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PATHO exam 3
diabetes
124
Physiology
Undergraduate 3
03/19/2012

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Term
insulin comes from the..
Definition
beta cells, islets of langerhans of the pancreas
Term
without insulin..
Definition
the body does not properly utilize glucose
Term
cells that dont need insulin to utilize glucose
Definition
liver, red blood cells, brain cells, glucose can enter cells without insulin present
Term
one thing that characterizes any type of diabetes is..
Definition
hyperglycemia
Term
what percent of population has diabetes
Definition
7.8%
Term
risk factors for diabetes
Definition
all age group, more prevalent in NA, AA and hispanics, 7th leading cause of death of adults
Term
diabetes is most prevalent in..
Definition
hispanics
Term
what country has the most people with diabetes?
Definition
India
Term
sweet smelling urine comes from
Definition
inability of kidneys to retain most sugars, sugars should be zero in urine
Term
diabetes is the number one cause for..
Definition
ESRD
Term
diabetes can cause what in eyes?
Definition
blindness
Term
what happens in type 1?
Definition
autoimmune process, actual destruction of beta cells
Term
what happens in type 2?
Definition
a process of insulin resistance, receptor sites on cells become resistant to insulin receptors.
Term
progression of diabetes
Definition
diminshed tissue responsiveness to isnulin at one or more points in the insulin pathway, leading to hyperglycemia and then eventually overt diabetes
Term
what are incretins
Definition
help to reduce the responsiveness to glucose
Term
in type 2 diabetes incretin response is
Definition
decreased
Term
in hpyerglycemia, the liver will inappropriately produce..
Definition
glucose
Term
type 2 is a combination of
Definition
decreased insulin production and cellurar resistance to insulin
Term
A1c must be greater than what to be diabetic?
Definition
A1C>=6.5%
Term
fasting blood glucose for diabetics
Definition
>126 mg/dl
Term
normal blood sugar
Definition
70-110, 80-120 fasting glucose
Term
if you have diabetes or not, your glucose will be
Definition
normal in two hours
Term
fasting blood sugar for gestational diabetes
Definition
fasting- >92
1 hr- >180 mg
2 hr - >153
Term
signs of type 1
Definition
polydipsia, polyphagia, polyuria, weight loss, hunger, hyperglycemia
Term
type 1 is most common in people
Definition
under the age of 30
Term
symtpoms of type 1 are due to..
Definition
an absolute lack of insulin available to cells
Term
w/o treatmeant, type 1 dbts, it progresses to
Definition
diabetic ketoacidosis leading to coma and death
Term
treatment for type 1 dbts
Definition
insulin, diet, and exercise
Term
type 1 dbts patients must receive
Definition
exogenous insulin or they'll die
Term
type 1 dbts- islets cell destruction is influenced by..
Definition
genetic susceptability autoimmunity, and an environmental insult
Term
in patients with type 1, what is found in islets?
Definition
CD4+ and CD8+ t lymphocyte, 90% have circulating ICA, 10% have other organ specific autoimmune disorders such as graves or addison's
Term
viruses and cows milk are suspected to cause..
Definition
type 1 dbts, environmental factors
Term
hepatic glucose production is controlled by
Definition
glucagon
Term
purpose of glucagon..
Definition
maintain blood glucose between meals and during periods of fasting
Term
actions of glucagon..
Definition
opposite of insulin, eg- increases BG level, increases lipolysis
Term
patient with type 1 has lost weight (25 lbs), which must be replaced in order to regain homeostasis?
Definition
insulin, duh
Term
pt with diabetes is complaining of feeling shaking and hungry, treatment is?
Definition
ORAL GLUCOSE! 15 gm of orange juice. (iv glucose is for unconscious patients), (fatty food is slow acting)
Term
Risk factors for type 2 diabetes in children
Definition
low levels of exercise, high fat levels, coke machines
Term
three mechanisms that controlf BG
Definition
insulin secretion, uptake and utilization of glucose by peripheral tissues, glucse production of the liver (glucogynesis)
Term
glucagon ? sugar
Definition
increase glucose/sugar by alpha cells
Term
type 2 diabetes effect
Definition
inappropriate production of glucose in liver (continues even when pt isn't eating)
Term
major metabolic defects in type 2
Definition
Peripheral insulin resistance in muscle and fat
Decreased pancreatic insulin secretion
Increased hepatic glucose output
Increased triglyceride levels
Decreased HDL levels
Increased LDL levels
Term
other things that can cause hyperglycemia
Definition
catecholamines (epinephrine and norepinephrine)
Term
epinephrine and or norepinephrine raise BG during..
Definition
stress, fever, surgery, emotional problems, pain
Term
how do catecholamines work on insulin?
Definition
inhibits insulin release, promotes glycogenolysis by stimulating the conversion of muscle and liver glycogen to glucose
Term
glucocorticoid hormones effect blood glucose..
Definition
