Term
| What is pathologically diagnostic of DM? |
|
Definition
insulitis and near total depletion of B cells
insulitis, nodular glomerulosclerosis, renal efferent arteriosclerosis, retinopathy |
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Term
|
Definition
| assoc w/ severe necrotic changes in beta cells particularly in infants of diabetic mothers |
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Term
| When would you see an increase in size and number of pancreatic islets? |
|
Definition
non-diabetic infants of diabetic mothers (in response to hyperglycemia)
hyperplasia early in type I |
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Term
| isley hyalinization is characteristic of which types of DM? |
|
Definition
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|
Term
| When do you typically see the complications of DM? |
|
Definition
| about 10-15 years after onset of hyperglycemia |
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Term
| What is the most common cause of death in DM? |
|
Definition
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Term
| What microvascular changes do you see with diabetes, and where do you see these changes? |
|
Definition
Changes are most evident in art/caps of skin, sk muscle, retina, renal medulla and glomeruli
thickened BM
increased type IV collagen, decrease PGs
increased platelet agg & altered fibrinolysis--> microthrombi
profound effect on tissue profusion/wound healing |
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Term
| How is the kidney affected by DM? |
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Definition
| glomerular lesions, arteriosclerosis and atherosclerosis, pyelonephritis, tubular lesions |
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Term
| Describe diffuse glomerulosclerosis, and when does it occur? |
|
Definition
thickening of glomerular basement membrane and increased mesangial matrix
can occur with diabetes, old age, HT |
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Term
| What lesion is diagnostic of diabetes? |
|
Definition
|
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Term
| What are the exudate lesions of the glomerular from diabetes? |
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Definition
capsular drop- eosinophilic, PAS + deposits in parietal layer of Bowman's capsule
fibrin cap- eosinophilic deposits under visceral epithelium of Bowmna's capsule; not specific for diabetes |
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Term
| When do you see efferent ateriolosclerosis in the kidney? |
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Definition
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|
Term
| How does diabetes increase the risk of pyelonephritis? |
|
Definition
| decreased host response and dystonia of the bladder |
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|
Term
| What are Armani-Ebstein Cells? |
|
Definition
| glycogen infiltration in tubular cells; NOT assoc w/tubular dysfxn |
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Term
| How does diabetes affect the liver? |
|
Definition
fatty change
glycogen vacuolation in hepatocyte nuclei |
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Term
| What are the mucocutaneous infections assoc w/ diabetes? |
|
Definition
cellulitis w/or w/o leg ulcers and recurrent curuncles and carbuncles
candida vulvovaginitis
rhinocerebral mucormycosis (rare) complicates DKA, malignant external otitis |
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|
Term
| rhinocerebral mucormycosis |
|
Definition
black nasal turbinates, bloody nasal discharge, periorbital edema, internal jugular and cerebral venous sinus thrombosis
untreated: death in 7-10 days! |
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|
Term
| malignant external otitis |
|
Definition
severe, sudden pain from a chronically draining ear--pseudomonas aerugonisa
50& mortality |
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Term
| How are host defenses diminished by diabetes? |
|
Definition
decreased neutrophil chemotaxis, phagocytosis, and IC killing
decreased cellular immunity
tissue ischemia and hypoxia
decreased protective neural reflexes
increased iatrogenic exposure to microorganisms |
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Term
| What 2 mechanisms link hyperglycemia and it's long term complications? |
|
Definition
| nonenzymatic glycosylation and the polyol pathway |
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Term
| Explain how the polyol pathway causes damage. |
|
Definition
gluc->sorbitol via aldose reductase
polyols accum in tissues which have insulin-indep gluc transport (lens, nerve, kidney, BVs)
accumulated polyols increase osm>osm cell dmg |
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