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OCC4040 > BMA - Amputation & Diabetes > Flashcards

BMA - Amputation & Diabetes Flashcards

1
Q

Why amputate?

A

To control pain or disease (peripheral vascular disease (PVD)

  1. malignancy
  2. gangrene
  3. severe trauma

Or preventative, punishment

When revascularisation is not possible

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2
Q

Is amputation more common in the upper or lower body?

A

Lower body

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3
Q

What are the causes of lower extremity amputation?

A
  1. Peripheral vascular disease (diabetes, hypertension, hyperlipidaemia, smoking)
  2. Infection
  3. Injury - there are modifiable and non-modifiable risk factors
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4
Q

2 points and commonality

what is Peripheral Vascular Disease?

A
  1. narrowing of the blood vessels outside the heart and brain
  2. Narrowing or complete obstruction of blood vessel lumen and weakening of vessel wall
  3. most commonly due to atherosclerosis
  4. Less commonly due to thromboembolism, vasculitis, Raynaud’s disease, cold injury (frost bite)
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5
Q

Describe the physiology of blood vessels. What do they vary in?

A

They vary in length, diameter, wall thickness and tissue makeup

Can be affected by:

  • arteriosclerosis
  • arteriolosclerosis
  • atherosclerosis (which we focus on)
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6
Q

What is atherosclerosis?

(Remember the endothelium is the inner lining of blood vessels)

A

“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

  1. Chronic endothelial injury
  2. Endothelial dysfunction
  3. Smooth muscle emigration
  4. Macrophages and smooth muscle cells engulf lipids
  5. Smooth muscle cell proliferation and deposition of collagen
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7
Q

What are the 5 steps leading to occlusion of the arteries in atherosclerosis?

A
  1. damage to the endothelium
  2. response to injury
  3. macrophages/endothelial cells/platelets stimulate smooth muscle hyperplasia via cytokine releaselymphocyte activity in the intima and fatty streaks desposited
  4. lipid debris desposited beneath the endothelium and firofatty atheroma forms in the intima
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8
Q

Signs and symptoms of PVD - skin assessment

What is PVD?

A

Peripheral Vascular Disease

Skin assessment

  • touch
  • hair growth
  • appearance
  • nails
  • pulse
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9
Q

PVD ulcer assessment

A
  • pain
  • colour
  • edges
  • location
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10
Q

PVD Pain assessment

A

Type

activity

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11
Q

PVD treatment

A
  • Lifestyle changes
  • Treatment of existing conditions
  • Medications
  • Angioplasty
  • Vascular surgery
  • If revascularisationis not possible –>AMPUTATION
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12
Q

Levels of lower extremity amputation

A
  • 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)
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13
Q

List the causes of upper extremity amputation

A

severe trauma (more common)

peripheral vascular disease

thermal burns and frost bite

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14
Q

List the pathophysiology of upper extremity amputation

A
  • severe blood loss, nerve damage and shock
  • impaired circulation
  • tissue necrosis
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15
Q

What are the levels of upper extremity amputation?

A
  • Amputation of digits
  • Metacarpal amputation
  • Wrist disarticulation
  • Forearm amputation
  • Elbow disarticulation
  • Above-elbow amputation (transhumeral)
  • Shoulder disarticulation
  • Forequarter amputation
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16
Q

What is required to fit a prostheses?

A
  • soft tissue envelope
  • sufficient mass of muscle
  • full thickness skin
  • subcutaneous tissue
17
Q

Amputation summary

A
  • 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)
18
Q

What are the top 2 leading causes of daeth world-wide?

A
  1. ischaemic heart attack
  2. stroke
19
Q

What is diabetes melitus?

A

a chronic disorder of carbohydrate, fat and protein metabolism due to defective/deficient insulin

20
Q

What is glucose?

A

a carbohyddrate used to make energy (ATP)

21
Q

What is hyperglycaemia?

A

Characterised by:

  1. high blood glucose level (BGL)
  2. inability of the cells to take in glucoise from the blood due to a lack of or defect in the hormone insulin
22
Q

Explain the process of glucose metabolism

A
  • 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)
23
Q

What is insulin and what does it do?

A

• 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

24
Q

Describe the role and functions of the Pancreas

A

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

OCC4040 (1 decks)

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