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Final Notes > FN: diabetic Complications > Flashcards

FN: diabetic Complications Flashcards

1
Q

Summary of complications

A 
HyperglycaemiaL DKA, HONK
Hypo
Infetion
Macrovascular: MI, CVA
Microvascular
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2
Q

Macrovascular complication sinclude

A

MI: may be silent due to autonomic neuropathy

  1. PVD: claudication, foot ulcers
    1. CVA
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3
Q

Management of macrovascular ocmplications

A 
Manage CV risk factors
BP - aim for 130/80
Smoking
Lipids
HBa1c
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4
Q

Prevention of macrovascular complications

A
  1. good glycaemic control (e.g. HBA1c
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5
Q

Diabetic foot two types

A

Ischaemia

Neuropathy

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6
Q

ISchaemia

A 
Critical toes
Absent pulses (do AMPI)
UlcersL painful, punched-out, foot margins, pressure points
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7
Q

Neuropathy

A
  1. Loss of protective sensation
    2, Deformity: Charcots joints, pes cavus, claw toes
  2. Injury or infection over pressure points
  3. Ulcers: painles, pnched out, metatarsal heads, calcaneum
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8
Q

Management of diabetic feet conservative

A

Daily foot inspection (e.g. with mirror)
Comfortable/therapeutic shoes
Regular chirody (remove callus

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9
Q

Medical management of diabetic foot

A

Treat infection: benpen + fluclox ± metronidazole

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10
Q

Surgical management of diabetic foot types of conditions treated

A

Abscess or dep infection
Spreading cellulitis
Gangrene
Suuprative arthritis

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11
Q

Neuropathy pathophysiology

A

Hyoerglycaemia –> nephron loss and glomerulosclerosis

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12
Q

Neuropathy features

A
  1. Microalbuminaemia: urine albumin: CR (ACR) >30mg/mM
  2. If present -> ACEi/ARA
  3. Refer if UCR>70
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13
Q

retinopathy path

A

Microvascular disease –> retinal ischaemia -> leads to raised VEGF
VEGF leads to new vessel formation

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14
Q

Retinopathy presentation

A
  1. Retinopathy and maculopathy
  2. Cataracts
  3. Ruberosus iris: new vessels on iris –> glaucoma
  4. CN palsies
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15
Q

Investigations for retinopathy and maculopathy

A

Refer if pre-proliferative retinopathy/maculopathy

Fluorescein angiograohy

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16
Q

Treatment or retinopathy or maculopathy

A

Laser photocoagulation

17
Q

Types

A

BAckgroun retinopathy
Pre-proliferative retinopathy
Proliferative retinaopthy
Maculopathy

18
Q

BAckground retinopathy

A

Dots: microaneuryms
Blot haemorrhages
Hardexudates: yello lipid patches

19
Q

Pre-proliferative retinopathy

A

Cotton-wool spots (retinal infarcts)
Venous vleedings
HAemorrhages

20
Q

prolfierative retinopathy

A

New vessels

Pre-retinal or vitreous haemorrhage

21
Q

Nephropathy pathophysiology

A

Hyoerglycaemia –> nephron loss and glomerulosclerosis

22
Q

Nephropathy features

A
  1. Microalbuminaemia: urine albumin: CR (ACR) >30mg/mM
  2. If present -> ACEi/ARA
  3. Refer if UCR>70
23
Q

Background retinopathy

A

Dots: microaneuryms
Blot haemorrhages
Hardexudates: yello lipid patches

24
Q

Maculopathy

A

reduced acuity may be only signs

Hard exudates w/i one disc width of macula

25
Q

Neuropathy path

A

MEtabolic: glycosylation, ROS sorbitol accumulation
IschaemiaL
loss of vasa nervorum

26
Q

Symmetric sensory polyneuropthy

A
  1. Glove and stocking: length-dependent (therefore feet1st) - loss of all modalities
  2. absent ankle jerks
  3. Numbness, tingling, pain (worse @ night)
27
Q

Symmetric sensory polyneuropathy Rx

A
  1. Paracetamol
  2. Amytroptyline, Gabapentin, SSRI
  3. Capsaicin cream
  4. Baclofen
28
Q

Mononeuropathy/Mononeuritis Multiplex exampe

A

CN3/6 palsiy

29
Q

Femoral Neuropathy/Amyotrophy

A
  1. Painful asymmetric weakness and wasting of quads with loss of knee jerks
30
Q

Femoral Neuropathy/amyotrophy

A

Nerve conductino studies and electromyography

31
Q

Autonomic Neuropathy

A
  1. Postural hypotension - RX fludrocortison
  2. Gastroparesis –> early satiety, GORD, bloating
  3. Diaarrhoea: Treatment with codein phosphate
  4. urinary retentino
  5. ED

Final Notes (196 decks)

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