GP 2 Flashcards
What is dyspepsia?
Indigestion - upper abdo symptoms such as heartburn/acidity/pain/discomfort/nausea/bloating
Symptoms of dyspepsia?
Epigastric pain often related to hunger, specific foods, or time of day
Bloating, fullness, heartburn
ALARMS symptoms in dyspepsia?
Anaemia Loss of weight Anorexia Recent onset/progressive Melaena/haematemesis Swallowing difficulty
> 55 years
If >55 or ALARMS signs what is management?
Upper GI endoscopy
If <55 or no ALARMS signs what is management?
Lifestyle advice, ITC antacids, review
If no improvement test for H.pylori - Carbon 13 breath test
Management if no H.pylori present and still symptoms?
PPI (omeprazole) or H2 blockers (ranitidine) for 4 weeks
Management if H.pylori present?
Omeprazole AND amoxicillin (or metronidazole) AND clarithromycin
What is GORD?
Gastrooesophageal reflux disorder
Pathophysiology of GORD?
Reflux of stomach contents causes symptoms i.e. heartburn or complications i.e. oesophagitis
Causes of GORD? (6)
Lower oesophageal sphincter hypotension Hiatus hernia Loss of gastric peristalsis/slow emptying Obesity Acid hypersecretion Smoking, alcohol, overeating
Symptoms of GORD? (5)
Heartburn - burning retrosternal discomfort, worse on lying or after big meal Acid/bile/water regurgitation Belching Painful swallowing Can cause cough, hoarse voice
Complications of GORD?
Oesophagitis Benign stricture Ulcers Iron deficiency Metaplasia - barrett's oesophagus (squamous to columnar change)
Investigations in GORD? (4)
Endoscopy - esp if ALARMS, refractive, palpable mass, persistent vomiting
Barium swallow may show hiatus hernia (gastro-oesophageal junction slides into chest and sphincter is less competent)
Oesophageal pH monitoring
Bloods - FBC for anaemia
Lifestyle changes for GORD? (6)
Raise bed head
Weight loss
Stop smoking
Smaller, regular meals
Avoid - hot drinks, fizzy, alcohol, citrus fruits, spicy foods, coffee, chocolate, eating before bed
Avoid NSAIDs or other gastric damaging drugs
Medications for GORD?
Antacids - magnesium trisilicate mixture
Alginates - Gaviscon
Proton pump inhibitor - lansoprazole
H2 blocker - ranitidine
Surgery for GORD?
Nissen fundoplication to increase LOS pressure
How do antacid containing alginates work?
Form a foam raft over gastric contents to reduce reflux
How do PPIs work?
Inhibits the membrane enzyme H+/K+ ATPase to inhibit gastric acid secretion
CI/SEs of PPIs
CI: can increase risk of fractures in elderly, GI infections, may mask gastric cancer symptoms
SE: abdo pain, constipation, dizziness
How does ranitidine work?
Blocks the H2 (histamine) receptors, stops cells from producing acid
What is IBS?
Irritable bowel syndrome - mixed group of abdominal symptoms for which no organic cause can be found
Cause of IBS?
Most due to disorders of intestinal motility or enhanced visceral perception
Diagnosis of IBS?
Abdominal pain/discomfort relieved by defecation OR associated with altered stool form/frequency AND 2 of: Urgency Incomplete evacuation Abdominal bloating/distension Mucous PR Worse symptoms after food
Chronic >6 months
What can exacerbate IBS?
Menstruation
Stress
Gastroenteritis
Signs of IBS?
May have generalised abdo tenderness
Pt is younger woman
Tests for IBS?
Exclude other diagnoses - FBC, ESR, CRP, LFT, coeliac serology
Colonoscopy if unsure
May need Ca125 to exclude ovarian Ca
Management of IBS? (4)
Healthy diet - fibre, lactose, starch, caffeine, alcohol may worsen
Bisacodyl laxative
Loperamide for diarrhoea
Antispasmodics - mebeverine
What is coeliac disease?
T cell mediated autoimmune disease of the small bowel
Pathophysiology of coeliac disease?
Prolamin intolerance i.e. gliadin (gluten proteins) causes villous atrophy and malabsorption
Associated conditions with coeliac?
