pancreatic Disorders

Question 1

The pancreas exocrine function

Answer 1

consist of glands which produce pancreatic juice

duct system carries pancreatic juice to small intestine

Question 2

the pancreas endocrine function

Answer 2

islets of langherans - pancreatic islets where hormones are produced

Question 3

Glucagon

Answer 3

secreted by Alpha cells, acts to raise blood glucose levels
Stimulates liver to release glucose stores from glycogen and other storage sites
Stimulates glucogenogensis by breaking down fats and fatty acids

Question 4

Insulin

Answer 4

secreted by B cells 
acts to lower blood glucose levels
increases glucose transportation into cells
increases glucose metabolism by cells 
increases liver glycogen stores

Question 5

Somatostatin

Answer 5

produced by the delta cells
regulates cells of the pancreatic islet
inhibits the secretion of insulin and glucagon
also inhibits the release of GH from the pituitary gland

Question 6

Carbs

Answer 6

converted to simple sugar molecules for cellular metabolism
excess CHO are stored in the liver and muscle as glycogen, available for short term energy needs
additional CHO is converted to fat for intermediate and long term energy needs

Question 7

Fats

Answer 7

When no insulin is available to enable glucose transport into cells, fatty acids stored in the liver can be broken down for energy - this leads to the production of acetate and ketone bodies

Question 8

Protein

Answer 8

in the absence of insulin, muscle protein breakdown occurs
circulating amino acids are then directly used for energy
loss of protein leads to muscle wasting and organ dysfunction

Question 9

Type 1 Diabetes

Answer 9

characterised by a deficiency in insulin secretion resulting in hyperglycaemia
disorder of CHO, fat and protein metabolism

Question 10

T1D caused by

Answer 10

destruction of B cellsin the pancreas
autoimmune mediated
combination of hereditary factors, environmental factors and precipitating events

Question 11

signs and symptoms of T1DM

Answer 11

develop quickly in the absence of insulin
polyuria, polydispia (increased thirst), dry mouth, lethargy, polyphagia (increased hunger), rapid weight loss, diabetic ketoacidosis

Question 12

type 2 diabetes

Answer 12

characterised by hyperglycaemia, lack of insulin secretion and/or insulin resistance
insufficient insulin secretion from B cells in pancreas leading to lower levels of circulating insulin and hyperglycaemia
insulin resistance on cells in muscles, liver and fat tissue

Question 13

causes of T2DM

Answer 13

obesity, lack of exercise, genetic component, medications including glucocorticoids, thiazines, beta blockers, previous gestational diabetes, testosterone deficiency

Question 14

Signs and symptoms of T2DM

Answer 14

polyuria
polydipsia
polyphagia
weight loss
blurred vision
peripheral neuropathy 
fatigue
recurrent infection

Question 15

treatment of T2DM

Answer 15

focus on lifestyl intervention 
manage concurrent health concerns such as HT and hyperlipidaemia 
dietary changes and increase exercise
oral anti-diabetic agents 
weight loss surgery

Question 16

Gestational Diabetes

Answer 16

high blood glucose levels during pregnancy in women who have nil Phx of diabetes

Question 17

cause of gestational diabetes

Answer 17

likely due to pregnancy related factors which decreases insulin resistance

Question 18

risk factors for gestational diabetes

Answer 18

polycystic ovary syndrome, previous gestational diabetes, family Hx, increased maternal age, obesity, ethnicity, maternal smoking

Question 19

complications of gestational diabetes

Answer 19

growth abnormalities of the foetus
difficulties with delivery
neonatal hypoglycaemia
resp distress syndrome of the neonate
pre-eclampsia

Question 20

treatment of gestational diabetes

Answer 20

dietary change and exercise

anti-diabetic drug therapy

Question 21

Acute complications hypoglycaemia

Answer 21

reduction of BGL

Question 22

causes of hypoglycaemia

Answer 22

admin of too much insulin, increased activity level, decreased food intake, lcohol intake in diabetic pts, illness/infection

Question 23

signs and symptoms of hypoglycaemia

Answer 23

shaking, tachycardia, palpitations, diaphoresis, pallor, headache, hunger, impaired judgement, confusion, irritability, parasthesia, slurred speech, fatigue, ataxia, seizures, coma

Question 24

treatment of hypoglycaemia

Answer 24

conscious pts: oral admin of 15g CHO

unconscious: IV dextrose, IM glucagon injection

Question 25

Acute complications diabetic ketoacidosis

Answer 25

precipitated by a shortage of insluin counter-regulatory hormones such as glucagon and adrenaline are released causes acidosis

Question 26

signs and symptoms of ketoacidosis

Answer 26

n + v, dehydration, tachycardia, hT, polydipsia, polyuria, abdo pain, hyperglycaemia, confusion, lethargy, increased resps, ketotic odour on breath, cerebral odema

Question 27

treatment of ketoacidosis

Answer 27

fluid replacement therapy insulin bolus and infusion potassium infusion IV mannitol and hypertonic saline

Question 28

hyperosmolar hyperglycaemic state

Answer 28

hyperglycaemic state resulting in osmotic diuresis, but in the absence of ketone bodies usually occurs in T2DM pts who will secrete enough insulin to mitigate the formation of ketone bodies

Question 29

signs and symptoms of hyperosmolar hyperglycaemia state

Answer 29

``` hyperglyaemia polyuria dehydration minimal - no ketone bodies present sensory and motor impairment hyperviscosity of blood seizure coma death ```

Question 30

treatment of hyperosmolar hyperglycaemic state

Answer 30

IV fluid admin electrolyte replacement insulin infusion to obtain normoglycaemia

Question 31

Chronic complications

Answer 31

hyperglycaemia leads to damage of blood vessels

Question 32

Diabetic retinopathy

Answer 32

damage to the retina with prolonged hyperglycaemia or poorly controlled BGLs in the diabetic pt can lead to blindness

Question 33

diabetic neuropathy

Answer 33

nerve damage secondary to poorly controlled diabetes thought to be a result of poor vascular supply to nerve endings can affect all peripheral nerves

Question 34

signs and symptoms of diabetic neuropathy

Answer 34

``` parasthesia dizziness muscle weakness dysphagia nerve pain sexual dysfunction speech impairment ```

Question 35

Diabetic nephropathy

Answer 35

progressive renal impairment caused by damage to the blood vessels in the glomeruli results in diffuse scarring of the glomeruli

Question 36

late signs of nephropathy

Answer 36

tiredness, headache, nausea and vomiting, frequent urination, lower limb oedema

Question 37

diabetic cardiomyopathy

Answer 37

ventricular dilation, enlargement of heart cells, decreased systolic function and interstitial fibrosis

Question 38

causes of diabetic cardiomyopathy

Answer 38

vascular disease neuropathy metabolic alteration and alterations in ion homeostasis