Pancreas Path

Question 1

what are the 4 main types of cells found in th eislets of langerhans

Answer 1

beta, alpha, delta and pancreatic polypeptide cells

Question 2

what cells produce insulin

Answer 2

beta cells in the iselts of langerhan

Question 3

what cells secrete glucagon

Answer 3

alpha cells

Question 4

role of glucagon

Answer 4

to stimulate glycogenolysis and increase blood suga

Question 5

what cells secrete somatostatin

Answer 5

delta

Question 6

role of somatostatin

Answer 6

suppresses insulin and glucagon release

Question 7

What is role of pancreatic polypeptide

Answer 7

stimulates secretion of gastric and intestinal enzymes and inhibits intestinal motility

Question 8

what are the 2 rare cell types in the islets of langerhans

Answer 8

D1 cells and enterochromaffin cells

Question 9

What do D1 cells do

Answer 9

elaborate vasoactive intestinal polypeptide that induces glycogenolysis and hyperglycemia
also stimulates GI fluid secretion and causes secretory diarrhea

Question 10

Enterochromaffin cells do what

Answer 10

synthesize serotonin and are source of pancreatic tumors that cause the carcinoid syndrome

Question 11

halo around cell on electron microscopy indicates what

Answer 11

beta cells in islets of langerhans

Question 12

leading cause of end stage renal disease in US

Answer 12

DM

Question 13

what is the normal range for blood glucose

Answer 13

70-120mg/dL

Question 14

what is Dx of DM based on fasting plasma glucose? based on random plasma glucose?

Answer 14

fasting- >126 mg/dL

random- >200 mg/dL

Question 15

during an oral glucose tolerance test with loading of 75 gm what is Dx of DM

Answer 15

2 hour plasma glucose >200 mg/dL

Question 16

what is normal limit for glycated HbA1c

Answer 16

6.5%

Question 17

what are the plasma glucose levels for prediabetes

Answer 17

fasting between 100 and 125
2 hour plasma glucose 140 and 199
glycated Hb between 5.7 and 6.4

Question 18

what is DM I

Answer 18

autoimmune
destruction pancreatic beta cells
absolute deficiency of insulin

Question 19

what is DM II

Answer 19

combination of peripheral R to insulin action and inadequate secretory response by beta cells

Question 20

weight differences of DM I and DM II patients

Answer 20

DM I weight loss preceding Dx,

DM II obese

Question 21

what islet Ab circulate in DM I

Answer 21

anti insulin, anti-GAD and anti-ICA512

Question 22

without Tx what can occur in DM I

Answer 22

diabetic ketoacidosis in absence of insulin

Question 23

without Tx what can occur in DM II

Answer 23

nonketotic hyperosmolar coma

Question 24

which DM more likely to have insulitis? beta cell depletion? amyloid deposition?

Answer 24

DM I- insulitis and beta cell depletion

DM II- amyloid

Question 25

what immune cell has the problem in DM I

Answer 25

T cells

Question 26

why are the insulin requirements minimal in first 1-2 years of DM I

Answer 26

ongoing endogenous insulin secretion | "honeymoon period"

Question 27

what are some cc before Dx DM II

Answer 27

unexplained fatigue, dizziness, blurred vision

Question 28

classic triad DM I

Answer 28

polyuria, polydipsia, polyphagia

Question 29

morbidity of longterm DM is due to

Answer 29

diabetic macro and microvascular disease from chronic hyperglycemia

Question 30

macrovascular disease in DM increases risk for

Answer 30

MI, stroke, lower extremity ischemia

Question 31

microvascular disease is seen where in DM

Answer 31

diabetic retinopathy, nephropathy, neuropathy

Question 32

reduction in nu,ber and size of islets

Answer 32

DM I

Question 33

leukocytic infiltration of iselts

Answer 33

DM I

Question 34

amyloid in islets

Answer 34

DM II

Question 35

increas in number and size of islets

Answer 35

nondiabetic newborns of DM mothers

Question 36

most common cause death in DM

Answer 36

MI from atherosclerosis

Question 37

what occurs in kidneys in DM

Answer 37

renal hyaline arteriosclerosis

Question 38

what is included in diabetic nephropathy

Answer 38

glomerular lesions(nodular sclerosis), renal vascular lesions, pyelonephritis and necrotizing papillae

Question 39

what occurs to BM of glomeruli in DM

Answer 39

thickening because very leaky

Question 40

what type of neuropathy occurs in DM

Answer 40

distal extremities, motor and sensory

Question 41

what type of genetic abnormalities occur with DM

Answer 41

defects in beta cell dysfunction and also abnormalities of the insulin R signaling

Question 42

what 4 pathways are assoc with long term complications of DM

Answer 42

advanced glycation end products activation PKC increase in oxidative stress overload of hexosamine pathway

Question 43

term for pancreatic islet cell tumor

Answer 43

pancreatic neuroendocrine tumor

Question 44

criteria for malignancy of pancreatic neuroendocrin tumor

Answer 44

mets, vascular invasion, local infiltration

Question 45

90% insulin producing tumors are malignant or benign

Answer 45

benign

Question 46

3 most common functional syndromes assoc with pancreatic neuroendocrine tumor

Answer 46

hyperinsulinism hypergastrinemia (zollinger ellison) MEN multiple endocrine neoplasia

Question 47

insulinomas present how

Answer 47

hypoglycemic episodes when blood glucose is below 50 mg/dL | confusion, stupor, loss of consciousness

Question 48

if a tumor is around the pancreas, not in it. is it morelikley ot be benign or malignant

Answer 48

malignant

Question 49

deposition of amyloid is characteristic of what pancreatic endocrine tumor

Answer 49

insulinoma

Question 50

lab finding for insulinoma

Answer 50

high circulating insulin and high insulin:glucose ratio

Question 51

Tx insulinoma

Answer 51

removal tumor

Question 52

where do gastrinomas arise

Answer 52

duodenum and peripancreatic soft tissues

Question 53

intractable jejunal ulcer found

Answer 53

zollinger ellison

Question 54

are gastrin producing tumors locally invasive

Answer 54

yes | many have mets by time of Dx

Question 55

presenting Sx in gastrinomas

Answer 55

diarrhea

Question 56

Tx zolinger ellison

Answer 56

H K pump inhibitors and excision of neoplasm

Question 57

what can cause mild DM with migratory erythema rash and anemia

Answer 57

alpha cell tumors (glucagonomas)

Question 58

whats req for Dx delta cell tumor (somatostainomas)

Answer 58

high levels of somatostatin

Question 59

Sx VIPoma

Answer 59

watery diarrhea, hypokalemia, achlorhydria or WDHA syndrome