HLA DQ9/8 - other autoimmune disease Dermatitis herpetiformis (severe itching, red raised patches that often blister)
Symptoms of coeliac disease? (11)
Diarrhoea Stinking stools/steatorrhoea Abdominal pain Bloating Nausea, vomiting Apthous ulcers Angular stomatitis Weight loss Fatigue Osteomalacia Failure to thrive
Diagnosis/investigation of coeliac disease? (4)
Bloods - low Hb, low B12, low ferritin
Antibodies - alpha gliadin, tissue transglutaminase, IgA anti-endomysial (most specific)
Endoscopy and biopsy
SYMPTOMS/SIGNS REVERSE ON GLUTEN FREE DIET
What is seen on endoscopy/biopsy in coeliac?
Duodenal biopsy shows subtotal VILLOUS ATROPHY, INTRA EPITHELIAL WBCs, CRYPT HYPERPLASIA
Treatment of coeliac disease? (3)
Lifelong gluten free diet
Can prescribe gluten free bread, pasta, flour
Verify diet by anti-endomysial antibody monitoring
Complications of coeliac disease? (6)
Anaemia T cell lymphoma Malignancy - gastric, oesophageal, bladder Myopathies Neuropathies Osteoporosis
What is ulcerative colitis?
Relapsing and remitting inflammatory disorder of the colonic mucosa
Distribution of UC?
Just the rectum (proctitis) or extend to part of the sigmoid or whole colon - never proximal to ileocaecal valve
Cause of UC?
Unknown. Some genetic risk
Smoking is protective
Pathology of UC?
Haemorrhagic granular colonic MUCOSA, possibly with pseudopolyps formed by inflammation
Punctate ulcers into lamina propria but not usually transmural
Symptoms of UC? (5)
Episodic/chronic diarrhoea possibly with blood and mucus Crampy abdo pain Bowel frequency Urgency Fever, malaise, weight loss
Signs of UC?
If acute may be fever, tachycardia, tender abdomen
Extraintestinal signs of UC? (6)
Clubbing Apthous ulcers Erythema nodosum Conjunctivitis, episcleritis, iritis Large joint arthritis Ankylosing spondylitis
Tests for UC?
Blood - FBC, U+E, LFT, ESR, CRP, cultures
Stool MC+S
Abdo XR
Colonoscopy and biopsy
What is seen on abdo XR in UC?
Mucosal thickening and colonic dilatation
What is seen in colonoscopy biopsy in UC? (5)
Inflammatory infiltrate Goblet cell depletion Glandular distortion Mucosal ulcers Crypt abscesses
Complications of UC? (5)
Perforation Haemorrhage Toxic colon dilatation Venous thrombosis Colonic cancer
How is mild UC treated? (<4 stools, small bleeding) (2)
5-aminosalicylic acid (5-ASAs) - sulfasalazine for remission induction/maintenance
Prednisolone low dose 2 wks helps remission induction
How is moderate UC treated? (4-6 stools, moderate bleeding) (3)
Oral prednisolone high dose for 2 weeks
Lower dose for 4 weeks with sulfasalazine and steroid enemas
How is severe UC treated? (>6 stools, unwell, large bleeding) (5)
ADMIT for NBM and fluids
Hydrocortisone IV
Rectal hydrocortisone
Daily testing, consider transfusion
Transfer to prednisolone high dose and sulfasalazine if improving
How is severe UC that is not improving treated? (2)
Rescue therapy - ciclosporin or infliximab
Surgery - colectomy
What is Crohn’s disease?
Chronic inflammatory GI disease
Pathology of Crohn’s?
TRANSMURAL granulomatous inflammation affecting the GI tract from mouth to anus
Skip lesions - unaffected areas between disease (UC is continuous)
Cause of Crohn’s?
Unknown. Smoking increases risk, genetics
Symptoms of Crohns? (5)
Diarrhoea/urgency Abdo pain Weight loss/FTT Fever, malaise, anorexia Vomiting
Signs of Crohns?
Apthous ulcers
Abdo tenderness
Perianal abscesses/fistulae/SKIN TAGS
Anal strictures
Extraintestinal signs of Corhns? (5)
Clubbing Erythema nodosum Large joint arthritis Ankylosing spondylitis Conjunctivitis, episcleritis, iritis
Complications of Crohns? (7)
Small bowel obstruction Toxic dilatation - rarer than UC Abscesses Fistulae Perforation Haemorrhage Colon cancer
Tests for Crohns? (6)
Bloods - FBC, ESR, CRP, U+E, LFT, ferritin, folate, B12 Stool MC+S Colonoscopy and biopsy Small bowel enema, barium enema MRI to assess extent and fistulae
What is seen on colonoscopy and biopsy in Crohns? (6)
Deep fissured ulcers - transmural Skip lesions Narrowed lumen Inflammatory infiltrate Granulomas with or without langhans giant cells Lymphoid hyperplasia
How are mild attacks (systemically well) treated in Crohns?
