Podcast
Questions and Answers
What is one of the primary endocrine functions of the pancreas?
What is one of the primary endocrine functions of the pancreas?
Which of the following conditions is characterized by the presence of high blood glucose levels and dehydration without significant ketoacidosis?
Which of the following conditions is characterized by the presence of high blood glucose levels and dehydration without significant ketoacidosis?
Which hormone is NOT secreted by the pancreas?
Which hormone is NOT secreted by the pancreas?
What are the acinar cells of the pancreas primarily responsible for?
What are the acinar cells of the pancreas primarily responsible for?
Signup and view all the answers
What is a common cause of acute pancreatitis?
What is a common cause of acute pancreatitis?
Signup and view all the answers
Which hormone stimulates the secretion of bicarbonate-rich fluid from the pancreatic cells?
Which hormone stimulates the secretion of bicarbonate-rich fluid from the pancreatic cells?
Signup and view all the answers
What is one potential consequence of severe acute pancreatitis due to the activation of proinflammatory cytokines?
What is one potential consequence of severe acute pancreatitis due to the activation of proinflammatory cytokines?
Signup and view all the answers
Which of the following is NOT considered a risk factor for acute pancreatitis?
Which of the following is NOT considered a risk factor for acute pancreatitis?
Signup and view all the answers
Acute pancreatitis can result from the obstruction of which of the following?
Acute pancreatitis can result from the obstruction of which of the following?
Signup and view all the answers
What can happen when pancreatic cells undergo autodigestion due to acute pancreatitis?
What can happen when pancreatic cells undergo autodigestion due to acute pancreatitis?
Signup and view all the answers
What clinical manifestation may indicate paralytic ileus in a patient with acute pancreatitis?
What clinical manifestation may indicate paralytic ileus in a patient with acute pancreatitis?
Signup and view all the answers
Which of the following conditions can be caused by the systemic effects of acute pancreatitis?
Which of the following conditions can be caused by the systemic effects of acute pancreatitis?
Signup and view all the answers
Which of the following is a consequence of chronic ethanol use related to acute pancreatitis?
Which of the following is a consequence of chronic ethanol use related to acute pancreatitis?
Signup and view all the answers
What is a potential respiratory complication associated with severe acute pancreatitis?
What is a potential respiratory complication associated with severe acute pancreatitis?
Signup and view all the answers
Which laboratory value is likely to be significantly elevated in a patient with acute pancreatitis?
Which laboratory value is likely to be significantly elevated in a patient with acute pancreatitis?
Signup and view all the answers
Which of the following best describes Type 1 diabetes?
Which of the following best describes Type 1 diabetes?
Signup and view all the answers
What is a common endocrine dysfunction observed in acute pancreatitis?
What is a common endocrine dysfunction observed in acute pancreatitis?
Signup and view all the answers
What indicates the presence of prediabetes?
What indicates the presence of prediabetes?
Signup and view all the answers
Which type of diabetes includes cases due to an autoimmune process?
Which type of diabetes includes cases due to an autoimmune process?
Signup and view all the answers
What is a common metabolic consequence in acute pancreatitis related to blood glucose levels?
What is a common metabolic consequence in acute pancreatitis related to blood glucose levels?
Signup and view all the answers
Which of the following is NOT part of the GI assessment in acute pancreatitis?
Which of the following is NOT part of the GI assessment in acute pancreatitis?
Signup and view all the answers
What is the serum glucose concentration characteristic of hyperglycemia hyperosmolar state?
What is the serum glucose concentration characteristic of hyperglycemia hyperosmolar state?
Signup and view all the answers
Which of the following is NOT a common complication during the management of hyperglycemic emergencies?
Which of the following is NOT a common complication during the management of hyperglycemic emergencies?
Signup and view all the answers
What is the primary characteristic of glucose levels in a patient with hyperglycemia hyperosmolar state compared to those with diabetic ketoacidosis?
What is the primary characteristic of glucose levels in a patient with hyperglycemia hyperosmolar state compared to those with diabetic ketoacidosis?
Signup and view all the answers
Which electrolyte disturbance is commonly observed in hyperglycemic emergencies?
Which electrolyte disturbance is commonly observed in hyperglycemic emergencies?
