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Endocrine > DM Foot problems > Flashcards

DM Foot problems Flashcards

1
Q

What are the three major complications that arise from DM?

A
  • Peripheral neuropathy
  • Autonomic Neuropathy
  • PVD
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2
Q

What are the arteries that are classically associated with PVD?

A

Tibial

Peroneal (fibular)

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3
Q

What are the three major contributing factors of PVD in DM?

A
  • Smoking
  • HTN
  • Hyperlipidema
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4
Q

What happens to bone with autonomic dysfunction of the foot?

A

Dilation of vessels, causing increased bone resorption

charcot foot

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5
Q

What happens to the skin of the foot with autonomic dysfunction of the foot?

A

Dry, cracked skin

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6
Q

What are the immune consequences of PVD?

A

Impaired wound healing

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7
Q

What are the components of metabolic syndrome?

A
  1. Hyperinsulinemia
  2. Hypertriglyceridemia
  3. HTN
  4. Central obesity
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8
Q

What are the ssx of PVD?

A
  • Atrophic skin
  • Rest pain
  • Claudication
  • Pallor on elevation
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9
Q

What happens to the aorta and medium sized vessels with PVD?

A

Accelerated atherosclerosis

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10
Q

What are the major PE findings of PVD?

A
  • Diminished pulses
  • Cap refill time
  • Skin atrophy
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11
Q

What is the inexpensive test that can be used to evaluate for PVD?

A

Ankle brachial index

Greater than 0.50

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12
Q

What is the minimum value of the ABI and transcutaneous oxygen that is needed for healing in the foot?

A

More than 0.5

More than 30 mmHg

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13
Q

What is a normal ankle brachial index? Moderate obstruction?

A

Above 0.9

Moderate = 0.5-0.8

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14
Q

At what level of obstruction does loss of the arterial rebound with occur? What about loss of the reversal of blood flow

A

Mild obstruction

Moderate obstruction

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15
Q

What can cause an inaccurate ABI? Why?

A

Calcified vessels will lower the ratio, since they will not compress as readily

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16
Q

What happen to the waveform of the doppler US as you progress from normal to severe obstruction?

A 
Normal = triphasic
Mild = biphasic
Moderate = monophasic
Severe = loss of peaks
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17
Q

What is transcutaneous oxygen pressure measurement?

A

O2 levels in the arteries through the skin

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18
Q

Why may someone with a poor ABI have a normal transcutaneous oxygen pressure?

A

Collateral circulation

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19
Q

What are the invasive vascular exam that may be performed to assess for arterial oxygen? (3)

A

Arteriography
MRA
DSA

20
Q

What are the causes of the increased ulceration risk with peripheral neuropathy, beside the loss of sensation and increased blood flow?

A

More pressure on the toes and bony prominences

21
Q

What is “neuro-traumatic” theory of Charcot foot osteoarthropathy?

A

Exaggerated overuse injury coupled with loss of protective sensation

Allows for continued tissue destruction in

22
Q

What is “neurovascular” theory of Charcot foot osteoarthropathy?

A

AV shunting leads to excessive bone resorption, contributing to fractures

23
Q

What is stage 1 Charcot neuropathy?

A

The acute destructive phase, characterized by inflammation, joint effusion, and degradation of bone

24
Q

What is stage 2 Charcot neuropathy?

A

Coalescence phase:

-Further bone/cartilage destruction, but initiation of sclerosis where cartilage has degraded, and fusion of bone fragments

25
Q

What is stage 3 Charcot neuropathy?

A

Reconstruction phase:

  • Remodeling of joint surfaces
  • Sclerosis
26
Q

What is the treatment for the acute stage of Charcot foot?

A
  • Reduce weight bearing
  • Cast immobilization
  • Drugs to inhibit bone resorption
  • Manage ulcers
27
Q

What is the major issue with immobilization of one foot for charcot?

A

Will favor the other foot, causing Charcot on the other

28
Q

How do you follow Charcot?

A

Weekly foot x-rays

29
Q

When is surgery for Charcot indicated?

A

If causing pressure ulcers d/t bone remodeling

30
Q

What happens to the bones with Charcot foot?

A

“Rocker-bottom” foot d/t loss of midfoot

31
Q

What are the four major types of ulcerations?

A

Arterial
Venous
Neuropathic
Pressure

32
Q

What are the molecular stages of chronic wound healing?

A

Constant inflammatory cytokines increases proteases and MMPs, and a loss of GFs and TIMPs

33
Q

What is grade 0 Wagner’s foot?

A

No evidence of ulcer or infx

34
Q

What is grade 1 Wagner’s foot?

A

Superficial ulcers

35
Q

What is grade 2 Wagner’s foot?

A

Ulcers that have not yet penetrated to the bone or fascial plane

36
Q

What is grade 3 Wagner’s foot?

A

Ulcers extend to bone, or have invaded fascial plane

37
Q

What is grade 4 Wagner’s foot?

A

Feet have gangrene of the forefoot

38
Q

What is grade 5 Wagner’s foot?

A

Gangrene of the entire foot that will likely require amputation

39
Q

What are the general principles of ulcer wound management (3)

A
  • Increase vascular supply
  • Debride/wound management
  • Offload
40
Q

What are the most common infections seen in DM Pts?

A

Bacterial and fungal skin infx

41
Q

How do you collect a good culture of the foot?

A

Deep swab and collect purulence

42
Q

What is the definitive diagnostic modality for osteomyelitis?

A

Bone biopsy

43
Q

What are Tc-99m scans used for?

A

Collects on osteoapatite

very sensitive, but not specific

44
Q

What can indium scans detect?

A

WBCs with:
Acute osteomyelitis
Acute cellulitis

45
Q

What can ceretec scans detect?

A

WBCs with:

Acute osteomyelitis

46
Q

What can Tc-99 scan detect? (4)

A
  • Acute/inactive osteomyelitis
  • Acute cellulitis
  • Charcot joint
47
Q

Why is it that the indium scan no detect inactive chronic osteomyelitis?

A

No WBCs present

Endocrine (32 decks)

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