Prednisolone high for 1 week, lower for 4 and wean off
How is severe Crohns treated?
ADMIT for NBM, fluids
IV hydrocortisone, rectal hydrocortisone
Metronidazole IV
Daily testing, consider transfusion
If improving transfer to oral prednisolone
How to treat severe Crohns that is not improving?
Infliximab, adalimumab
Surgery if refractive
Other drugs that may be given in Crohns? Useful in <50%
Azathioprine, methotrexate - steroid sparing
Sulfasalazine MAY work
How does sulfasalazine work? CI, SEs
Decreases inflammation, inhibits prostaglandin formation
SE: reversible infertility in men, rash, headache (rarely pancreatitis, hepatitis)
CI: asthma, risk of hepatic toxicity
How do infliximab/adalimumab work? CI, SEs
TNF alpha inhibitors, counter granuloma formation and WC infiltration
CI: sepsis, liver disease
SE: rash, infections
What is osteoarthritis?
Commonest joint condition.
Disease of synovial joints, usually primary but may be secondary i.e. to obesity
Structures involved in osteoarthritis?
The whole joint structure inc. cartilage, ligaments, capsule
Localised disease usually knee or hip
Pathogenesis of OA?
Loss of articular cartilage
Remodelling of underlying bone due to mechanical damage/inflammation/metabolic defect
In whom is OA most common?
Females >50
Symptoms of localised OA? (6)
Usually KNEE or HIP pain on movement Crepitus Worse at end of day Background pain at rest Stiffness AFTER rest Joint instability
Symptoms of generalised OA? (7)
Commonly DIP joints, thumb meta-carpals, knees Heberden's nodes - DIP Bouchards nodes - PIP Joint tenderness Derangement Bony swelling Decreased ROM Synovitis
Investigations in OA?
Bloods - ESR, CRP
XR/MRI
What does XR show in OA?
Loss of joint space
Osteophytes
Subarticular sclerosis
Sunchondral cysts
Management of OA? (6)
Exercise, weight loss
Analgesia - paracetamol, topical NSAIDs, codeine
Intra-articular steroid injections
MDT - Physio, OTs
Heat/cold packs, stretching
Surgery - joint replacement for hip or knee
MDT advice to give in OA?
Physio for exercises, splints OT for aids i.e. walking stick Chiropodist for foot care Social worker for benefits, housing Orthopaedics for surgery
What is rheumatoid arthritis?
Most common disorder of connective tissue
Cause of RA?
Immunological
Triggered by environmental factors in patients with a genetic predisposition
How does RA present? (6)
Commonly in middle aged females Symmetrical small joint involvement - pain, stiffness, swelling, functional loss EARLY MORNING STIFFNESS Joint deformity and damage Can be monoarthritis Systemic - malaise, pain
Signs of RA?
Predominantly peripheral joints
Joint effusions
Soft tissue swelling
Investigations of RA? (3)
FBC - anaemia, ESR/CRP high
Rheumatoid factor and anti-CCP antibodies
XR
What does XR show in RA?
Early - normal osteoporosis or soft tissue sweling
Later - loss of joint space, erosions, joint destruction
Management of RA? (4)
MDT - physio, OT, surgery, nurse
Exercise and splints
NSAIDs and paracetamol
Corticosteroid joint injections
DMARDS - methotrexate, sulfasalazine, rituximab
Surgery - joint fusion/excision/replacement
Complications of RA? (5)
Disability Depression Osteoporosis Infections Amyloidosis
Features of RA in the hands? (4)
Ulnar deviation of the fingers Z deformity of thumb Swan neck (extended PIP, flexed DIP) and boutonniere (flexed PIP, extended MCP and DIP) deformities of the fingers
Non joint features of RA?(6)
Rheumatoid nodules on forearms Vasculitis Sjogrens, episcleritis, scleritis Mononeuritis/peripheral neuropathy Pleural effusions, lung nodules Pericarditis
Indications of warfarin? (3)
Prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation,
Prophylaxis after insertion of prosthetic heart valve,
Prophylaxis and treatment of venous thrombosis and pulmonary embolism, TIAs
Target INR for warfarin?
