Chapter 17: Diseases of Pancreas

Question 1

What are the levels of glucose controlled by?

Answer 1

the opposing effects of insulin and glucagon

Question 2

High blood glucose levels cause increased pancreatic secretion of what?

Answer 2

insulin

Question 3

Low blood glucose levels cause increased pancreatic secretion of what?

Answer 3

Glucagon

Question 4

Glucagon stimulates what?

Answer 4

the liver to convert stored glycogen to glucose

Question 5

Which pancreatic islet of Langerhans produces what?

Answer 5

○ Beta cells: Insulin
○ Alpha cells: Glucagon

Question 6

When does pancreatic enzymes digestion occur?

Answer 6

duodenum

Question 7

Acute pancreatitis

Answer 7

○ Is acute inflammation of the pancreas
○ sudden and painful
* can be a catastrophic medical emergency associated with shock and death

Question 8

Chronic pancreatitis

Answer 8

○ repeated episodes of acute pancreatitis that destroys and scars the pancreas
○ less dramatic, less painful, and less dangerous

Question 9

What conditions is associated with acute pancreatitis?

Answer 9

○ Gallstones: half of the patients with acute pancreatitis have gallstones
○ Alcoholism: 2/3 of the cases are associated
○ Unknown (idiopathic): 10% of the cases
○ Other: virus infections, high levels of calcium

Question 10

What are symptoms for people with gallstones? How is it discovered?

Answer 10

○ never had any symptoms, though larger stones may have a cramping pain in the middle to right upper abdomen (biliary colic)
○ discovered when having a routine x ray, abdominal surgery, or other medical procedure

Question 11

What are some symptoms that may occur with pancreatitis?

Answer 11

○ Pain in the right upper or middle upper abdomen, that may go away and come back
○ Fever
○ Yellowing of skin and whites of the eyes (jaundice)

Question 12

Tests used to detect gallstones or gallbladder inflammation

Answer 12

○ Abdominal ultrasound
○ Abdominal CT scan
○ (ERCP)
○ radionuclide scan
○ Endoscopic ultrasound
○ (MRCP
○ (PTCA

Question 13

Blood tests for gallstones or gallbladder inflammation

Answer 13

○ Bilirubin
○ Liver function tests (LFTs)
○ Pancreatic enzymes

Question 14

List out LFT’s (Liver function tests)

Answer 14

○ Albumin
○ Alpha-1 antitrypsin
○ ALP
○ ALT
○ AST
○ Gamma-glutamyl transpeptidase (GGT)
○ Prothrombin time
○ Serum bilirubin
○ Urine bilirubin

Question 15

Large amounts of bilirubin in the blood can lead to what?

Answer 15

○ Jaundice
○ a yellow color in the skin, mucus membranes, or eyes

Question 16

What aren’t a part of LFTs

Answer 16

amylase and lipase

Question 17

What happens to amylase and lipase during acute pancreatitis?

Answer 17

○ amylase levels rise and fall quickly after injury
○ lipase levels rise more slowly and stay elevated longer

Question 18

What is the most common cause of chronic pancreatitis?

Answer 18

alcohol abuse

Question 19

What is the least common cancer type in males and females?

Answer 19

Cancers of the pancreas

Question 20

What is often a sign of Pancreatic Carcinoma?

Answer 20

Upper abdominal pain or back pain usually is the first symptom

Question 21

if the tumor obstructs the common bile duct…

Answer 21

Painless jaundice may be the initial sign

Question 22

How many patients survive pancreatic carcinoma? For how long?

Answer 22

○ Only about 1% of patients with pancreatic carcinoma survive five years

Question 23

Beta cell tumors (insulinomas)

Answer 23

○ Usually a benign mass secreting insulin
○ Causing hypoglycemia
○ Glucose < 50mg/dl
○ Effects the ANS: Nervousness, sweating, irregular heartbeats, tremor, hunger

Question 24

Zollinger-Ellison

Answer 24

○ results from gastrinomas
○ Causing stomach and duodenum ulcer

Question 25

Diabetes Mellitus

Answer 25

○ A disorder of insulin action ○ results in high blood glucose (hyperglycemia)

Question 26

What defines Diabetes mellitus?

Answer 26

○ fasting blood glucose level 126 mg/dl or more ○ blood glucose level 200 mg/dl on any occasion

Question 27

Type 1 diabetes

Answer 27

the pancreas does not secret enough insulin

Question 28

Types-2 diabetes

Answer 28

Insulin produced is not effective

Question 29

What is Type-1 diabetes known as? What is it responsible for?

Answer 29

○ (juvenile diabetes ○ 10% of the diabetes

Question 30

What type of diabetes is responsible for the remaining 90% of cases?

Answer 30

Type-2

Question 31

Insulin deficiency that results from what?

Answer 31

autoimmune destruction of the islets by anti-islet antibodies

Question 32

Pathogenesis of Type 1 Diabetes

Answer 32

○ A lifelong disorder ○ autoimmune disorder ○ Early on islets become infiltrated with T lymphocytes ○ Runs in families, however, more so in type 2

Question 33

Pathogenesis of Type 2 Diabetes

Answer 33

○ target cell resistance to insulin ○ Majority have a parent or sibling with the disease ○ Peripheral tissue begins to resist insulin as much as 10 years before the diagnosis becomes apparent ○ Obesity is the cause of 80%

Question 34

What are short term complications of Diabetes Mellitus?

Answer 34

○ Glycosuria- blood glucose raise above renal threshold (180 mg/dl), thus glucose in urine ○ Polyuria – frequency urination ○ Polydipsia – increased water intake ○ Polyphagia – increased appetite ○ The paradox: ravenous appetite and weight loss

Question 35

Diabetic comas occur from what?

Answer 35

○ acidosis or severe dehydration ○ Acidosis occurs when insulin is lacking, with glucose unavailable, the body must burn fat for fuel

Question 36

Diabetic ketoacidosis

Answer 36

Rapid, deep breathing as lungs labor to expel acid in the form of ketones and CO2

Question 37

What does Diabetic ketoacidosis lead to?

Answer 37

○ Glycosuria – as blood glucose levels exceed the renal threshold – glucose spills into urine. ○ Acidosis – low blood pH owing to ketone buildup. ○ Ketonuria – excretion of ketones in urine. ○ Osmotic diuresis – high urine output as glucose in urine carries water with it. ○ Volume depletion – body loses water in urine

Question 38

Acute Complications of Diabetes Mellitus

Answer 38

○ Hypoglycemia ○ Diabetic ketoacidosis ○ Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) ○ Somogyi effect ○ Dawn phenomenon

Question 39

Long-term Complications of Diabetes

Answer 39

○ Accelerated atherosclerosis ○ Myocardial infarction ○ Stroke ○ Peripheral vascular insufficiency & gangrene ○ Retinal disease (retinopathy) ○ Renal insufficiency ○ Peripheral nerve disease