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Summer 2020 - Physiology 2 - Endocrine > Pancreas - Quiz 4 > Flashcards

Pancreas - Quiz 4 Flashcards

(56 cards)

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1
Q

Where is the Pancreas located?

A

Back of Abdomen behind the Stomach

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2
Q

What are the two main hormones that the Pancreas secrete?

A

Insulin & Glucagon - opposite functions

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3
Q

How does the body raise its blood sugar?

A

Low blood sugar –> Pancreas secretes Glucagon –> Converts Glycogen to Glucose in the Liver –> Releases Glucose into Blood

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4
Q

How does the body lower its blood sugar?

A

High blood sugar –> Pancreas secretes Insulin –> Converts Glucose to Glycogen in Liver & Stimulates Glucose uptake

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5
Q

What cell type makes of the majority of the Pancreas

A

Acini - exocrine function - secretes digestive juices into duodenum

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6
Q

Which cells make up the Islet of Langerhans of the Pancreas?

A
  • Alpha Cells - Glucagon
  • Beta Cells - Insulin
  • Delta Cells - Somatostatin
  • Pancreatic Polypeptide Cells
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7
Q

What does Insulin do to Carbs & Amino Acids?

A

Store Carbs as Glycogen in Muscle & Liver

Excess Carbs converted to Fats & stored in Adipose

Promotes uptake of Amino Acids & converts to Protein

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8
Q

What stimulates Insulin secretion?

A

High Blood Glucose

Amino Acids

Beta-Keto Acids

Glucagon

Acetylcholine

Intestinal Hormones

Beta Agonists

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9
Q

What inhibits Insulin Secretion?

A

Low Blood Glucose

Fasting

Glucagon

Cortisol

Catecholamines

Growth Hormone

Somatostatin

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10
Q

What is the Half Life of Insulin

A

Unbound - 6 to 7 minutes

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11
Q

Which enzyme degrades unused Insulin?

A

Insulinase

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12
Q

How do Neurons, Muscle, and Adipose cells react to Insulin?

A

Muscle & Adipose - Glucose uptake via Endocytosis

Neurons - Permeable to glucose

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13
Q

At what blood sugar does Insulin start to release?

A

100 mg/dL w/ max response at 400-600 mg/dL

Plasma insulin levels can increase by 10x after a meal

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14
Q

What are the Anabolic effects of Insulin?

A

↑Glycogenesis

Inhibits Glycogenolysis

Inhibits Gluconeogenesis

Traps Glucose for Later Use

↑Protein Synthesis

↑Liver Uptake, Storage, and Use of Glucose

↑Lipogenesis

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15
Q

Insulin facilitates entry of glucose into cells of all tissue EXCEPT which?

A

Brain

Kidney Tubules

RBCs

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16
Q

How does Insulin effect fatty acid when fed vs fasting?

A

Fed: Insulin suppresses fatty acid mobilization (glucose already available)

Fasting: Insulin releases free fatty acid into circulation for fuel

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17
Q

What are produced when Insulin Levels are Low during Fasting?

A

Ketone Bodies

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18
Q

What are Glucagon’s Catabolic Effects?

A

Activates enzymes for Glycogenolysis

↑Gluconeogenesis

↑Lipolysis & Ketogenesis

↑Proteolysis & Flow of Amino acids from Muscle to Liver for Gluconeogenesis

↑Heart Strength & Blood Flow

↑Bile Secretion

Inhibits Gastric Acid Secretion

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19
Q

What stimulates the release of Glucagon?

A

Fasting Hypoglycemia

Amino Acids

Beta-Adrenergic Stimulation

Exercise

Cholecystokinin

Gastrin

Cortisol

Surgery

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20
Q

What Inhibits Glucagon release?

A

High Glucose

Somatostatin

Free Fatty Acids

Ketones

Insulin

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21
Q

What is Diabetes Mellitus?

A

Syndrome of impaired Carb, Fat, and Protein metabolism

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22
Q

What is the difference between Type I & Type II Diabetes?

A

Type I
Lack of Insulin Secretion
Effects Any Age, Thin bodied, and DKA is often

Type II
Decreased Insulin Sensitivity or Insulin Resistance
Effects Obese Adults, More Prevalent, and DKA is rare

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23
Q

What would you expect when over 180mg/dL of Glucose is reabsorbed by the Kidney?

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A

Osmotic Diuresis

Loss of Na, K, & Glucose in Urine

Hypovolemia, Hypotension & Dehydration

Polyuria

Polydipsia & Polyphagia

24
Q

What are the Acute Symptoms of Diabetes?

