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Quick Review of Pathology for clinicians and senior students.
Pathology of Diabetes

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  1. 1. “Climbing to the top demands strength, whether it is to the top of Mount Everest or to the top of your career.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.<br />
  2. 2. Quick Pathology Review<br />Pathology of <br />Diabetes<br />System : Endocrine<br />Class : Diabetes<br />Topic : Complications of Diabetes.<br />Shashidhar Venkatesh Murthy<br />A/Prof.& Head of Pathology<br />School of Medicine & Dentistry <br />James Cook University Australia.<br />
  3. 3. CPC 24- GIT-PUD: Core Learning Issues(CLI)<br />Major CLI:<br />Etiology and Pathogenesis of Diabetes types.<br />Pathogenesis of Type 1 & 2 DM.<br />Common Complications: <br />retinopathy, neuropathy & peripheral vascular disease. Nephropathy, erectile dysfunction, cardiovascular disease. <br />Minor CLI:<br />Acute metabolic complications of diabetes.<br />Ketoacidosis, coma, <br />Other types of Diabetes. <br />Gestational, MODY, LADA, Secondary, etc.<br />Diabetes insipidus<br />Incretins & incretin pathway.<br />
  4. 4. A 61y man with long standing hypertension & diabetes receives heparin after femoral fracture repair. A week later he develops severe thrombocytopenia, hematuria and died a week later due to rapidly developing renal failure. Image shows his right and left kidney’s. What is the most likely diagnosis ?<br />Acute tubular necrosis.<br />Right renal hemorrhage.<br />Right kidney infarction.<br />Benign nephrosclerosis.<br />Endstage kidney disease.<br />Briefly describe gross & Microscopic features of Right and Left Kidneys?<br />Briefly describe pathogenesis of Right & Left kidney pathology? <br />Why heparin was given? What Heparin complication has he developed?<br />
  5. 5. A 65y man, BMI 40, peripheral neuropathy, retinopathy and abdominal aortic aneurysm is now developing renal failure. His FBS is 18.3 mmol/L, microscopic examination of his renal biopsy. What is the microscopic feature shown?<br />Renal papillary necrosis.<br />Nodular glomerulosclerosis.<br />Hyaline artereolosclerosis.<br />Atrophy + Amyloid deposition.<br />Diffuse glomerular sclerosis.<br />What is the chemical nature of nodular deposit within glomerulus?<br />Briefly describe steps in the Pathogenesis of nodular glomerulosclerosis?<br />What other renal pathology are commonly seen in diabetic patients?<br />
  6. 6. A 47 year old man, Hypertensive & DM2 since 6 years for checkup. Complains of his vision as spectacles recently made does not seem to help. Image shows his fundoscopy. What is the most likely diagnosis ?<br />Normal fundus.<br />Mild Hypertensive retinopathy.<br />Non proliferative retinopathy.<br />Proliferative retinopathy.<br />Retinal detachment.<br />Retinopathy – Differences between Hypertensive & Diabetic retinopathy?<br />Briefly describe steps in the Pathogenesis of diabetic retinopathy?<br />Differentiate soft & hard exudates, dots & blots, proliferative & non-proliferative.?<br />
  7. 7. A 65y man, BMI 40, Diabetes since 18 years. His FBS is 18.3 mmol/L, is now developing hypertension since 3 years (BP 186/98 mm of Hg) . Image shows microscopic appearance of his renal biopsy. What microscopic feature shows pathogenesis of high blood pressure?<br />Hyperplasticartereosclerosis<br />Protein cast within tubule.<br />Artereolosclerosis.<br />Nodular glomerulosclerosis.<br />Both A & C.<br />What is the pathogenesis of feature A (hyperplasticarterosclerosis) in the image?<br />Briefly describe feature B and its clinical presentation?<br />What is seen in the interstitium of this kidney? Pathogenesis? Clinical feature?<br />
  8. 8. A 52y woman, recently diagnosed diabetic presents with 3 day history of fever, dysuria and flank pain. Examination reveals flank tenderness. Urinalysis shows numerous WBC & WBC casts. Image shows appearance of her kidney biopsy. What is the most likely diagnosis ?<br />Acute glomerulonephritis.<br />Acute tubular necrosis.<br />Renal papillary necrosis.<br />Nodular glomerulosclerosis.<br />Acute interstitial nephritis.<br />Briefly describe 3 microscopic features ? What gross features would be seen?<br />Briefly describe steps in the Pathogenesis of diabetic interstitial nephritis?<br />List common pathologic findings expected in a diabetic kidney?<br />
  9. 9. A 72y woman with 22 year history of diabetes, now has creatinine clearance of 20 mL/min (n 75-115mL/min). Image shows appearance of her kidney biopsy. What is the most likely diagnosis ?<br />Diffuse glomerulosclersosis.<br />Acute interstitial nephritis.<br />Hyaline artereolosclerosis.<br />Nodular glomerulosclerosis.<br />Chronic papillary necrosis.<br />Briefly describe pathogenesis of hypertension in diabetes?<br />Briefly describe Pathogenesis of infections in diabetic patients?<br />What other clinical features are more likely in her?<br />
  10. 10. A 42 year female presents with recent onset polyuria, polydypsia and decreasing vision. HbA1c was 16.1%. She is chronic alcoholic with past history of jaundice. Image shows her pancreatic biopsy compared with normal. What is the most likely diagnosis ?<br />Secondary diabetes.<br />Late onset Type 2 diabetes.<br />Chronic cholecystitis.<br />Cushing’s syndrome.<br />Type 1 diabetes.<br />Normal Patient<br />Briefly describe features of LADA?<br />What further investigations can be done to confirm the diagnosis?<br />List less common types of Diabetes ?<br />
  11. 11. 70y man brought from nursing home with progressive confused & disoriented status since 2 weeks. Not eating or drinking well. On steroid therapy for COPD.<br />What is the most likely diagnosis ?<br />Diabetic ketoacidosis.<br />Non-ketotichyperosmolar coma.<br />Diabetic lactic acidosis.<br />Respiratory acidosis.<br />Diabetic nephropathy.<br />Lab tests:<br />List & briefly discuss common metabolic complications of Diabetes?<br />?<br />?<br />
  12. 12. “I was willing to accept what I couldn't change.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.<br />