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Endocrine > diabetes complications > Flashcards

diabetes complications Flashcards

1
Q

diabetes microvascular complications

A

retinopathy
nephropathy
neuropathy
gastroparesis

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2
Q

diabetes macrovascular complications

A

peripheral arterial disease
cerebral vascular disease
LHD

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3
Q

what is diabetes microangiopathy

A

diabetes of the small blood vessels

-histological hallmark is thickening of the capillary basement membrane with increased vascular permeability

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4
Q

pathogenesis of diabetic retinopathy

A
  • hyperglycaemia increases retinal blood flow
  • disrupts metabolism in retinal endothelial cell
  • impaired vascular autoregulation, increased production vasoactive substances &endothelial cell proliferation
  • decreased retinal blood flow
  • capillary hypoperfusion and closure causes chronic retinal ischaemia so get production of VEGF_> vascular endothelial growth factor that further stimulates deleterious endothelial cell growth and increased vascular permeability (retinal leak and exudation)
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5
Q

risk factors for retionpathy

A
  • long duration dm
  • pregnancy
  • poor glycaemic control
  • hypertension
  • hyperlipidaemia
  • nephropathy/renal disease
  • obesity and smoking
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6
Q

3 stages of retinopathy

A

non-proliferative
pre-proliferative
proliferative

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7
Q

signs of non-proliferative retinopathy

A
  • microaneurysms

- retinal haemorrhages: dot and blot from microaneurysms that have burst or leak

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8
Q

pre-proliferative retinopathy signs and what causes them

A
  • capillary hypoperfusion
  • hard exudates: leaking of cholesterol through microaneurysms-macular oedema
  • cotton wool spots: capillary infarct in nerve fibre layer
  • venous beading
  • intra-retinal microvascular abnormalities
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9
Q

signs of proliferative retinopathy

A
  • neovascularisation
  • vitreous haemorrhage
  • retinal detachment
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10
Q

presentation of retinopathy

A
  • loss of visual acuity if near macular

- sudden visual loss= vitreous haemorrhage or retinal detachment

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11
Q

what is good hba1c control

A

<53

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12
Q

mangement of retinopathy

A
  • control
  • ranibizumab which binds to VEG-A and is anti-angiogenic for dm macular oedema
  • retinal photocoagulation (laser treatment)
  • vitrectomy
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13
Q

what is the most common cause of end stage renal failure

A

diabetic retinopathy

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14
Q

pathophysiology progression of nephropathy and clinical sign for each stage

A
  1. microalbuminuria: thickened glomerular basement membrane, mesangium- increased GFR
  2. sustained proteinuria: glomerulosclerosis worsens, renal function worsens-GFRdecreases
  3. nephrotic range proteinuria
  4. renal failure
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15
Q

test that can be used for microalbuminuria

A

albumin: creatinine ration
males >30
females >20

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16
Q

management of nephropathy

A
  • statins

- ACEI - for BP and reduce ang II vasoconstriction to decrease pressure

17
Q

when are ACEI ci

A

Renal artery stenosis

18
Q

diabetic neuropathy types

A
  • somatic/ peripheral nervous system
  • visceral autonomic system
  • symmetrical sensory polyneuropathy
19
Q

types of somatic nephropathy

A
  • symmetrical sensory distal
  • asymmetrical motor proximal
  • mononeuropathy-mononeuritis multiplex
20
Q

symmetrical sensory polyneuropathy

A
  • often asymptomatic
  • distal
  • numb feet
  • pain in lower limbs worse at night
  • abnormal gait
  • weakness and atrophy of interosseous muscles
21
Q

what does symmetrical sensory polyneuropathy lead to

A

diabetic and charcot foot=rocker bottom foot

  • claw toe due to loss of lateral and transverse arch
  • calluses
  • cant feel caluses so walk on them and get infected leading to ulceration
22
Q

asymmetrical motor polyneuropathy symptoms

A
  • severe and progressive weakness and wasting of the proximal muscles of lower and upper limbs
  • pain
  • hyperparaesthesia
  • weight loss
  • loss tendon reflex
23
Q

prognosis and cause of asymmetrical motor polyneuropathy

A

usually acute infarction of LMN of lumbrosacral plexus so recovery usually in 12months however some deficits are permanent

24
Q

mononeuropathy somatic which nerves are affected

A
  1. usually 3rd and 6th cranial nerves causing diplopia, femoral and sciatic nerves motor and sensory
  2. nerve compression palsies cause carpal tunnel synrome, polpiteal
25
Q

features of autonomic neuropathy

A
  • cardio: postural hypotension (drop to 30), tachycardia, fixed hr
  • GI: dysphagia, gastroparesis, nocturnal diarrhoea, constipation
  • genitourinary: difficulty micturition, erectile dysfunction , uti due to atonic bladder
  • sudomotor: nocturnal sweats
  • vasomotor: cold feet, dependent oedema
  • pupillary: decreased pupil size
26
Q

prognosis autonomic neuropathy

A

-10 years 50% dead from cardio resp arrest

27
Q

causes of erectile dysfunction

A
  • alcohol
  • antihypertensives thiazide duretics
  • beta blockers
  • neuropathy diabetes and vascular
  • depression
28
Q

management for autonomic neuropathy ie for features above

A
  • insulin
    1. pain and paraesthesia
  • anticonvulsants
  • antidepressants
  • substance p deplete
  • opiates
  • membrane stabilisers
  • antioxidants
    2. postural hypo=fludrocortisone
    3. gastroparesis: laxative or loperamide
    4. atonic bladder=catheter
    5. sweating: anticholinergic
    6. erectile dysfunction: phosphodiesterase type 5 inhibitor
29
Q

causes of a diabetic foot

A
  1. trauma in the prescence of neuropathy
  2. PAD ischaemia reduced healing
  3. infection cause ulcer under calluses
30
Q

what is charcot neuro-arthopathy

A
  • weakness and atrophy of interosseous msucle
  • trauma to foot
  • loss of transverse and lateral arch
  • get claw toe
  • inflammation cause joint dislocation and pathological fractures
  • get rocker bottom foot
31
Q

management dm foot

A
  • educate
  • microfilament
  • foot pulses
  • foot ulcer: boot and orthotics

Endocrine (14 decks)

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