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eLCRS - 엔도 > Endo 17: Microvascular complications > Flashcards

Endo 17: Microvascular complications Flashcards

1
Q

What are the 3 major sites of microvascular complication?

A
  • retinal arteries
  • glomerular arterioles
  • vasa vasorum
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2
Q

The higher the mean systolic/diastolic BP, the greater the risk of micro + macrovascular complications

A

The higher the mean systolic BP, the greater the risk of micro + macrovascular complications

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3
Q

List 5 major factors affecting the risk of microvascular complications

A
  • severity of hyperglycemia
  • hypertension
  • genetic
  • hyperglycemic memory
  • tissue damage
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4
Q

Mechanisms of glucose damage

A

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5
Q

What might you see through a fundoscope in a patient with diabetic retinopathy?

A
  • hard exudates (leakage of lipid contents) appear as cheesy yellow spaces in the retina
  • micro aneurysms –> can return to cause:
  • blot hemorrhages
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6
Q

What might you see through a fundoscope in a patient with pre proliferative diabetic retinopathy?

A
  • soft exudates (cotton wool spots) –> shows retinal ischemia
  • pre-retinal haemorrhage
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7
Q

What might you see through a fundoscope in a patient with proliferative diabetic retinopathy?

A
  • formation of new vessels
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8
Q

Why might you get formation of new vessel in proliferative retinopathy?

what effect might it cause?

A
  • retinal ischemia causes formation of new vessels

- can cause problems with acuity + color vision

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9
Q

What might you see through a fundoscope in a patient with maculopathy?

A
  • hard exudates near macula

- -> can threaten direct vision

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10
Q

What are the 4 different types of retinopathy ?

A
  • Background Diabetic Retionpathy
  • Pre-proliferative Retinopathy
  • Proliferative Retinopathy
  • Maculopathy
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11
Q

how would you manage the different types of diabetic retinopathy?

  • Background Diabetic Retionpathy
  • Pre-proliferative Retinopathy
  • Proliferative Retinopathy
  • Maculopathy
A

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
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12
Q

What is pan retinal photocoagulation?

A

you laser the retina to stop vessels from bleeding

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13
Q

What are features of diabetic nephropathy?

A
  • hypertension
  • progressively increasing proteinuria
  • progressively deteriorating kidney function
  • classic histological feature
  • increases risk of cardio events
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14
Q

What glomerular changes might you see in diabetic nephropathy?

A

Glomerular changes:

  • mesangial expansion
  • basement memb thickening
  • glomerulosclerosis
  • -> hardening of capillaries
  • -> less flexible + harder glomerulus
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15
Q

Why do you get glomerular changes in diabetic nephropathy?

A
  • 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
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16
Q

what is the effect of angiotensin on capillary pressure?

A

AT causes constriction of efferent arterioles –> therefore increases Transglomerular Capillary Pressure

17
Q

What are 3 major clinical features of diabetic nephropathy?

A
  • progressive proteinuria (normal = <30mg/24hrs)
  • increased BP
  • deranged Renal function
18
Q

Give 3 strategies for intervention of Diabetic Nephropathy

A
  • diabetic control
  • BP control
  • inhibition of activity of RAS system e.g ACE inhibitors
  • stop smoking
19
Q

What causes Diabetic neuropathy?

A
  • blockage of vasa nervorum (small vessels supplying nerves)
20
Q

What are the 6 different types of diabetic neuropathy?

A 
o	Peripheral polyneuropathy
o	Mononeuropathy
o	Mononeuritis multiplex
o	Radiculopathy
o	Autonomic neuropathy
o	Diabetic amyotrophy
  • at parties marilyn monroe regularly abuses drugs
21
Q

What is Peripheral neuropathy?

A
  • loss of sensation
  • -> esp hands + feet
  • -> can’t sense injury to foot
  • causes loss of ankle jerks + vibrational sense
22
Q

How would you test for peripheral neuropathy?

A
  • loss of ankle jerks + vibrational sense

- monofilament examination

23
Q

What is mononeuropathy?

A
  • sudden motor loss
24
Q

What might mononeuropathy cause?

A
  • wrist drop
  • foot drop
  • cranial nerve palsy
  • double vision –> due to 3rd nerve palsy
25
Q

What are features of pupil sparing 3rd nerve palsy?

A
  • down and out eye orientation

- pupil DOES respond to light

26
Q

How does aneurysm cause 3rd nerve palsy ?

A

in diabetes, pupil still responds to light but for tumour/ hemorrhage –> it presses on the Parasympathetic nerves –> causing fixed dilated pupil

27
Q

What is mononeuritis multiplex?

A
  • random combination of peripheral nerve lesions
28
Q

what is radiculopathy?

A
  • pain over spinal nerves

- affecting dermatome on abdomen / chest wall

29
Q

What is autonomic neuropathy?

A
  • loss of sympathetic + parasympathetic nerves to the GI tract / bladder / cardiovascular system
30
Q

What is the effect of autonomic neuropathy on the GI tract ?

A
  • difficulty swallowing
  • delayed gastric emptying
  • constipation/ nocturnal diarrhea
  • bladder dysfunction
31
Q

What is the effect of autonomic neuropathy on the cardiovascular system?

A
  • postural hypotension

- cardiac autonomic supply

32
Q

How would you check for autonomic neuropathy?

A
  • measure change in HR
  • -> in response to Valsalva Manouevre
  • make patient blow into a tube –> normally causes change in HR
  • then look at ECG + compare R-R intervals
33
Q

Angiotensin II improves/ worsens the effects of diabetic nephropathy

A

Angiotensin II worsens the effects of diabetic nephropathy

34
Q

Neuropathy is more like to occur in short/ tall individuals.

A

Neuropathy is more like to occur in tall individuals.

35
Q

Why do patients with diabetic nephropathy get oedematous?

A
  • There is an increase in proteinuria –> so they are losing albumin through their urine
  • Which decreases serum albumin
  • Which decreases osmotic potential of plasma
  • So less fluid = drawn back into circulation

eLCRS - 엔도 (20 decks)

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