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BRS Y2 > Macrovascular Complications of Diabetes > Flashcards

Macrovascular Complications of Diabetes Flashcards

1
Q

What are the main macrovascular disease in diabetes?

A

Early widespread atherosclerosis
Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease

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2
Q

What are the initial cells that develop in atherosclerosis?

A

Isolated foam cells

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3
Q

What are the stages of actherosclerosis?

A 
Initial lesion
Fatty streak
Intermediate
Atheroma
Fibroatheroma
Complicated
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4
Q

Whats is atherosclerosis associated with?

A

Dyslipidaemia (high LDL, low HDL)

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5
Q

When atheroma stage is reached, what is the growth in?

A

Smooth muscle

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6
Q

In earlier atherosclerosis what is growth in?

A

Fat

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7
Q

How is cardiovascular disease linked to diabetes?

A

Hyperglycaemia greatly increases the risk cardiovascular disease

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8
Q

Out of morbidity and mortality, what do microvascular and macrovascular complications cause?

A

Microvascular: causes morbidity
Macrovascular: causes morbidity and mortality

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9
Q

How does post MI survival differ in those living with diabetes vs without?

A

Survival is a lot lower if they are living with diabetes

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10
Q

How does risk of CHD differ with ethnicity?

A

Risk is a lot higher in some ethnicities eg higher in south asians than white caucasians

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11
Q

What is the major cause of morbidity and mortality in diabetes?

A

Ischaemic heart disease

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12
Q

What is the relationship between cerebrovascular disease and diabetes?

A

Occurs earlier in those living w diabetes

Is more widespread

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13
Q

What does renal artery stenosis contribute to?

A

Hypertension and renal failure

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14
Q

How does treatment for hyperglycaemia affect cardiovascular risks?

A

Doesn’t reduce the risk much, doesn’t reduce mortality either

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15
Q

How does renal artery stenosis occur?

A

Atherosclerosis

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16
Q

How does insulin resistance affect risk of complications?

A

Resistance even before hyperglycaemia contributes to increased risk

17
Q

What are the non modifiable risk factors for macrovascular disease?

A

Age
Sex
Birth weight
Family history/genes

18
Q

What are the modifiable risk factors for macrovascular disease?

A

Dyslipidaemia
High BP
Smoking
Diabetes

19
Q

How do we treat those with diabetes to reduce risk of macrovascular complications?

A

Agressive treatment of multiple risk factors eg lipids, BP

20
Q

How does life expectancy change when there is multifactorial intervention?

A

Many years of life are gained (7.9 yrs average)

21
Q

What 2 main targets are managed to reduce macro vascular disease?

A

BP

Lipids

22
Q

What complication of diabetes is a major reason for bedstay in the UK?

A

Diabetic foot

23
Q

Describe the pathway to foot ulceration

A 
Sensory neuropathy
Motor neuropathy
Limited joint mobility
Autonomic neuropathy
Peripheral vascular disease
Trauma- a repeated and minor/discrete episode
Reduced resistance to infection
Other diabetic complications eg retinopathy
24
Q

What are the 3 types of diabetic foot?

A

Neuropathic foot
Ischaemic foot
Neuro-ischaemic foot

25
Q

Describe the neuropathic foot

A 
numb
warm
dry
palpable foot pulses
ulcers at points of high pressure
26
Q

Describe the ischaemic foot

A

cold
pulseless
ulcers at foot margins

27
Q

Describe the neuro-ischaemic foot

A 
numb
cold
dry
pulseless
ulcers at points of high pressure and foot margins
28
Q

How do we assess the foot of a diabetic patient?

A

Appearance- is there deformity or callus
Feel it- it is hot or cold? is it dry?
Check for foot pulses
Check for neuropathy- vibration sensation, temp, ankle jerk reflex, fine touch sensation

29
Q

What are some preventative measures for diabetic foot?

A

Control hyperglycaemia, lipids and BP
Wear suitable footwear always, check the insides of it
Cut nails straight

30
Q

How is ulceration managed?

A 
Relief of pressure via bed rest
Antibiotics
Amputation
Debridement 
Revascularisation
31
Q

Where on the foot is affected by osteomyelitis?

A

Forefoot: MIPs and IPs
Hindfoot: calcaneus

32
Q

Where on the foot is affected by active charcot?

A

Midfoot and subarticular

33
Q

Out of active charcot and osteomyelitis which has ulcer?

A

Osteomyelitis

34
Q

Out of active charcot and osteomyelitis which has hot red foot?

A

Both

35
Q

What will show on MRI for osteomyelitis

A

Marrow oedema in forefoot and hindfoot near ulcer

36
Q

What will show on MRI for active charcot

A

Marrow oedema and midfoot subchondral

37
Q

Will active charcot or osteomyelitis show on xray?

A

Not in the first few weeks

BRS Y2 (85 decks)

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