Pathology of the Endocrine Pancreas Flashcards Preview

Pathology > Pathology of the Endocrine Pancreas > Flashcards

Flashcards in Pathology of the Endocrine Pancreas Deck (31):
1

What is a defining features of all types of diabetes mellitus?

Hyperglycemia

2

What other major disease is diabetes mellitus associated with?

- Renal Failure
- Heart Disease
- Stroke

3

What are the requirements for a Dx of diabetes from a random glucose test?

Classical signs of diabetes mellitus - polyuria, polydypsia, unexplained weight loss with a random glucose level greater than 200 mg/dL

4

What are the requirements for a Dx of diabetes from a fasting glucose test?

Fasting glucose greater than or equal to 126 mg/dL

5

What level of HbA1C is Dx for DM?

HbA1C greater than or equal to 6.5

6

DM Type I

Autoimmune and is due to pancreatic beta cell destruction that leads to insulin deficiency

7

What is the pathogenesis of DM Type I?

– Failure of self‐tolerance in T‐cells
– Activated T‐cells cause ‐cell injury
• CD8 CTLs directly injure  cells
• TH1 cell injury via cytokines

8

What can trigger DM Type I onset?

Stressing factors such as illness can turn someone on the verge to having full DM.

9

What will be seen in the islets for a patient with DM Type I?

Lymphocytes

10

DM Type II

Peripheral Insulin RESISTANCE - the beta cells are initially in tact and crank up insulin production due to the decreased peripheral response, but over time, the increased production wears the beta cells out.

11

What is the function of adiponectin?

Adiponectin sensitizes tissues to insulin

12

What are the function of adipokines?

Adipokines cause insulin resistance

13

How do FFAs affect insulin?

They increase insulin resistance

14

What will be seen in the islets in DM Type II?

Amyloid deposition of the protein amylin

15

Nonketotic Hyperosmolar Coma

Seen rarely with extreme hyperglycemia (greater than 600) more often in nursing home patients

16

What is the age of patients in Type I VS II DM?

Type I - young children or adolescents
Type II - adults

17

What happens to DM Type I patients in the absence of insulin therapy?

Diabetic Ketoacidosis

18

Nonenzymatic Glycosylation (AKA Glycation)

Glucose covalently attaches to multiple proteins nonenzymatically like cellular basement membrane proteins in the ocular lens

19

Over time labile products of glycaion undergo complex chemical rearrangements to form _________________.

Advanced Glycosylation End-Products (AGEs)

20

What happens due to non enzymatic glycosylation to the vasculature?

- Deposition of extracellular matrix
- Increase vascular stiffness
- Increase vascular permeability

21

What are the effects of hyperglycemia on PKC?

Intracellular hyperglycemia results in activation of Protein Kinase C which causes:
• Production of VEGF
• Decreased expression of endothelial nitric oxide
synthase
• Production of profibrinogenic factors(TGF‐beta)

22

What is the effect of increased intracellular glucose?

Excess glucose metabolized by aldose reductase to sortibol via NADPH co‐factor which depletes NADPH, an antioxidant and can also mediate cell damage via sorbitol.

23

Diabetic Retinopathy

Microvascular changes lead to increased production of VEGF and retinal angiogenesis with retinopathy caused by new vessel formation on disc, retina, and elsewhere

24

Insulinoma

Arise in beta cells and most are benign and solitary

25

What is Whipple's triad for insulinomas?

- Hypoglycemia (less than 50)
- CNS symptoms
- Symptoms resolve with feeding or glucose

26

What are the lab findings for insulinoma?

- Hypoglycemia
- High circulating levels of insulin
- High insulin:glucose ratio

27

Gastrinoma

Gastrin producing cells found in pancreas, duodenum, and in peripancreatic tissue

28

Zollinger‐Ellison Syndrome

Hypergastrinemia causes gastric acid secretion and peptic ulceration often in unusual places like the jejunum

29

Alpha‐cell tumors presenting with diabetes, a skin rash, often middle aged and older women, anemia, high glucagon levels.

Glucagonoma

30

Diabetes and malabsorption associated with d‐cell tumors, very hard to localize pre-op.

Somatostatinoma

31

Severe secretory diarrhea‐‐‐can be associated with neural crest tumors

VIPoma

Decks in Pathology Class (203):