Diseases of Endocrine Pancreas PDF

Page 3 Saturday, September 21, 2024 8:13 PM Diseases of Endocrine Pancreas - Alpha cells of the pancreas produce glucagon; beta cells of the pancreas produce insulin - Diabetes mellitus ○ Diabetes means urine, mellitus means sweet -> glucose in the urine...

Page 3 Saturday, September 21, 2024 8:13 PM Diseases of Endocrine Pancreas - Alpha cells of the pancreas produce glucagon; beta cells of the pancreas produce insulin - Diabetes mellitus ○ Diabetes means urine, mellitus means sweet -> glucose in the urine ○ Diagnosis ▪ Hyperglycemia in a fasting glucose exam □ Normal is 125 during fasting is positive for D.M. ▪ Abnormal glucose tolerance test (2 hour period) □ Normal is 200 after 2 hours is positive for D.M. ○ Classification ▪ Primary D.M. □ Type I Insulin dependent D.M. ◊ Formerly called juvenile-onset Body is not producing insulin at all □ Type II Non-insulin dependent D.M. ◊ Formerly called adult-onset ◊ This is the most common type of diabetes due to obesity Body is not producing a lot of insulin, but is producing just enough to get by □ Gestational D.M. For pregnant women that are experiencing hyperglycemia ▪ Secondary D.M. □ Chronic pancreatitis Due to alcoholism and biliary disease □ Hormonal tumors Pheochromocytoma, acromegaly, Cushing's, Grave's □ Hemochromatosis Iron overload with excess storage of iron □ Drugs Glucocorticoids ○ Incidence ▪ Life-time risk for Type I is 0.5%, life-time risk for Type II is 5-7% ○ Pathogenesis of Type I D.M ▪ Loss of beta cell function ▪ Most patients have autoantibodies against Islet cells ○ Metabolic derangements of Type I D.M ▪ Polyphagia □ Increased consumption of food ▪ Polyuria □ Excess urine and dilute ▪ Polydipsia □ Excess need to drink water Exam 1 Page 1  □ Excess need to drink water ▪ Will see ketoacidosis and elevated acetone which can lead to a coma ○ Pathogenesis of Type II D.M ▪ Obesity that leads to hyperglycemia that increases insulin secretion ▪ The beta cells over time secreting them ○ Metabolic derangements of Type II D.M ▪ Ketoacidosis is very rare ▪ Will see hyperosmolar non-ketotic coma □ The glucose levels are hyper-elevated in tissue cells surrounding the brain which draws water out of the brain, leading to a coma and dehydration ▪ Polyuria and polydipsia, nocturnal urination ○ Complications ▪ Most common cause of death in a diabetic person is cardiac failure ▪ 2nd most common cause of death is kidney failure Diseases of the Skeletal System - Injuries ○ Soft tissue injuries ▪ Contusions □ Petechiae (pinpoint), Purpura (1cm; bruise) ▪ Hematoma ▪ Lacerations ○ Joint injuries ▪ Strains □ Stretching or partial tearing of a muscle or tendon □ Pain is increased with stretching ▪ Sprains □ Stretching or partial tearing of a ligament around a joint □ Degrees of sprains Grade 1 = mild Grade 2 = moderate sprain with a hematoma Grade 3 = severe sprain with total disruption of the ligament Grade 4 = severe sprain with an avulsion of the bone ▪ Treatment for both strains and sprains □ RICE: rest, ice, compression, and elevation □ Immobilization, graded exercise, or surgery ▪ Dislocations □ Most common location is at the shoulder joint or AC joint □ Causes Congenital like seen in developmental dysplasia of the hip Traumatic like seen in accidents Pathologic like seen in infections, RA, neuromuscular diseases ▪ Loose bodies/ joint mice □ Characterized by small pieces of cartilage or bone within a joint space ▪ Shoulder and rotator cuff injuries □ Most sever near the tendon insertion □ Most common location is the supraspinatus tendon ▪ Knee injuries □ Meniscus injuries The medial meniscus is attached to the MCL Most commonly occur due to rotational injury from sudden pivot or direct blow to the knee □ Chondromalacia Condition where you have softening of the articular cartilage most often under the patella Exam 1 Page 2  often under the patella Most common in young female adults You can hear the crepitations when extending or flexing the knee ▪ Hip injuries □ Dislocation of the hip Most commonly occur in the posterior direction with medial rotation Tension can be applied to the profunda femoris which can cause avascular necrosis of the femoral head □ Fractures of the hip Most common type of fracture of the hip is the proximal femur with lateral rotation of the femoral neck ○ Fractures ▪ Classifications □ Location i.e. proximal vs. distal □ Open vs. closed fracture □ Complete vs. incomplete break i.e. comminuted, green stick □ Configuration i.e. transverse vs. oblique ○ Bone healing ▪ Step 1 □ Hematoma formation with acute inflammation ▪ Step 2 □ Formation of a fibrocartilaginous callus ▪ Step 3 □ Formation of a bony callus ▪ Step 4 □ Remodeling ○ Complications of fractures & musculoskeletal injuries ▪ Fracture blister □ Where an injured area undergoes swelling and around the areas of fat can develop a blister ▪ Compartment syndrome □ Increased pressure within a compartment which leads to decreased blood flow A cast that is too tight Myoglobinuria where after a fracture, the surrounding tissue loses blood flow causing muscle necrosis ▪ Complex regional pain syndrome □ Classified as a reflex sympathetic dystrophy where afferent signals of pain to not match the type of injury ▪ Pulmonary fat embolism - Infections of bone ○ Acute suppurative osteomyelitis ▪ Classified as an infection following trauma due to an open wound □ The most common bacteria is Staphylococcus aureus □ In patients with sickle-cell anemia it is Salmonella ▪ Pathogenesis □ Dead bone is called a sequestrum □ New bone forms under the periosteum which encases the old, necrotic bone This new bone is called involucrum Exam 1 Page 3  This new bone is called involucrum ▪ Complications □ Brodie's abscess Classified as chronic osteomyelitis which can lead to squamous carcinoma of the skin ○ Miliary Tuberculosis ▪ The primary location of tuberculosis is in the lungs, but miliary is classified as tuberculosis in regions other than the lungs ▪ Pott Disease □ Classified as tuberculosis in the spine with a discharge of caseous material Reactivation of Mycobacterium □ This disease does NOT invade the IVD - Osteonecrosis ○ This is due to any condition that causes ischemia Exam 1 Page 4