ITM The Middle Aged Patient Flashcards
What is the difference between T1 and T2 diabetes
T1: body cannot produce any insulin due to a genetic predisposition to autoimmune pancreatic B cell destruction
T2: there is not enough insulin due to impaired B cell function
Define insulin resistance
The organs and tissues of the body lose their sensitivity to the action of insulin
What is insulin resistance triggered by
Chronically: overweight / obesity and physical inactivity
Acutely: infection / trauma / injury / pregnancy
What is the diagnostic criteria for T2 diabetes
Fasting glucose >7 mmol/l
Blood glucose of >11.1 mmol/l after a 2 hour oral glucose tolerance test
HbA1c level >48 mmol/mol
What are the microvascular complications of DM
Eyes
Kidneys
Peripheral nervous system
What are the macrovascular complications of DM
Stroke and MI
What is metabolic syndrome
A cluster of risk factors for cardiovascular disease and T2 DM
What are the risk factors for metabolic syndrome
Central obesity (88cm female, 104cm men)
Triglycerides >1.7mmol/l (usual is 1 mmol /l)
HDL cholesterol <1 mmol/l males, <1.3mmol/l female
Blood pressure >130/85 mmHg
Fasting glucose >5.6mmol/l
Presence of ectopic fat (liver, pancreas, skeletal muscle)
What causes insulin resistance
High dietary fat availability
Adiposity - ectopic fat accumulation
Physical inactivity (2-3 days of bed rest can cause insulin resistance)
What are the 2 components of pre diabetes
Impaired fasting glucose (IFG) and / or impaired glucose tolerance (IGT) markedly increase the risk of developing T2D
If not reversed the rate of conversion to T2D is 5-10% per annum
Healthy HbA1c is <38mmol/mol; T2D >48 mmol/mol
What are impaired fasting glucose and impaired glucose tolerance
IFG = fasting glucose >5.6mmol/l - <7mmol/l (when the liver is less sensitive to insulin it pumps out more glucose)
IGT= blood glucose of >7.8mmol/l - <11.1mmol/l after a 2 hour oral glucose tolerance test
Define pain
A highly unpleasant physical sensation caused by illness or injury
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
Define acute abdominal pain
Previously undiagnosed abdominal pain that arises suddenly and is of less than 7 days and usually less than 48h duration
3 classifications of abdominal pain
Visceral: crampy, achy, diffuse, poorly localised
Somatic: sharp, cutting, stabbing, well localised
Referred: distant from site of generation, symptoms but no signs
Surface anatomy of the foregut, midgut and hindgut
Epigastric region: foregut
Periumbilical region: midgut
Pelvic region: hindgut
Does psoriasis increase cardiovascular risk
Slight increased risk due to inflammation inside the body which can eventually affect the heart and blood vessels
Post operative causes of abdominal pain
Intra-abdominal bleeding or collection, anastomotic leak / dehiscence
Abdominal compartment syndrome
Pulmonary causes of abdominal pain
Lobar pneumonia
Pleurisy (inflammation of pleura between lungs and ribs)
Pulmonary embolism
Cardiac causes of abdominal pain
Acute MI
Congestive cardiac failure
Myocarditis
Metabolic / endocrine causes of abdominal pain
Porphyria Diabetic keotacidosis Lead poisoning Hypercalcemia Adrenal insufficiency
Vascular causes of abdominal pain
Henoch-schonlein purpura
Systemic lupus
Polyarteritis nodosa
Familial Mediterranean fever
When is the location and severity of abdominal pain altered
Pregnancy
The older adult
Immunocompromised patients
Altered anatomy eg malrotation, sinus inversus
What is methotrexate and how is it prescribed
Methotrexate is a drug used for immunocompromised patient eg with rheumatoid arthritis. It is prescribed weekly as it is seen to be less hepatotoxic when given weekly
When are beta blockers contraindicated
In patients with asthma or COPD due to their increased probability of causing bronchospasm
What is the caution with ACE inhibitors
Start with a low dose and adjust according to response. Hyperkalaemia and other side effects of ACE inhibitors are more common in those with impaired renal function and the dose may need to be reduced
Risk of ACE inhibitors and pregnancy
ACE inhibitors should be avoided in pregnancy unless essential
May adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydraminos have also been reported
Different routes of administering drugs
Po: oral Im: intramuscular Iv: intravenous Sc: subcutaneous Neb: nebuliser Sl: sublingual (under tongue) ih: inhalation
Why does psoriasis increase cardiovascular risk
Because if there is long term inflammation is can eventually harm the heart and blood vessels
When can preventative metformin be given
If the patient is unable / unwilling to change their lifestyle factors
What is acute pancreatitis
A condition in which the pancreas becomes inflamed over a short period of time
Usually heals within a week
What investigations would you run if acute pancreatitis is suspected
Blood tests to measure 2 digestive enzymes: amylase and lipase. If the levels are high then acute pancreatitis is likely
Underlying causes of acute pancreatitis
Drinking Steroid treatment (psoriasis) Gall stones Metabolic disorders Infections
How is acute pancreatitis treated
Monitored in hospital for signs of serious problems and given fluids and oxygen
What does high gamma glutamyl transpeptidase indicate
Liver disease or damage to the bile ducts can be caused by drinking
Risk factors for developing T2 DM
Obesity Age >40 PCOS Black / south Asian ethnicity Family history of DM Gestational DM Physical inactivity Dyslipidaemia
Complications of DM
Micro vascular and macro vascular complications
Diabetic ketoacidosis
Acute hypoglycaemia
Hyperosmolar hyperglycaemic state
What is the molecular target for metformin
AMP kinase
What is the mode of action of a sodium glucose transport inhibitor
In a healthy person, glucose is filtered at the renal glomeruli and reabsorbed in the PCT via sodium glucose transporters in the luminal membrane of the tubular cells of the PCT
SGLT 2i block glucose reabsorption leading to glucosuria
And the loss of glucose in the urine leads to lowered blood glucose
