Endo 17: Microvascular complications Flashcards
What are the 3 major sites of microvascular complication?
- retinal arteries
- glomerular arterioles
- vasa vasorum
The higher the mean systolic/diastolic BP, the greater the risk of micro + macrovascular complications
The higher the mean systolic BP, the greater the risk of micro + macrovascular complications
List 5 major factors affecting the risk of microvascular complications
- severity of hyperglycemia
- hypertension
- genetic
- hyperglycemic memory
- tissue damage
Mechanisms of glucose damage
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What might you see through a fundoscope in a patient with diabetic retinopathy?
- hard exudates (leakage of lipid contents) appear as cheesy yellow spaces in the retina
- micro aneurysms –> can return to cause:
- blot hemorrhages
What might you see through a fundoscope in a patient with pre proliferative diabetic retinopathy?
- soft exudates (cotton wool spots) –> shows retinal ischemia
- pre-retinal haemorrhage
What might you see through a fundoscope in a patient with proliferative diabetic retinopathy?
- formation of new vessels
Why might you get formation of new vessel in proliferative retinopathy?
what effect might it cause?
- retinal ischemia causes formation of new vessels
- can cause problems with acuity + color vision
What might you see through a fundoscope in a patient with maculopathy?
- hard exudates near macula
- -> can threaten direct vision
What are the 4 different types of retinopathy ?
- Background Diabetic Retionpathy
- Pre-proliferative Retinopathy
- Proliferative Retinopathy
- Maculopathy
how would you manage the different types of diabetic retinopathy?
- Background Diabetic Retionpathy
- Pre-proliferative Retinopathy
- Proliferative Retinopathy
- Maculopathy
Background Diabetic Retionpathy:
- improve control of blood glucose
Pre-proliferative Retinopathy:
- pan retinal photocoagulation
- Proliferative Retinopathy:
- pan retinal photocoagulation
- Maculopathy:
- GRID of photocoagulation in affected area
What is pan retinal photocoagulation?
you laser the retina to stop vessels from bleeding
What are features of diabetic nephropathy?
- hypertension
- progressively increasing proteinuria
- progressively deteriorating kidney function
- classic histological feature
- increases risk of cardio events
What glomerular changes might you see in diabetic nephropathy?
Glomerular changes:
- mesangial expansion
- basement memb thickening
- glomerulosclerosis
- -> hardening of capillaries
- -> less flexible + harder glomerulus
Why do you get glomerular changes in diabetic nephropathy?
- in diabetic nephropathy –> there is OVER production of matrix
- which leads to mesangial expansion + basement memb thickening
- then you get sclerosis of glomerulus –> which increases pressure in glomerular capillaries
- which stimulates the expansion of the matrix
what is the effect of angiotensin on capillary pressure?
AT causes constriction of efferent arterioles –> therefore increases Transglomerular Capillary Pressure
What are 3 major clinical features of diabetic nephropathy?
- progressive proteinuria (normal = <30mg/24hrs)
- increased BP
- deranged Renal function
Give 3 strategies for intervention of Diabetic Nephropathy
- diabetic control
- BP control
- inhibition of activity of RAS system e.g ACE inhibitors
- stop smoking
What causes Diabetic neuropathy?
- blockage of vasa nervorum (small vessels supplying nerves)
What are the 6 different types of diabetic neuropathy?
o Peripheral polyneuropathy o Mononeuropathy o Mononeuritis multiplex o Radiculopathy o Autonomic neuropathy o Diabetic amyotrophy
- at parties marilyn monroe regularly abuses drugs
What is Peripheral neuropathy?
- loss of sensation
- -> esp hands + feet
- -> can’t sense injury to foot
- causes loss of ankle jerks + vibrational sense
How would you test for peripheral neuropathy?
- loss of ankle jerks + vibrational sense
- monofilament examination
What is mononeuropathy?
- sudden motor loss
What might mononeuropathy cause?
- wrist drop
- foot drop
- cranial nerve palsy
- double vision –> due to 3rd nerve palsy