Signup and view all the answers
In elderly patients, which factor is most likely to precipitate hyperglycemia hyperosmolar state?
In elderly patients, which factor is most likely to precipitate hyperglycemia hyperosmolar state?
Signup and view all the answers
Which physiological condition leads to the hyperosmolarity observed in hyperglycemic emergencies?
Which physiological condition leads to the hyperosmolarity observed in hyperglycemic emergencies?
Signup and view all the answers
Which of the following assessments is essential before managing hyperglycemic emergencies?
Which of the following assessments is essential before managing hyperglycemic emergencies?
Signup and view all the answers
What is a common neurologic consequence of hyperosmolarity in hyperglycemic emergencies?
What is a common neurologic consequence of hyperosmolarity in hyperglycemic emergencies?
Signup and view all the answers
What is the primary reason Type 1 Diabetes requires exogenous insulin?
What is the primary reason Type 1 Diabetes requires exogenous insulin?
Signup and view all the answers
What percentage of the diabetes population is affected by Type 2 Diabetes?
What percentage of the diabetes population is affected by Type 2 Diabetes?
Signup and view all the answers
Which of the following is NOT a common complication associated with diabetes?
Which of the following is NOT a common complication associated with diabetes?
Signup and view all the answers
What triggers the development of hypoglycemia symptoms?
What triggers the development of hypoglycemia symptoms?
Signup and view all the answers
Which characteristic primarily distinguishes Type 2 Diabetes from Type 1 Diabetes?
Which characteristic primarily distinguishes Type 2 Diabetes from Type 1 Diabetes?
Signup and view all the answers
What is the primary metabolic issue in Diabetic Ketoacidosis (DKA)?
What is the primary metabolic issue in Diabetic Ketoacidosis (DKA)?
Signup and view all the answers
Which demographic is at increased risk for developing gestational diabetes?
Which demographic is at increased risk for developing gestational diabetes?
Signup and view all the answers
Among the following, which is NOT a neuroglycopenic symptom of hypoglycemia?
Among the following, which is NOT a neuroglycopenic symptom of hypoglycemia?
Signup and view all the answers
What immediate condition can result from severe hypoglycemia?
What immediate condition can result from severe hypoglycemia?
Signup and view all the answers
What is a common physiological response to DKA?
What is a common physiological response to DKA?
Signup and view all the answers
Which lifestyle factor is significantly associated with the development of Type 2 Diabetes?
Which lifestyle factor is significantly associated with the development of Type 2 Diabetes?
Signup and view all the answers
What symptom is most indicative of metabolic acidosis in DKA?
What symptom is most indicative of metabolic acidosis in DKA?
Signup and view all the answers
What type of diabetes is described by insulin resistance combined with inadequate insulin secretion?
What type of diabetes is described by insulin resistance combined with inadequate insulin secretion?
Signup and view all the answers
Which of the following best describes the prevalence of gestational diabetes?
Which of the following best describes the prevalence of gestational diabetes?
Signup and view all the answers
Study Notes
Endocrine Function Alterations
- This lecture covers alterations in endocrine function, focusing on the pancreas, acute pancreatic dysfunction, acute endocrine dysfunction, diabetes, diabetic ketoacidosis (DKA), and hyperglycemia hyperosmolar state (HHS).
Topics for This Lecture
- Structure and function of the pancreas
- Acute pancreatic dysfunction (including acute pancreatitis)
- Acute endocrine dysfunction
- Diabetes
- Diabetic ketoacidosis (DKA)
- Hyperglycemia hyperosmolar state (HHS)
By the End of This Lecture
- Students will be able to critically reflect on the endocrine system's anatomy and physiology and how dysfunction causes systemic changes.
- Students will be able to explain the pathophysiology and effects of acute pancreatitis, diabetes (DKA and HHS), on the body.
- Students will begin to prioritize patient conditions related to nursing assessment of clinical manifestations and how it relates to other systems.
Objectives for This Lecture
- Identify at least two causes of pancreatitis and its effects on the body.
- Verbalize the pathophysiology of type 1 and type 2 diabetes.
- Differentiate between diabetic ketoacidosis (DKA) and hyperglycemia hyperosmolar state (HHS).