2-3 (2.5)
If recurrent VTE, 3.5 (higher dose warfarin)
Length of warfarin treatment after VTE?
Provoked - 3 months
Unprovoked - 6 months
Treatment of CHADSVASC scores 0, 1, >2?
0 - no antithrombotic, or aspirin
1 - aspirin or warfarin/NOAC
>2 - warfarin/NOAC
Contraindications for warfarin? SEs?
48 hrs post partum, significant bleeding
Haemorrhagic stroke
SE: haemorrhage, nausea, hepatic damage
Mechanism of warfarin?
Warfarin decreases the body’s ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. Vitamin K is needed to make clotting factors and prevent bleeding.
What are the vitamin K dependent clotting factors?
II, VII, IX and X
2 7 9 10
Causes of hyperthyroidism? (4)
Graves disease Thyroiditis Toxic nodular goitre Drugs - amiodarone Postpartum
Presentation of hyperthyroidism? (14)
Weight loss Diarrhoea Heat intolerance Irritability Hyperactivity Tremor Palpitations Atrial fibrillation Hyperhidrosis Infertility, ED Alopecia Eye signs Amenorrhoea Pretibial myxoedema
How may hyperthyroidism present in the elderly?(4)
Confusion
Dementia
Apathy
Dementia
Eye signs in hyperthyroidism? (6)
Lid lag Lid retraction Exopthalmos Proptosis Double vision Opthalmoplegia of upward gze
Tests for hyperthyroidism? (6)
Low TSH High T3 and T4 May be anaemia, hypercalcaemic, high ESR Check thyroid autoantibodies Isotope scan Check eyes
What is Graves disease?
Most common form of hyperthyroidism - may also be hypo
Associated with smoking
Pathophysiology of Graves disease?
Autoimmune
Antibodies to the TSH receptor are produced, activating thyrotropin receptors causing smooth thyroid enlargement and increased hormone production
Features of Graves?
Hyperthyroidism
Diffuse goitre +/- thyroid bruit
Eye disease, pretibial myxoedema, oncholysis
What is a thyroid storm?
Severe hyperthyroid - confusion, agitation, tachycardia, AF, heart failure/CV collapse, coma
Causes of thyroid storm? (4)
Recent thyroid surgery/radioiodine
Infection
MI
Trauma
Management of thyroid storm? (6)
Sedate Propanolol Digoxin Carbimazole Hydrocortisone Treat infection
Management of hyperthyroidism? (4)
Beta blockers propanolol
Carbimazole - most relapse
Radioiodine - most hypothyroid after
Surgery - thyroidectomy if large goitre/refractive
Carbimazole mechanism? CI, SEs
Stops iodine conversion into usable form, so thyroid hormones not produced
CI: severe blood disorders due to bone marrow suppression
SE: bone marrow suppression, haemolytic anaemia, severe skin reaction
Symptoms of hypothyroidism? (11)
Tired/sleepy Lethargic Low mood Cold intolerance Weight gain Constipation Menorrhagia Hoarse voice Decreased memory/cognition Myalgia Weakness
Signs of hypothyroidism? (11)
Bradycardic Reflexes slow Ataxia Dry thin hair/skin Yawning (drowsy, coma) Cold Ascites, oedema, effusions Round puffy face/obese Depression Immobile Congestive heart failure
Investigations for hypothyroidism?
TSH high
T4 low
Causes of hypothyroidism? (5)
Primary atrophic hypothyroidism Hashimotos thyroiditis - rarely hyperthyroid first IODINE DEFICIENCY Post thyroidectomy/radioiodine Drugs - carbimazole, amiodarone, lithium
Associations of hypothyroidism?
Type 1 DM, Addisons
Turners, Downs
Cystic fibrosis
Hypothyroid problems in pregnancy? (6)
Eclampsia Anaemia Prematurity LBW Stillbirth PPH
Management of hypothyroidism?
Levothyroxine lifelong (if elderly/ill, lower dose)
Complication of hypothyroidism? (3)
Hypothyroid coma
Heart disease
Dementia
What is diabetes mellitus?
Common syndrome caused by lack of or decreased effectiveness of endogenous insulin
Primary metabolic derangement in diabetes?
Hyperglycaemia
What is type 1 diabetes?
Usually adolescent onset, caused by insulin deficiency from autoimmune destruction of insulin secreting pancreatic beta cells
Cytoplasmic islet cell antibodies (CIA)
Cause of type 1 diabetes?
