path 7- pancreas

the clusters of cells that make up the pancreas are called

islets of langerhan

4 major cell types in the islets of langerhan

B cell

a cel

delta cell

PP cells

delta cells secrete

somatostatin

D1 cells secrete

VIP

enterochromaffin cells synthesize

serotonin

what causes the islet destruction in T1D

immune cells reacting against endogenous B-cell antigens

fundamental immune abnormality in T1D is what

failure of self-tolerance in T cells

2 metabolic defects seen with T2D

dec response of peripheral tissues to insulin --> insulin resistance

B cell dysfunction

monogenic forms of DM are caused by

defect in insulin-insulin R signaling

primary defect in B cell dysfunction

inheritance of monogenic forms of DM

AD

clinical features of monogenic forms of DM

mild persistent hyperglycemia

severe diabetes requiring insulin for survival

MCC of monogenic DM

MODY

complications of diabetes

macrovascular disease

microvascular disease

macrovascular disease from diabetes causes

atherosclerosis --> inc risk of MI, stroke, LE gangrene

microvascular disease from diabetes causes

diabetic retinopathy, nephropathy, and neuropathy

what is seen in histo for T1D

leukocyte infiltrates in the islets (insulitis)

islet atrophy

what is seen in histo for T2D

amyloid deposits within islets

most consistent finding for diabetes

diabetic microangiopathy

diabetic microangiopathy

Diffuse thickening of the basement membrane

diabetic nephropathy histo findings

diffuse mesangial sclerosis

nodular glomerulosclerosis

BM thickening

stain for amyloid

Congo red

--> see apple green birefringence

renal vascular lesions from diabetes

hyaline arteriosclerosis

pattern for pyelonephritis

necrotizing papillitis (papillary necrosis)

s/s of T1D

polyuria

polydipsia

polyphagia

which diabetes is assocaited with HLA? what HLA is it associated with?

T1D

HLA-DR4 and DR3

pathogenesis of diabetic ketoacidosis

insulin def --> lipolysis and oxidation of free fatty acids --> inc ketone bodies

s/s of diabetic ketoacidosis

Delirium/psychosis

Kussmaul respirations

Abdominal pain/N/V

Dehydration

fruity breath

DKA is Deadly

pathogenesis of hyperosmolar hyperglycemic state

profound hyperglycemia --> osmotic diuresis --> dehydration and inc serum osmolality

most common pancreatic endocrine neoplasm

insulinoma

insulinoma is a tumor of

B cells

s/s of insulinoma

hypoglycemic episodes

histo for insulinoma

deposition of amyloid

treatment for insulinoma

surgical resection

cause of Zollinger-Ellison syndrome

gastrinoma of duodenum or pancreas

ZE syndrome s/s

recurrent ulcers in duodenum and jejunum

malabsorption

glucagonoma s/s

6 D's

dermatitis (necrolytic migratory erythema)

diabetes

DVT

declining weight

depression

diarrhea

glucagonoma is a tumor of

pancreatic a cells

D1 cells synthesize

VIP

somatostatinoma s/s

DM

cholelithiasis

steatorrhea

hypochlorhydria

VIPoma s/s

Watery Diarrhea

Hypokalemia

Achlorhydria

WDHA syndrome