stimulate liver to breakdown glycogen to glucose, can moderately decrease tissue use of glucose
Term
GCCH may actually cause..
Definition
diabtes mellitus in some predisposed persons
Term
Tye 2 letter?
Definition
the "p" polydyspia, polyuria, polyhungry
Term
TYPE 2 signs..
Definition
Hyperglycemia
Most common over age 40
Acute classical signs of Type 1 rarely are present
Blurred vision, fatigue, paresthesias, skin infections, foot ulcers, vulvovaginitis (yeast)
Term
pathogenesis of type 2
Definition
Projected: Beta Cell Failure will most likely eventually occur, requiring insulin injections.
Term
concordance rate between twins for type 1 and type 2
Definition
50%, 90%
Term
Type 2 diet/treatment
Definition
individualized, focuses on mild/moderate weight loss, limitation of fat to <30% fat calories, counting carb grams, and protein according to ADA, etc.
Term
REview different types of insulin
Definition
Term
NPH
Definition
a basal insulin, been around since 50's
Term
no need to know isnulin action profiles
Definition
Term
where is the vomiting center of the brain located?
Definition
medulla and chemoreceptor center located on the floor of the fourth ventricle and mediates emetic effects of blood borne drugs and toxins
Term
treatement for gerd
Definition
small meals, sit upright, avoid foods that lone tone of ESPG sphincter(caffeine, chocolate, fats, alcohol) sleep w head elevated, lose weight, no eating after 5
Term
3 types of chronic gastritis..
Definition
H pylori, autoimmune and chemical gastrothapy
Term
Peptic ucler disease
Definition
diet doesnt play a role, h pylori increases mucosal damage, burning gnawing, cramping, stomach pain, especially when stomach if empty. pain is midline
Term
stress uclers are also called..
Definition
curling's ulcer
Term
gallstones risk factor
Definition
obese, female, pregnancies, oral contraceptives
Term
acute pancreatitis?
Definition
premature activation of trypsin causes autodigestive process of the pancrease, eventually causing multisystem organ failure
Term
risk factors for acute pancreatitis?
Definition
stones in ducts or alcohol abuse, hyperlipidemia, viral infections, hypercalcemia, surgery and trauma, thiasidine diuretics
Term
HEP A conctracted through..
Definition
fecal/oral route, contaminated food/water. HEP A available for high risk groups.
Term
HEP B contracted through..
Definition
blood, semen oral. vaccine widely given and numbers have decreased
Term
HEP C contracted through..
Definition
blood transmission, rec drug use, semen and tattoos/acupuncture
Term
Stages of Hepatitis..
Definition
preicteric (symptoms are vague, symptoms are fatigue, dark urine, GI problems), icterus (symptoms worsen along with beginning of jaundice), posticteric (improving symptoms after 2-3 weeks w complete recovery in HEP A in 9 weeks or so) stages
Term
causes of cirrhosis
Definition
drugs, viruses, alcohol, heredity
Term
portal hypertension?
Definition
venous blood cannot flow through liver normally
Term
severe liver cirrhosis signs
Definition
severe ascites, peripheral edea, malnutrition, bleeding, portal hypertension, clay colored stools, jaundice, pruritis, endocrine disorders, esophageal varices
Term
what can cause peritonitis?
Definition
diverticulitis and diverticulosis, also due to perforation of the intestines or an ulcer is usual cause
Term
signs of appendicits
Definition
RLQ pain, rebound tenderness, elevated WBC, surgery
Term
Bowel obstruction leads to...
Definition
necrosis, perforation, and sepsis!
Term
what is volvulus?
Definition
twisting of the bowel
Term
adhesions may cause..
Definition
bowel obstruction
Term
3rd most common cancer in men and women, 2nd leading cause of cancer deaths..
Definition
colon cancer
Term
risk factors for colon cancer..
Definition
>50, family hx, crohns, ulcerative colitis, polyps, high fat, low fiber diet
Term
what seems to prevent colon cancer?
Definition
aspirin?
Term
what is a late symptom of colon cancer?
Definition
pain
Term
colon cancer is bad bc..
Definition
symptoms are late and cancer had spread, pain is late sign
Term
colonoscopy should be done every..
Definition
5 years after age 50
Term
hypothalamus and pituitary gland are the..
Definition
"masters" of the endocrine system
Term
primary endocrine disorder?
Definition
secretion of a hormone is too low, the problem is with the thyroid gland itself, not pituitary
Term
secondary endocrine disorder?
Definition
secretion of another hormone is too low, thereby decreasing the secretion of another hormone (even if gland is fine- thyroid) problem in pituitary instead
Term
thyroid gland hormones
Definition
T3- triidothyronine, T4- thyroxine, T3 and T4 target tissues almost all body systems are affected
Term
major effects of T3 and T4
Definition
energy metabolism
Term
hypothyroidism..
Definition
most common disorder, primary disorder, low secretion of T3and4, decline in metabolic rate
Term
S and S of hypothyroidism
Definition
less metabolic heat generated, weak, sluggish, constipation, decreased cardiac output, increased weight body weight, decreased liver function - rise in blood cholesterol