HLA D3 and D4 linked
Autoimmune beta cell destruction
Possible - lack of breastfeeding, CMV/coxsackie exposure
Presentation of type 1 diabetes?
Polydipsia Polyuria Weight loss Bacterial/fungal infection Blurred vision Ketoacidosis
Secondary causes of diabetes? (4)
Drugs - steroids, anti retrovirals, thiazides
Pancreatitis, pancreatic surgery/trauma
Cushings disease, hyperthyroid, acromegaly
Pregnancy
What is LADA?
Latent autoimmune diabetes of adults - form of type 1 DM, slower progression and present later in life
Pathogenesis of type 2 diabetes?
Decreased insulin secretion (beta cell dysfunction) and increased insulin resistance
Cause of type 2 diabetes? (5)
Genetics - Asians, 80% concordance in twins (30% in type 1) Age - although can occur in teens Obesity Lack of exercise Alcohol and calorie excess
How does type 2 diabetes present?
Asymptomatic
With complications - MI, peripheral neuropathy
What is MODY?
Maturity onset diabetes of the young - autosomal dominant, affects young people with positive family history
How is diabetes diagnosed?
Symptoms AND raised venous glucose detected once, or raised glucose on 2 separate occasions
Fasting >/=7mmol/L
Random >/=11.1mmol/L
HbA1c >/=49mmol/L (glycosylated Hb over 3 months)
What is metabolic syndrome?
Central obesity and 2 of: BP >130/85 Triglycerides >1.7mmol/L HDL < Fasting glucose >5.6 or DM
General advice for diabetes? (4)
Lifestyle - exercise, diet, smoking
Statin
Control BP
Foot care
Diet recommended in diabetes? (4)
Low saturated fats
Low sugar
High starch
Moderate protein
Do diabetics need to inform DVLA?
Yes
Do not drive if hypoglycaemic spells - loss of doing this may lead to loss of licence
Advice for insulin users?
Self adjust dose if exercise/ill/increased calories
Avoid binge drinking
Glucogel if needed
Main types of SC insulin therapy? (4)
Ultrafast acting - novorapid - start of meal or just after
Variable 4-12hr peak - Isophane insulin
Premixed insulin - Novomix - 30% short acting 70% long
Long acting - recombinant human insulin analogues - insulin glargine used at bedtime
Common insulin regimens? (3)
BD biphasic - twice daily premixed
QDS - ultra fast before meals, bedtime long acting
OD nocte - long acting
Methods of insulin delivery?
Disposable pens - vary injection site (outer thigh, abdomen) to avoid fatty change
Insulin pump
Pharmacological treatment for type 2 diabetes?
Metformin (biguanide) Gliclazide (sulfonylurea) Insulin or Glitazone (thiazolidinediones) DPP-4 inhibitors (sitagliptin) SGLT-2 inhibitors (gliflozin) GLP-1 mimetic (exenatide)
How does metformin work? CI, SEs
Metformin is a biguanide, increases insulin sensitivity
CI: acute metabolic acidosis inc. DKA, caution in renal damage
SE: GI upset, weight loss
How does gliclazide work? CI, SEs
Gliclazide is a sulfonylurea, increases insulin secretion
CI: ketoacidosis
SEs: HYPOGLYCAEMIA, weight gain
How does glitazone work? CI, SEs
Glitazone is a thiazolidinedione, reduces peripheral insulin resistance and lowers blood sugar
CI: congestive heart failure, osteoporosis
SEs: fractures, fluid retention, weight gain
How does sitagliptin work? CI, SEs
Inhibits dipeptidylpeptidase-4 to increase insulin secretion and lower glucagon secretion
CI: ketoacidosis
SEs: headache, constipation, dizzy
How does gliflozin work? CI, SEs
Inhibits sodium glucose co-transporter 2 in the kidney so glucose resorption is reduced, urinary glucose exrection increased
CI: ketoacidosis, CV disease - risk of hypotension
SE: constipation, hypotension, HYPOGLYCAEMIA
How does exenatide work? CI, SEs
Activated glucagon-like peptide 1 receptor to increase insulin secretion, suppress glucagon, and slow gastric emptying
CI: ketoacidosis, severe GI disease
SE: weight loss, GI upset
What is diabetic ketoacidosis?
