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Endocrine System > Diabetic Foot Syndrome > Flashcards

Diabetic Foot Syndrome Flashcards

1
Q

Why is Diabetic Foot Syndrome known as a syndrome?

A

Associated symptoms affect other organs, and have a variety of complications

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2
Q

What is Diabetic Foot Syndrome?

A

A foot that exhibits any pathology that results directly from diabetes mellitus or any chronic complications of diabetes mellitus

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3
Q

What do diabetic foot infections cause?

A

Substantial morbidity & frequent visits: 24% of patients with diabetic foot users will end up with amputations

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4
Q

What are the factors that allow for diabetic foot syndrome to occur?

A

Azotemia
Impaired Immunity
Poor circulation –> less functional cells
Hyperglycemia

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5
Q

What are some diabteic foot pathologies?

A

Infection
Diabetic foot ulcer
Neuropathic Osteoarthropathy

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6
Q

What are the ranges of diabetic foot syndrome?

A

Uninfected
Mild
Moderate
Severe

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7
Q

What are the complications of diabetes that can lead DFS?

A

Vascular disease
Neuropathy

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8
Q

What is the associated risk factor with high blood sugar levels?

A

Lowered immunity –> resistance

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9
Q

What are the contributing factors to DFS?

A

Trauma
Shoe irritation
Low temperature
Ischemia
Foot ulcers
Skin hyperkeratosis, lesions, and fungal infections
Metabolic instability
Deep tissue penetration
Toxin producers and virulent bacteria

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10
Q
A
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11
Q

What is the doctor for feet called?

A

Podiatrist

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11
Q

How is the loss of fat pad a risk factor for DFS?

A

Protection of foot by fat pad
Slippage and thinning of the plantar fat pad
Lost fat pad (risk to ulcer)

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11
Q

What causes the reduced pain sensation in diabetic patients?

A

Neuropathy as a result of chronic diabetes complication

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12
Q

Why is the risk of losing fat pad greater in women?

A

The shoes that women wear are inadequate for offloading pressure, which accelerates the process of losing the fat pad

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13
Q

What is the physiology of DFS (simplified)?

A

High glucose
Oxidative stress
Inflammation
Neuropathy and Angiopathy
Ulcer

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14
Q

Why is early detection and treatment of diabetic foot ulcers instant?

A

Patients with diabetes already have delayed wound response because of the compromised immune system, delaying treatment would mean the damage escalates, and the treatment will be even less effective

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15
Q

Why is diabetic foot ulceration response delayed?

A

Excessive inflammation and necrosis which leads to microbial colonization and gangrene

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16
Q

What is the grading of diabetic foot ulcers?

A

Grade 0 to Grade 5

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17
Q

What is garde 0 of diabetic foot ulcers like?

A

No open lesion –> only monitor

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18
Q

What is grade 1 diabetic foot ulcers like?

A

Superficial ulcers, topical antibiotic

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19
Q

What is grade 2 of diabetic foot ulcers like?

A

Deep ulcer, system antibiotics

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20
Q

What is grade 3 of diabetic foot ulcers like?

A

Abscess osteitis, IV antibiotics

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21
Q

What is grade 4 of diabetic foot ulcers like?

A

Gangrene forefoot, necrotized tissue –> amputation of toes

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22
Q

What is grade 5 of diabetic foot ulcers like?

A

Gangrene entire foot, amputation of the foot as a whole

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23
Q

What is the grade scale for diabetic foot ulcers?

A

Wagner classification

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24
Q

What is osteomyelitis?

A

Infection of the bone and the muscle

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25
Q

How rapidly can a diabetic foot infection progress?

A

As fast as 10 days

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26
Q

What are diabetic foot infections like?

A

They are polymicrobial infections, can be caused by a combination of fungi, anaerobes, gram (+) aerobes, and gram (-) aerobes

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27
Q

Which type of organism is the major cause of diabetic foot infection?

