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Y3R5: Medicine I 🩺 > L4: Microvascular Complication in DM > Flashcards

L4: Microvascular Complication in DM Flashcards

1
Q

what are microvascular complications of DM?

A

1) Diabetic Retinopathy

2) Diabetic Nephropathy

3) Diabetic Neuropathy

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2
Q

Mechanism of Hyperglycemia induced Damage

A
  • Increased Polyol - sorbitol Pathway flux
  • Increased AGES formation
  • Activation of protein kinase C
  • Increased Hexosamine pathway flux.
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3
Q

what are Eye complications of DM?

A
  • Catarct
  • Retinopathy
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4
Q

Stages of Retinopathy

A

1) Background

2) Pre-proliferative

3) Proliferative

4) Advanced diabetic eye disease

5) Maculopathy

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4
Q

Mechanism of Cataract in DM

A
  • Non enzymatic glycation of lens protein and subsequent cross linking
  • Sorbitol accumulation could also lead to osmotic swelling of the lens but evidence of involvement in cataract formation is less strong
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5
Q

Prevelance & Incidence of Ritonapthy in DM

A
  • DR is the leading cause of blindness in the working population of the Western world
  • The prevalence increase with the duration of the disease
  • (Few within 5 years, 80 – 100% will have some form of DR after 20 years)
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6
Q

Maculopathy is most common in type ….. patients and can cause severe visual loss

A

2

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7
Q

Charactes of Background Retinopathy

A
  • Micro aneurysms ( 1st to occur )
  • Scattered exudates
  • Hemorrhages (flame shaped, Dot and Blot)
  • Cotton wool spots (<5)
  • Venous dilatations
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8
Q

Charactes of Pre-Proliferative Retinopathy

A
  • Rapid increase in amount of micro aneurysms
  • Multiple hemorrhages
  • Cotton wool spots (>5)
  • Venous beading, looping and duplication
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9
Q

Charactes of Proliferative Retinopathy

A
  • Proliferative Retinopathy
  • New vessels (on disc, elsewhere)
  • Fibrous proliferation (on disc, elsewhere)
  • Hemorrhages (preretinal, vitreous)
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10
Q

Charactes of Advanced Diabetic Eye Disease

A
  • Advanced Diabetic Eye Disease
  • Retinal detachment with or without retinal tears.
  • Rubeosis iridis.
  • Neovascular Glaucoma
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11
Q

Characters of Maculopathy in DM

A
  • Macular edema ( focal or diffuse )
  • Ischemic maculopathy
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12
Q

what are other ocular Complications?

A
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13
Q

Prevelance in Diabetic Nephropathy

A
  • Diabetes has become the most common cause of end stage renal failure in the US and Europe
  • 50 % of dialysis patients have DM
  • About 20 – 30 % of patients with diabetes develop evidence of nephropathy
  • The prevalence of DN is higher in Black Americans than in Whites
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14
Q

Stages of Diabetic Nephropathy

A
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15
Q

Which Stages of nerphropathy are reversible with TTT?

A

Incipient nephropathy (reversible with ttt)

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16
Q

Which Stages of Diabetic Nephropathy are Irreversibel with TTT?

A

Overt nephropathy

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17
Q

What are other Renal Complications of DM?

A
  • Infection: as cystitis, Pyelonephritis & acute necrotizing papillitis
  • Increase incidence of renal stones d.t. recurrent infection & stasis
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18
Q

what are types of Diabetic Neuropathy?

A
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19
Q

what is the most common type of Diabetic Neuropathy?

A

Sensory Neuropathy

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20
Q

Symptoms of Sensory Neuropathy

A
21
Q

Early symptoms of Sensory Neuropathy

A

pain & paresthesia. It bilateral & symmetrical, starting in the lower limb then upper limb

22
Q

Late Symptoms of Sensory Neuropathy

A

stock & glove hyposthesia occur

23
Q

Tendon Jerk in Sensory Neuropathy

A

There may be lost ankle & preserved knee jerk

24
Q

Deep Sensations in Sensory Neuropathy

A
  • There’s loss of deep sensations except muscle sense leading to tender calf
  • The earliest sensation to be lost in diabetic neuropathy is vibration sense then 10 gm monofilaments test
25
Q

Complications in Sensory Neuropathy

A
26
Q

Motor Neuropathy in DM

A
  • Distal muscle weakness
  • Wrist & foot drop
27
Q

Symptoms of Autonomic Neuropathy

A
28
Q

Autonomic Neuropathy (Another Classification)

A
29
Q

Types of Mononeuropathies

A
30
Q

Entrapment Neuropathies

A
31
Q

Proximal Motor Neuropathy

A
32
Q

What are other neurological Complications of DM?

A
33
Q

Screening of eye disease in DM

A
34
Q

When to refer a Diabetic Patient to an ophthalmologist?

A
35
Q

Management of Diabetic Retinopathy

A
36
Q

Screening for Nephropathy disease

A
37
Q

Why we do screening for Micro albuminuria?

A
  • Increased risk for overt nephropathy
  • Increased cardiovascular mortality
  • Increased risk of Retinopathy
  • Increased all-cause mortality

So Microalbuminuria is an indication for screening for possible vascular disease and aggressive intervention to reduce all cardiovascular risk factors.

38
Q

Screening test for micro albuminuria

A
39
Q

who to Screen For Microalbuminuria
Type 1 Diabetes Type 2 Diabete?

A
40
Q

Management of nephropathy in DM

A
41
Q

Screening for Neuropathy disease

A
42
Q

Management of neuropathy in DM

A
43
Q

Complications of DM (PPT)

A
44
Q

Definition of Diabetic Nephropathy

A
45
Q

Risk Factors of Diabetic Nephropathy

A
46
Q

Pathology of Diabetic Nephropathy

A
47
Q

Clinical Picture of Diabetic Nephropathy

A
48
Q

Investigations in Diabetic Nephropathy

A
49
Q

Transient microalbuminuria occurs in the following: …….

A

1) Exercise

2) Fever

3) Heart failure

4) Poor glycemic control

Y3R5: Medicine I 🩺 (47 decks)

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