Ketoacidosis is an alternative metabolic pathway to carbohydrate metabolism, normally used in starvation states, produces acetone
Occurs in type 1 diabetes as there is excess glucose but lack of insulin so it can’t be utilised, creating starvation state
Presentation of DKA? (5)
Gradual drowsiness, coma Vomiting and dehydration Abdo pain Ketotic pear drop breath Kussmal breathing - deep sighing hyperventilation
Triggers of DKA? (6)
Infection Surgery MI Pancreatitis Drugs - chemo, antipsychotics Wrong insulin dose/non compliance
Diagnosis of DKA?
Acidaemia <7.3 blood pH
Hyperglycaemia
Ketonaemia
Management of DKA? (6)
ABC approach
Bolus saline
Test for pH, bicarb, glucose, ketones, U+Es
Fluids and insulin IV
Reassess blood, possible K+ replacement
Start glucose fluids to prevent hypoglycaemia
What is a hyperglycaemic hyperosmolar coma? HONK
Hyperglycaemia without ketosis/acidosis
Usually type 2
What causes hyperglycaemic hyperosmolar state?
Sugary food
Drugs - steroids, thiazides
illness or infection
Presentation of hyperglycaemic hyperosmolar state?
Dehydration
Danger of occlusive events - focal CNS signs, DIC, leg ischaemia
Management of hyperglycaemic hyperosmolar state?
Rehydrate
Replace potassium
Small amount of insulin
LMWH prophylaxis
What are the major complications of diabetes?
Diabetic nephropathy
Diabetic retinopathy
Diabetic neuropathy
Vascular disease
How to prevent microvascular complications in diabetes?
Good hyperglycaemic control
Treat BP, cholesterol (STATIN)
Stop smoking, exercise, lose weight
What is BP target in diabetes?
<140/80
Most common cause of death in diabetes?
Vascular disease - MI (more likely to be silent), stroke
Statin, control BP, aspirin if previous stroke/MI
How to reduce risk of vascular event? (3)
Statin, control BP, aspirin if previous stroke/MI
How to protect the kidneys from nephropathy?
ACE inhibitor or ARB - inhibit RAAS and lowers glomerular pressure
Possible spironolactone
Mechanism of nephropathy in diabetes? (4)
Afferent arteriole more dilated than efferent
High GMR and forces
Cell hypertrophy and thickened basement membrane
Glomerular sclerosis
Causes microalbuminuria
What eye problems occur in diabetes? (3)
Diabetic retinopathy (background, pre-proliferative, proliferative)
Maculopathy
Cataracts
Rubeosis iridis - new vessels on iris
How is diabetic retinopathy managed? (3)
Annual screening
Laser photocoagulation - stops angiogenic factors from the ischaemic retina
Possibly give aspirin
Mechanism of diabetic retinopathy?
Hyperglycaemia and hypertension causes high retinal blood flow
Causes microvascular occlusion, haemorrhages, hypoxia and new vessel formation
New vessels can proliferate, bleed, fibrose and detach the retina
How does diabetic retinopathy present?
Painless gradual loss o central vision
Cataracts
Floaters
What causes diabetic neuropathy?
Hyperglycaemia damages Schwann cells
Microvascular damage of nerve blood vessels
Types of diabetic neuropathy? (3)
Sensory polyneuropathy - glove and stocking paraesthesia
Mononeuritis multiplex - III and VI CNs
Autonomic neuropathy - hypotension
Management of neuropathic pain?
Amitriptyline
Gabapentin
Pregabalin
How does diabetic foot develop? (4)
Sensory deficit
Decreased awareness of injury
Motor deficit - distortion of weight
Autonomic deficit - poor control of sweating, vascular supply
Typical presentation of diabetic foot?
Painless punched out ulcer Thick callous Infection - abscess, cellulitis Absent ankle jerk Deformity - pes cavus, claw toes, loss of arch, rocker bottom foot
Investigations of diabetic foot? (4)
Degree of sensory loss
Ischaemia - foot pulses absent, cold foot, do Doppler pressure measurements
X ray - deformity i.e. Charcot’s joint caused by unimpeded mechanical stress
Infection - swabs, cultures
Management of diabetic foot? (4)
Regular chiropody
Therapeutic shoes
Abx if infection
Possible surgery - excision and drainage, vascular reconstruction, amputation if deep/rapid spreading infection
Serious complications of diabetic foot?
Gangrene
Osteomyelitis
Needs amputation
How does insulin work?
Made in the beta cells in the pancreas islets of Langerhans
Promotes absorption of glucose from the blood into the liver and muscle to be stored as glycogen
GLUCAGON promotes stored glycogen to be turned into glucose and used for energy