A

Fram positive bacteria

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28
Q

What are examples of fungi that cause diabetic foot infection? (2)

A
  1. Candida species
  2. Fusarium
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29
Q

What are examples of gram-positive aerobes that cause diabetic foot infection? (5)

A
  1. MRSA
  2. S. epidermidis
  3. Strep species
  4. Enetrococcus
  5. Corneobacterium species
30
Q

What are examples of gram-negative aerobes that cause diabetic foot infection? (8)

A
  1. Proteus mirabilis
  2. Proteus vulgaris
  3. E. coli
  4. Klabsiella
  5. Sevretis species
  6. Enterobacter
  7. Pseudomonas aeruginosa
  8. Acinobacter species
31
Q

What are examples of anaerobes that can cause diabetic foot infection? (5)

A
  1. Bacteroides fragilis
  2. Bacteroides species
  3. Clostridium perfivigens
    4.. Anaerobic Staph. pepiococcus species
  4. Anaerobic Staph. peptostreptococcus species
32
Q

What does “No Growth” indicate on culture?

A

The ulcer is not yet affected, or the patient has already received antibiotics

33
Q

When are gram-positive bacteria the most common causing pathogens when it comes to diabetic foot infections?

A

In previously untreated, mild or moderate diabetic foot infections

34
Q

When are polymicrobial infections the most common cause of diabetic foot infections?

A

In patients who have received antibiotics or have deep wond and chronic foot infections

35
Q

When is Clostridium a common cause for diabetic foot infections?

A

Among severely infected and gangrenous wounds

36
Q

Which virulence factors cause foot gangrene? (6)

A
  1. Toxins
  2. Exoenzymes
  3. Biofilm Formation
  4. Hemolysins
  5. Adhesion Factors
  6. Inflammatory mediators
37
Q

Why are diabetic foot infections difficult to treat?

A

Diabetic patients have:
1. Impaired microvascular circulation
2. Limited access to phagocytic cells to the infected area
3. Poor concentration of antibiotics in infected tissue
4

38
Q

What is cellulitis?

A

Infection of the subcutaneous tissue

39
Q

What is the prognosis of cellulitis?

A

Easier to treat and it is a reversible form of diabetic foot infections

40
Q

What is the prognosis of deep-skin and soft tissue infections?

A

They are treatable, however, they can be life-threatening and result in substantial morbidity

41
Q

What is the empiric antibiotic treatment for mild infections? Examples?

A

Oral antibiotics that cover skin flora, including streptococci and staph. aerus

Examples: Cephalexin, Dicloxacillin, Amoxicillin-Clavulanate, Clindamycin

42
Q

What is the treatment of patients with moderate to severe diabetic foot infections like?

A

Should be hospitalized for parenteral antibiotic therapy

Examples: Ampicillin-sulbactam, piperacillin-tazobactam, meropenem, ertapenem, ceftiaxone, cefepime, levofloxacin, moxifloxacin or aztreonam

43
Q

What is the purpose of the self-healing hydrogel in diabetic foot infections?

A

It includes antibacterial and angiogenic properties that, when covering the wound, are released and expedite the recovery process

44
Q

How does AI help control diabetes?

A

Glucotrack
D-Base
MediWise device
They all use infrared to detect the levels of glucose in the blood and inform the patient

45
Q

What are the diabetic foot “smart socks?”

A

They detect pressure and heat, which portray signs of inflammation, and make the patient; this is useful due to the decreased sensation in the legs

46
Q

What is the diabetic foot “smart shoe?”

A

Computer engineering approach that uses wireless technology and intelligence sensed data t interpretation to detect, prevent, and manage possible chronic diabetic diseases

47
Q

What are the spore-forming clostridium bacteria? What do they cause?

A

C. perfingens –> gas gangrene
C. botulinum –> Botulism
C. tetani –> Tetanus
C. difficile –> C. diff colitis

48
Q

What are spore-forming bacteria like?