Pancreatic Dysfunction
Pancreas, Structure, and Function
- Has both endocrine and exocrine functions.
- Endocrine: secretes hormones such as insulin, glucagon, somatostatin, and pancreatic polypeptide.
- Exocrine: acinar cells secrete enzymes, and duct networks secrete alkaline fluids crucial for digestion.
- Aqueous secretions contain potassium, sodium, bicarbonate, and chloride.
- Alkaline pancreatic juice neutralizes acidic chyme, enabling digestive enzyme function and intestinal fat absorption.
- Pancreatic enzymes (proteases, amylases, lipases) hydrolyze proteins, carbohydrates, and fats.
- Secretion is hormonally and vagally stimulated.
- Secretin stimulates bicarbonate-rich fluid secretion for chime neutralization and digestion.
- Cholecystokinin and acetylcholine stimulate enzymatic secretion.
Acute Pancreatitis
- Risk Factors: Obstructive biliary tract disease (cholelithiasis), alcoholism, obesity, peptic ulcers, trauma, hyperlipidemia, hypercalcemia, smoking, and genetic factors.
- Pathophysiology: Usually mild but can be necrotizing or hemorrhagic, developing due to pancreatic duct obstruction (e.g., gallstones). Leads to autodigestion of pancreatic cells, causing vascular damage, coagulation necrosis, fat necrosis, and edema. Ethanol metabolism in acinar cells creates toxic metabolites, leading to acinar cell injury and enzyme release. Chronic alcohol use can cause protein plug formation and sphincter of Oddi spasm, further obstructing pancreatic ducts and leading to inflammation and pancreatitis.
- Pathophysiology (continued): Severe acute pancreatitis involves pro-inflammatory cytokines activating leukocytes, injuring vessel walls, and leading to abnormal coagulation in lungs and kidneys. Paralytic ileus, gastrointestinal bleeding (GI bleed), and systemic inflammatory response syndrome (SIRS) can occur.
- Clinical Manifestations: Mid-epigastric or LUQ pain with nausea and vomiting (paralytic ileus), jaundice, fever, and leukocytosis. Patients may exhibit abdominal distention, hypovolemia, hypotension, tachycardia, myocardial insufficiency, and shock. Severe acute pancreatitis can manifest as tachypnea, hypoxemia, pulmonary edema, atelectasis, pleural effusions, hypovolemia, renal failure (acute tubular necrosis), tetany due to hypocalcemia, and transient hyperglycemia.
Acute Pancreatitis - Nursing Assessment
- GI assessment: Bowel sounds, distension, nausea, vomiting, and guarding.
- Respiratory assessment
- Cardiovascular assessment.
- Renal assessment: Hyperlipidemia, hyperglycemia, and hypocalcemia
- Lab Values: Lipase and amylase are often elevated (may be 3x normal), along with WBC, bilirubin, sodium, potassium, creatinine, BUN, lipids (TC, TG, HDL, LDL), calcium, troponin, and ABGs.
Endocrine Dysfunction
Regulation of Blood Glucose
- ...
Diagnosing Diabetes and Prediabetes
- Prediabetes: Impaired fasting glucose and/or impaired glucose tolerance seen on two separate tests.
Types of Diabetes Mellitus
- Type 1
- Type 2
- Other
- Gestational
Classification of Diabetes
- Type 1 diabetes: Primarily results from pancreatic beta-cell destruction, leading to insulin deficiency and a high risk of ketoacidosis. This form includes autoimmune cases and cases with unknown cause.
- Type 1 diabetes includes latent autoimmune diabetes in adults (LADA).
- Type 2 diabetes: Ranges from predominant insulin resistance to a predominant secretory defect, often with insulin resistance. Ketosis isn't as common as in type 1.
- Gestational diabetes mellitus: Glucose intolerance with onset during pregnancy.
So... What's Your Type?
- Type 1: Pancreas doesn't produce insulin, complete loss of beta cell function, unknown etiology potentially autoimmune or idiopathic, requires exogenous insulin — 10% of population
- Type 2: Pancreas produces insufficient insulin or there is insulin resistance, progressive loss of beta cell function, usually diagnosed in adults — 90% of population
- Other Specific Types: Genetic defects of beta-cell function, genetic defects in insulin action, diseases of the exocrine pancreas, endocrinopathies, drug or chemical-induced beta-cell dysfunction, infections, uncommon forms of immune-mediated diabetes, other genetic syndromes associated with DM.