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A

Polyuria

Polydipsia

Polyphagia

Irritability

Confusion

Impaired Vision

25
What are Chronic symptoms of Diabetes?
Infection Non-Alcoholic Fatty Liver Disease Macrovascular Disease (CAD, PAD, AMI, CHF, CVA) Microvascular Disease (Nephropathy, Retinopathy, Neuropathy)
26
What is the cause of Type I Diabetes?
Destruction of Beta Islet Cells d/t Viral Infections or Autoimmune Disorders
27
Plasma Insulin Levels are normally ______ in Type II Diabetes
Plasma Insulin Levels are normally **elevated** in Type II Diabetes**, but still not enough for glucose regulation**
28
What are the 4 ways to Diagnose Diabetes?
* A1c \> 6.5% * Fasting Glucose \> 126 mg/dL * Oral Glucose Tolerance after 2 hrs \> 200 mg/dL * Random Glucose \> 200 mg/dL w/ hyperglycemia symptoms
29
What does a Hgb A1c reflect?
Average Blood Sugar over 3 Months Normal: 4 - 5.6%
30
How does Glucose Control help during the Perioperative Period?
Insulin inhibits inflammatory growth factors relating to MI Insulin Improves Cardiac Contractility Better Patient Outcomes
31
How should Diabetic Meds be managed PeriOperatively?
Hold oral meds day of surgery Continue Basal Insulin for Type I Diabetics Continue Insulin Pump or Change to IV Insulin
32
What is the Target A1c in regards to taking Oral Hypoglycemics?
A1c \< 8%
33
What is the First Line Oral Medication for Diabetes?
Biguanides - Metformin ↓Liver Glucose Production ↑Insulin Uptake
34
What are the side effects of Metformin (Glucophage)?
Lacic Acidosis, especially for Liver/Kidney/CHF patients
35
What Diabetic medication Increases Insulin Secretion?
**Sulfonylureas -** Glimepiride (Amaryl) Glipizide (Glucotrol) Glyburide (Diabeta) **Meglitinides** Repaglinide (Prandin) **_Both classes carry Hypoglycemia risks_**
36
What do Thiazolidinediones do?
**Decrease Liver Glucose Production & Insulin Resistance** Drugs ending in "-tazone" Pioglitazone (Actos)
37
How is a patient's Insulin Regimen managed PeriOperatively?
Give 1/2 dose of Long Acting & Hold Short Acting on day of surgery
38
What can be added to Insulin to prolong their effects?
Protamine Careful when giving it to reverse Heparin
39
What are the Rapid Acting Insulins?
Aspart (Novolog) Lispro (Humalog) Glulisine (Apidra) Regular (Humulin/Novalin R)
40
What is the Onset, Peak, and Duration of Regular Insulin?
Onset: 30-60 min Peak: 2-4 hrs Duration: 6-8 hrs All other Rapids are 15 min, 1 hr, and 3-4 hrs respectively
41
Which Insulin type is Intermediate-Acting?
NPH Onset: 1-3 hrs Peak: 6-8 hrs Duration: 12-16 hrs
42
What are the Long Acting Insulins?
Detemir (Levemir) Glargine (Lantus) Onset: 1 hr and lasts from 6 - 34 hrs
43
What is the pathophysiology of DKA?
Dehydration Acidosis Electrolyte Depletion, especially Potassium Accelerated Protein Breakdown ↑Fatty Acids
44
What are symptoms of DKA?
N/V Polyuria Polyphagia Anorexia Kussmaul Breathing Acetone Halitosis
45
What is a patient DKA's level of consciousness related to?
Osmolality, NOT Acidosis
46
How is DKA treated?
Lots of Fluids Replace Lytes Insulin
47
What is Nonketotic Hyperosmolar State?
Same as DKA, but with really high blood sugar, no ketoacidosis, and higher motality
48
What are the symptoms of Nonketotic Hyperosmolar State?
Clots d/t Thick Blood Neuro Signs Confusion Seizure Coma
49
How is Nonketotic Hyperosmolar State treated?
Aggressive Fluids, then add sugar at BG of 250 Replace Kphos & Insulin if needed
50
What is the body's early response to Hypoglycemia?
Liver Glycogen Breakdown
51
What is the body's Late response to Hypoglycemia?
Sympathetic Stimulation & Epi Release
52
What is the body's Very Late response to Hypoglycemia?
Growth Hormone & Cortisol Secretion
53
What is Insulinoma?
Beta Cell Adenoma Causes Insulin Shock = coma w/ BG \< 20 mg/dL Treat w/ Glucagon & Epinephrine
54
At what Blood Glucose level will Hypoglycemic Shock happen?
20 - 50 mg/dL Fainting, Seizure, Coma
55
How is Hypoglycemic Shock treated?
D50 + D5 Infusion
56
What happens to the brain if the sugar is low?
Brain will use up all the sugar, then fats/ketones, eventually leading to brain death and apoptosis

Summer 2020 - Physiology 2 - Endocrine (5 decks)

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