
Insulin resistance combined with inadequate insulin secretion in relation to hyperglycemia
Women who are obese, older than 25 yrs old, family hx of DM, history of previous GDM, or of certain ethnic groups (Hispanic, First Nations, Asian, or African American) increased risk of developing GDM
Metabolic stress of pregnancy may uncover tendency for T2DM
etiology of type 1 diabetes
10% of patients with diabetes Diagnosed in childhood, adolescence, early adulthood absolute lack of insulin Autoimmune genetic(HLA) plus environmental trigger autoimmune response - destruction of cells years / seasonal Idiopathic cell destruction without markers