- Gestational: Insulin resistance combined with inadequate insulin secretion, common in women who are obese, older, or have a family history of diabetes —↑risk in women of certain ethnicities.
Etiology - Type 1 DM
- Accounts for 10% of diabetes cases.
- Diagnosed in childhood, adolescence, or early adulthood.
- Absolute lack of insulin.
- Etiology: autoimmune (genetic and environmental trigger) or idiopathic.
Etiology - Type 2 DM
- Accounts for 90% of diabetes cases.
- Common over 2004 Canadian >45
- Genetic, metabolic syndrome, insulin receptor substrate protein abnormalities in some young adults.
- Sedentary lifestyle, visceral obesity.
- Preventable.
Gestational DM
- Affects about 1-2% of pregnancies
- Gestational age 24-28 weeks: hormonal changes from placenta causing insulin resistance.
- Diagnosis: 50g oral glucose screen.
- Often resolves after pregnancy, 97% will not have it again, but a higher risk for postpartum type II.
- Offspring have increased risk for DM and obesity.
Complications Associated with Diabetes
-
Macrovascular:
- Cardiac ischemia
- CAD/ACS
- Angina
- MI
- Peripheral Arterial Disease
- Cerebrovascular/Carotid Disease
- TIA
- Stroke
-
Microvascular:
- Retinopathy
- Neuropathy
- Nephropathy
- CKD
Hypoglycemia
- Symptoms: autonomic (trembling, palpitations, sweating, anxiety, hunger, nausea, tingling) and neuroglycopenic (difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, headache, dizziness).
- Severity categories: Mild (autonomic symptoms, self-treatable); Moderate (autonomic and neuroglycopenic symptoms, self-treatable); Severe (individual requires assistance, unconsciousness may occur, plasma glucose typically < 2.8 mmol/L).
Diabetic Ketoacidosis (DKA)
- Hyperglycemia, gluconeogenesis, glycogenolysis (use of glucose by liver, muscle, and fat)
- Serum glucose concentration may be >27.8-44 mmol/L.
- Anion gap and metabolic acidosis.
- Ketonemia.
- Develops within 1-24 hours.
- Pathogenesis: Relative insulin deficiency, fasting/starvation, and stress hormone excess contribute to the development of DKA.
- Clinical Presentation: Dehydration (hypotension, shock), tachycardia, Kussmaul respirations, fruity breath, altered mental status, signs of precipitating cause, dry mouth, thirst, weakness, nausea, vomiting.
Diagnosis and Management
- Lab tests: Glucose, CBC with differential, electrolytes (to calculate anion gap), serum creatinine, venous blood gas, and urine for glucose and ketones.
- Other considerations: Airway management, cerebral edema, increased thrombotic event incidence, anticoagulation, phosphate, and magnesium.
Hyperglycemia Hyperosmolar State (HHS)
- Hyperglycemia: Serum glucose concentration > 56 mmol/L.
- Endogenous insulin present but ineffective.
- Severe dehydration; hyperosmolarity.
- Neurologic abnormalities; coma.
- Little to no ketosis.
- More common in elderly.
- Develops over days.
Priorities to Be Addressed in the Management of Adults Presenting With Hyperglycemic Emergencies
Key Points to Remember
- Assess renal and endocrine function, linking anatomy, physiology to endocrine system function.
- Explain the underlying "why" of endocrine assessments and their connections to other systems.
- Apply concepts of normal endocrine function and understand the pathophysiology, clinical manifestations, and nursing assessment related to acute pancreatitis and diabetes—including DKA and HHS.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This lecture explores the alterations in endocrine function, with a specific focus on the pancreas and various acute conditions such as acute pancreatitis, diabetes, and diabetic ketoacidosis. Students will learn about the anatomy and physiology of the endocrine system, emphasizing the systemic impacts of dysfunction. By the end, students will be equipped to assess and prioritize patient conditions related to endocrine dysfunction.
