BMA - Amputation & Diabetes Flashcards
Why amputate?
To control pain or disease (peripheral vascular disease (PVD)
- malignancy
- gangrene
- severe trauma
Or preventative, punishment
When revascularisation is not possible
Is amputation more common in the upper or lower body?
Lower body
What are the causes of lower extremity amputation?
- Peripheral vascular disease (diabetes, hypertension, hyperlipidaemia, smoking)
- Infection
- Injury - there are modifiable and non-modifiable risk factors
2 points and commonality
what is Peripheral Vascular Disease?
- narrowing of the blood vessels outside the heart and brain
- Narrowing or complete obstruction of blood vessel lumen and weakening of vessel wall
- most commonly due to atherosclerosis
- Less commonly due to thromboembolism, vasculitis, Raynaud’s disease, cold injury (frost bite)
Describe the physiology of blood vessels. What do they vary in?
They vary in length, diameter, wall thickness and tissue makeup
Can be affected by:
- arteriosclerosis
- arteriolosclerosis
- atherosclerosis (which we focus on)
What is atherosclerosis?
(Remember the endothelium is the inner lining of blood vessels)
“Hardening of the arteries”
A build up of cholesterol plaque in the walls of arteries, causing obstruction of blood flow. Plaques may rupture, causing acute occlusion of the artery by clot
- Chronic endothelial injury
- Endothelial dysfunction
- Smooth muscle emigration
- Macrophages and smooth muscle cells engulf lipids
- Smooth muscle cell proliferation and deposition of collagen
What are the 5 steps leading to occlusion of the arteries in atherosclerosis?
- damage to the endothelium
- response to injury
- macrophages/endothelial cells/platelets stimulate smooth muscle hyperplasia via cytokine releaselymphocyte activity in the intima and fatty streaks desposited
- lipid debris desposited beneath the endothelium and firofatty atheroma forms in the intima
Signs and symptoms of PVD - skin assessment
What is PVD?
Peripheral Vascular Disease
Skin assessment
- touch
- hair growth
- appearance
- nails
- pulse
PVD ulcer assessment
- pain
- colour
- edges
- location
PVD Pain assessment
Type
activity
PVD treatment
- Lifestyle changes
- Treatment of existing conditions
- Medications
- Angioplasty
- Vascular surgery
- If revascularisationis not possible –>AMPUTATION
Levels of lower extremity amputation
- Amputation of digits
- Partial foot amputation
- Ankle (Syme) disarticulation
- Below-knee amputation (transtibial)
- Above-knee amputation (transfemoral)
- Vas-ness rotation/rotationplasty
- Hip disarticulation
- Hemipelvectomy/hindquarter amputation
- Hemicorporectomy(amputation at the waist)
List the causes of upper extremity amputation
severe trauma (more common)
peripheral vascular disease
thermal burns and frost bite
List the pathophysiology of upper extremity amputation
- severe blood loss, nerve damage and shock
- impaired circulation
- tissue necrosis
What are the levels of upper extremity amputation?
- Amputation of digits
- Metacarpal amputation
- Wrist disarticulation
- Forearm amputation
- Elbow disarticulation
- Above-elbow amputation (transhumeral)
- Shoulder disarticulation
- Forequarter amputation
What is required to fit a prostheses?
- soft tissue envelope
- sufficient mass of muscle
- full thickness skin
- subcutaneous tissue
Amputation summary
- Reasons for amputation
- tissues no longer have an adequate blood supply (PVD)
- remove malignant tumours
- severe trauma
- A leading cause of amputation is peripheral vascular disease
- A leading cause of peripheral vascular disease is Diabetes Mellitus (DM)
What are the top 2 leading causes of daeth world-wide?
- ischaemic heart attack
- stroke
What is diabetes melitus?
a chronic disorder of carbohydrate, fat and protein metabolism due to defective/deficient insulin
What is glucose?
a carbohyddrate used to make energy (ATP)
What is hyperglycaemia?
Characterised by:
- high blood glucose level (BGL)
- inability of the cells to take in glucoise from the blood due to a lack of or defect in the hormone insulin
Explain the process of glucose metabolism
- We eat food → carbohydrate (glucose), fat and protein
- glucose supplied to bloodstream
- glucose transported from blood to cells using INSULIN
- Glucose used by cell to make ATP (glycolysis)
What is insulin and what does it do?
• A hormone that allows the transport of glucose into cells, thus lowering the blood glucose level (BGL)
Synthesis - B cells of the islets of Langerhans in pancreas
Storage and Release
• packaged into granules within b cells
• release triggered by increased BGLs
• biphasic release → 1st and 2nd phase release
Describe the role and functions of the Pancreas
The pancreas is an organ located in the abdomen. It plays an essential role in converting the food we eat into fuel for the body’s cells. The pancreas has two main functions: an exocrine function that helps in digestion (99%) and an endocrine function that regulates blood sugar (1%)
b cells synthesise and secrete insulin –>↓BGL
a cells synthesise and secrete glucagon –> ↑ BGL