Term
Sand S of hypothyroidism cont'd
Definition
decreased sex drive, period abnormalities, depression, slower mental processes, fatigue, decreased protein synthesis, fluid retention, puffiness in face/eyes
Term
thyroid hyperfunction
Definition
Grave's disease- autoimmune, hypersecretion of TSH from pituitary gland
Term
Graves/THY hyperfunction effects..
Definition
exaggerated target tissues responses (increased HR) increased metabolic rate, nervousness, irritability, profuse sweating, intolerance of heat, weight loss, goiter, exophthalmos
Term
physical signs of graves..
Definition
buldging eyes and enlarged thryoid
Term
thyroid storm/crisis is..
Definition
This is extreme hyperthyroidism, rarely seen because of improved diagnosis and treatment, but life-threatening when it occurs. Immediate and aggressive medical attention is required.
Term
hyper function of adrenal cortical hormones causes
Definition
increased cortisol and hypercorticolism
Term
cushings disease..
Definition
resulting from excess ACTH from pituitary/ pit adenoma
Term
cushing syndrome..
Definition
hyper functioning of the adrenal cortex (such as a tumor that is hypersecreting cortisol)
Term
manifestations of excess cortisol..
Definition
weight gain, with big belly, fatty deposits in face upper thoracic, high glucose blood levels, protein wasting- thin arms and legs, decreased healing increased bruising
Term
more clinical manifestations of excess coritsol
Definition
stretch marks, significant anti inflammatory affect, mental or emotional changes, depression euphoria, inability to sleep
Term
hyperaldosteronism causes..
Definition
primary: aldosterone secreting adenoma, secondary: renal ischemia which activeates the renin angiotensin aldosterone mechanism
Term
effects of hyperaldosteronism...
Definition
renal retention of sodium and water, loss of potassium..
Term
signs of hyperaldosteronism
Definition
hypertension and electrolyte imbalances.. up NA, down K
Term
Addison's disease
Definition
adrencortical hypOsecretion- cortisol insufficiency
Term
causes of addisons..
Definition
a. Destructive process, usually autoimmune
b. hypothalamic or pituitary disease
c. drug (steroid) induced inhibition of ACTH
Term
signs of addisons..
Definition
a. Slowly developing weakness and fatigue
b.  Appetite and weight loss
c. Characteristic pigmentation excess
d. Little ability to secrete cortisol - Highly vulnerable to stress
Term
cortisol is necessary for..
Definition
LIFE
Term
main job of Parathyroid glands..
Definition
calcium control
Term
PTH is controlled by..
Definition
plasma calcium concentration: low calcium concentration equals PTH secretion increased, high calcium concentration equals PTH secretion decreased
Term
PTH secretion results in..
Definition
calcium from body stores (bones) and diet moving into the blood stream
Term
hyperparathyroidism caused by..
Definition
benign or malignant tumors of parathyroid, hyperplasia of gland
Term
effects of hyperparathyroidism..
Definition
loss of bone calcium from excessive osteoclast activity, HYPERCALCEMIA
Term
signs of hyperparathyroidism..
Definition
bone weakness predisposes to bone pain, deformity and fracture. muscular and neurologic symptoms, kidney stone formation
Term
hypoparathyroidism caused by
Definition
removal of parathyroid glands during thyroid and other neck surgery, gland destruction from various causes
Term
effect of hypoparathyroidism..
Definition
hypocalcemia
Term
signs of hypoparathyroidism..
Definition
increased neuromuscular excitability (important), cardiac effects and c. skeletal effects ( if deficiency is long term
Term
what is trousseau's sign..
Definition
example of clinical manifestations in hypocalcemia
Term
SIADHS
Definition
syndrome of inappropriate antidiuretic hormone secretion, TOO MUCH ADH
Term
effects of SIADHS
Definition
marked water retention, with hyponatremia, low Na serum, urine specific gravity will be HIGH
Term
diabetes insipidus is caused by..
Definition
inadequate ADH production, caused by cancer abscesses meningitis?, radiation/surgical injury, severe head injuries
Term
diabetes insipidus causes..
Definition
inability to reabsorb water by kidneys
Term
manifestations of diabetes insipidus
Definition
polyuria, instense thirst and polydipsia, dryness of mouth and skin, urine pale and dilute, serum sodium?
Term
adrenal medulla hypersecretion
Definition
pheochromocytoma, caused by benign tumor
Term
effects of adrenal medulla hypersecretion..
Definition
excess catecholamine secretion (epinephrine and noreprinephrine)
Term
signs of adrenal medulla hypersecretion..
Definition
hypertension, headaches, heavy perspiration, tachycardia, and anxiety due to unregulated surges in catecholamine output
Term
Which is the active form T3 or T4?
Definition

T4: helps with metabolism, has a free state that allows itself to enter cells and release effects “active form”, and it's these levels that are measured by lab test to understand the function of the thyroid

 

 

 

 

 

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