A

Gram-positive, spore-forming rods
Obligate anaerobes
Oval or spherical spores
Synthesize organic acids, alcohols, and exotoxins
They are heat, and environment resistant

49
Q

What do spore-forming bacteria cause?

A

Wound infections, tissue infections and food poisoning

50
Q

What is antibiotic-associated diarrhea?

A

Caused by C. difficile
acute diarrhea generally develops 5 to 10 days after initiation of antibiotic treatment
May be brief and self-limited or more protracted

51
Q

Which medications are associated with antibiotic-associated diarrhea?

A

Clindamycin
Penicillins
Cephalosporins
Fluoroquinolones

52
Q

What is Pseudomembranous colitis?

A

Cause by C. difficile
Most severe form of C. difficile disease, with profuse diarrhea, abdominal cramping, and fever, whitish plaques over intact colonic tissue seen in colonoscopy

53
Q

What are the soft tissue infections of C. perfinigens?

A
  1. Cellulitis
  2. Suppurative myositis
  3. Myonecrosis
54
Q

What is cellulitis?

A

Localised edema and erythema with gas formation in the soft tissue, generally non-painful

55
Q

What is suppurative myositis?

A

Accumulation of pus (suppuration) in the muscle planes without muscle necrosis or systemic symptoms

56
Q

What is myonecrosis?

A

Painful, rapid destruction of muscle tissue, systemic spread with high mortality

57
Q

What are the different gastroeneteritis of C. perfingens?

A

Food poisoning
Necrotizing enteritis

58
Q

What is food poisoning?

A

Rapid onset of abdominal cramps and watery diarrhea with no fever, or vomiting, short duration and self limiting

59
Q

What is necrotizing enteritis?

A

Acute, necrotizing destruction of jejunum, with abdominal pain, vomiting, bloody diarrhea, and peritonitis

60
Q

What are the different infections caused by C. tetani?

A

Generalised tetanus
Localized tetanus
Neonatal tetanus

61
Q

What is generalised tetanus?

A

Generalized musculature spasms and involvement of the ANS in severe disease

62
Q

What is localized tetanus?

A

Musculature spasms restricted to localized areas of primary infection

63
Q

What is neonatal infection?

A

Primarily involving the umbilical stump, very high mortality

64
Q

WHat are the different kinds of Botulism caused by C. botulinum?

A

Foodborne botulism
Infant botulism
Wound botulism
Inhalation botulism

65
Q

What is foodbone botulism?

A

Initial presentation of blurred vision, dry mouth, constipation, and abdominal pain. Progresses to bilateral descending weakness of peripheral muscles, with flaccid paralysis

66
Q

What is infant botulism?

A

Initially non-specific symptoms (constipation, weak cry, failure to thrive) that progresses to flaccid paralysis and respiratory arrest

67
Q

What is wound botulism?

A

Clinical presentation is the same as the foodborne disease, although the incubation period is longer and fewer, GI symptoms reported

68
Q

What is inhalation botulism?

A

Rapid onset of symptoms (flaccid paralysis, pulmonary failure) and high mortality from inhalation exposure to botulinum toxin

69
Q

What is the pathogeneis of C. tetanus?

A

The tetanospasm toxin blocks inhibitory neurotransmitters release leading to continuous stimulation of excitatory transmitters

70
Q

What is the pathogeneis of C. botulinum?

A

The botulinum toxin blocks release of ACH thus inhibit muscle excitation, disease manifests as flaccid paralysis

71
Q

What food types contain C. Botulinum?

A

Home-made sausage
Egyptian fish

72
Q

What is the anaerobic culture method, and why is it done?

A

An anaerobic chamber or anaerobic jar is used where all oxygen is absorbed, in order for the anaerobic bacteria to be able to grow and thrive

73
Q
A

Endocrine System (10 decks)

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