Pathology of the Pancreas Flashcards Preview

Endo II > Pathology of the Pancreas > Flashcards

Flashcards in Pathology of the Pancreas Deck (67):
1

acinar cells

exocrine pancreas

2

cell types in islets of langerhans

alpha
beta
delta
PP

3

insulin production

beta cells

4

glucagon production

alpha cells

5

somatostatin production

delta cells

6

pancreatic polypeptide production

PP cells

7

insulin

reduce blood sugar levels

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glucagon

increase blood sugar levels

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somatostatin

suppress insulin and glucagon release

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pancreatic polypeptide

GI effects
-stimulates secretion of gastric and intestinal enzymes and inhibition of intestinal motility

11

D1 cells

in pancreas

elaborate vasoactive intestinal polypeptide

12

enterochromaffin cells

in pancreas

induce glycogenolysis and hyperglycemia

synthesize serotonin

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carcinoid syndrome

pancreatic tumor - of enterochromaffin cells

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predominant cell type in pancreas islet

beta cells - insulin

15

leading cause of ESRD, blindness, and amputations

diabetes mellitus

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normal blood glucose

70-120 mg/dL

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diagnosis of diabetes

fasting plasma glucose >126

random plasma glucose >200

2 hour plasma glucose >200 after oral glucose tolerance test

HbA1C level > 6.5%

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pre-diabetes

fasting plasma glucose 100-125

2 hour plasma glucose 140-199 after oral glucose tolerance test

HbA1C 5.7-6.4%

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DM I

autoimmune

beta cell destruction

insulin deficiency

patient younger than 20

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DM II

peripheral resistance to insulin action and inadequate secretory response

majority of DM patients** 95%

older and obese**

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increasing rate of obesity

more DM II in children an adolescents

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nonketotic hyperosmolar coma

DM II

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ketotic episodes

DM I

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islet autoantibodies

anti-insulin
anti-GAD
anti-ICA512

DM I

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GLA linkage

DM I

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insulitis

inflammatory infiltrate of T cells and macrophages

beta cell depletion

islet atrophy

in DM I**

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amyloid deposition in islets

DM II - chronic inflammation

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lymphocytes in islets

DM I

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honeymoon period

destruction beta cells during asymptomatic period

don't notice until 90% destroyed

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unexplained fatigue, dizziness, blurred vision in obese patient

DM II

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most frequent diagnosis of DM II

routine blood testing in asymptomatic person

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polyuria, polyphagia, polydipsia

3 Ps of diabetes

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metabolic derangement in diabetes

ketoacidosis
hyperglycemia > polyuria

volume depletion

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diabetic coma

volume depletion and ketoacidosis

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vascular disease in diabetes

macrovascular - MI, stroke, lower extremity ischemia

microvascular - diabetic retinopathy, nephropathy, neuropathy

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atherogenic profile

in hypothyroidism

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increased number and size of islets in pancreas

nondiabetic newborns of diabetic mothers

islet hyperplasia - response to maternal hyperglycemia

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amyloid

extracellular

in DM II

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most common cause of death in diabetes

myocardial infarction

atherosclerosis of coronary arteries

40

hyaline arteriosclerosis

in glomerulus
-diabetic microangiopathy

41

35yo obese male, BUN/Cr elevation

most likely DM II

42

diabetic nephropathy

glomerulosclerosis

arteriosclerosis of renal vasculature

pyelonephritis

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glomerular BM in diabetes

normal 200-300nm

diabetic 600nm

late stage 1200nm

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cataract

diabetes - hyperglycemia - opacification of lens

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chronic diabetes clinical

MI, renal vascular insufficiency, CVAs

diabetic nephropathy

visual impairment

distal symmetric polyneuropathy

enhanced susceptibility to infections

46

pancreatic neuroendocrine tumor

PanNETs

islet cell tumor

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most common islet cell tumor

beta cell
-insulinoma

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insulinoma prognosis

90% benign

49

second most common pancreatic tumor

zollinger ellison syndrome
-gastrinoma

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nonfunctional islet cell tumor

more likely malignant

51

functional pancreatic endocrine neoplasms

hyperinsulinism
hypergastrinemia (ZES)
MEN - multiple endocrine neoplasia

52

hypoglycemia episodes, confusion, stupor, loss of consciousness

precipitated by fasting or exercise and relieved by feeding

with insulinoma

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tumor in pancreas

insulinoma

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tumor around pancreas

malignant - gastrinoma

55

45yo M exercises and faints, blood sugar low

insulinoma

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amyloid

seen in insulinomas

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insulinoma lab findings

high levels of insulin

high insulin:glucose ratio

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diarrhea, stomach pain, H2 blockers don't get better, and multiple ulcers

ZES - gastrinoma

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most common ulcer in ZES

duodenum

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single gastrinoma

sporadic

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multifocal gastrinomas

familial - MEN-1

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jejunal ulcer

think ZES

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tx of ZES

H/K ATPase inhibitors and excision of neoplasm (whipple procedure)

64

alpha cell tumor

glucagonoma

increased serum glucagon

65

somatostatinomas

delta cell tumor

high plasma somatostatin

66

VIPoma

watery diarrhea, hypokalemia, achlorhydria

WDHA syndrome

VIP assay - all patients with severe secretory diarrhae

67

serotonin producing tumor

pancreatic carcinoid tumor