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Endocrine > Complications > Flashcards

Complications Flashcards

1
Q

What are microvascular complications

A

Retinopathy
Neuropathy
Nephropathy - glomerulus sclerosis
Suppressed immune system

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2
Q

What are macrovascular complications

A

Stroke
MI
PVD - poor healing / ulcer / diabetic foot
CAH / IHD

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3
Q

What are risks of MI

A

May present without pain due to neuropathy

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4
Q

What are RF for complications

A 
Duration 
Poor control causing high BG 
Smoking 
Hypertension
Hyperlipidaemia - statin even if no overt IHD / vascular 
Genetics / FH 
Gender 
Proteinuria
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5
Q

How does DM cause macrovascular complications

A

Accelerates atherosclerosis

Glucose attaches to LDL and stops it being removed = hyperlipidaemia

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6
Q

How does DM cause microvascular complications

A

Glucose traps molecules e.g. plasma protein in sub endothelial space
Basal lamina thickens + cross links with protein so can’t be removed
Leads to narrow arterioles, poor flow and ischaemia

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7
Q

What may microvascular complications lead too

A

Amputation
ESRF
Blindness

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8
Q

What causes diabetic foot disease and what are other RF

A

Neuropathy

  • Lose protective sensation of pain so repeat injury
  • Charcot’s
  • Dry skin

Peripheral artery disease

  • Lose inability to repair as less blood supply / impaired circulation
  • Increased infection

Other

  • Previous ulcer
  • Previous amputation
  • Prescence of callus / structural abnormality / deformity
  • Abnormal pressure and mechanical stress
  • Visual issue - impaired
  • Poor footwear
  • Trauma
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9
Q

How does diabetic foot present and how does Charcot present

A

Neuropathy

  • Loss of sensation only
  • Dry cracked skin

Ischaemia / PAD

  • Absent pulses - if absent refer for ABPI
  • Reduced ABPI
  • Intermittent claudication = early sign

Charcot
Painful foot
Initial callus
Warm foot
Bounding pulse
May suspect cellulitis but colour drains when lift foot
Have early recognition of OM and cellulitis

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10
Q

What are complications of diabetic foot disease

A 
AMPUTATION 
Ulcers = high risk of infection and amputation 
Calluses
Charcot's
Cellulitis
OM
Gangrene
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11
Q

What screening is done for DM foot disease

A 
Annually
Ask any issues / changes 
Look for any deformity or infection 
Palpate pulses - PT and DP and enquire about claudication 
If can't feel refer to vascular 
10g monofilament for neuropathy
Assign risk based on findings
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12
Q

If mod-high risk (any issue except from callus) what happens

A

Diabetic foot clinic / podiatry follow up
Educate, treat lesions, debride and advise on dressings
Footwear / pressure relief

Mod-high risk if 
Deformities
Neuropathy
Non-critical limb ischaemia
Previous ulceration or amputation
RRT

Rx Charcot

  • Pressure relief
  • Immobilisation
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13
Q

What type of neuropathy can you get

A

Peripheral = most common
Mononeuritis
Autonomic
Motor vs sensory

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14
Q

What do mononeuritis tend to cause

A

Ocular CN

Acute foot drop due to peroneal nerve

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15
Q

What does peripheral neuropathy tend to cause

A

Sensory loss not motor

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16
Q

What are the symptoms of peripheral neuropathy

A 
Sensory = more common 
Paraesthesia
Loss of sensation 
Burning / shooting pain = common 
Numbness
Motor 
Small muscle wasting
Small toe deformities - leads to increased pressure and increased risk of ulcer 
Absent ankle jerks 
Charcot's can develop
17
Q

How is DM neuropathic pain managed

A 
Same as other neuropathic pain
Amitryptilline / Gabapentin / Pregabalin = 1st line
TCA CI if BPH as risk of retention 
Tramadol for rescue / exacerbation
Topical capsaicin for localised
Pain management clinic if resistant
18
Q

Who does proximal motor neuropathy tend to affect and what does it cause

A 
Type II 
Elderly main
Wasting of thigh muscles
Pain
Weight loss
RARE
19
Q

What does GI autonomic neuropathy cause

A

Gastroporesis
Chronic diarhoea
GORD due to decreased LOS pressure

20
Q

How does gastroporesis present

A

Erratic BG control
Bloating
Vomiting

21
Q

How do you Rx

A

Metoclopramide
Domperidone
Erythromycin
All pro-kinetic

22
Q

What else does autonomic neuropathy cause

A

LOSS OF SWEATING
- Dry / split skin

Other 
Erectile dysfunction
Postural hypo
Urinary retention
Peripheral oedema
23
Q

How do you Rx neuropathy

A

Early detection through screening
Trauma avoidance
Protect feet with special footwear
Regular podiatry to treat callus etc.

24
Q

What are types of diabetic retinopathy

A

Background non-proliferative retinopathy
Proliferative retinopathy
Maculopathy = most advance

25
Q

How does mild retinopathy present

A

Microaneurysm
Haemorrhage

White fatty deposits

26
Q

What is poor guide for screening

A

Visual acuity

Will only pick up maculopathy

27
Q

What is proliferative

A

New vessel forms
Exudates
Bleeding = blurred vision
Retinal detachment and scarring can occur

28
Q

What are retinal abnormalities seen

A 
Microaneurysm
Blot haemorrhage
Hard exudates = white
Cotton wool spot
New vessel formation
Vitreous haemorrhage
29
Q

How do you Rx prolfierative

A

Laser photocoagulation to reduce new vessel formation - look black on fundoscopy
Vitrecetomy

30
Q

What does maculopathy look like

A 
Hard exudates and blot haemorrhage at macula
Ischaemic macula
Macular oedema
deforms
Decreased acquity
31
Q

How do you treat

A

Grid laser therapy
Tight control
Retinal screening annula

32
Q

What are other problems common in DM

A 
Cataract
Glaucoma
Vitreous haemorrhage
Retinal detachment 
Rubeosis iris - new vessels in iris
33
Q

What causes diabetic nephropathy

A

Damage to capillaries making up glomerulus

Become leaky and unable to filter blood

34
Q

What is used as screening test

A

Morning urine for ACR or overnight urine

Looking for microalbuminuria

35
Q

If progresses to proteinuria what does this mean

A

ESRF

36
Q

How do you Rx

A 
Optimise glycaomic control
Tight BP control
ACEI slows progression
Control CVS RF
Aspirin 75mg for 2 prevention 
Statin 20mg
37
Q

What is target BP in type 1

A

Treat if >135/85 with an ACEI

38
Q

What is target BPP in type 2

A

<140/80 or <130/80 if target organ damage

Endocrine (17 decks)

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