Medical CPGs Flashcards
Diabetes definition
Disease of the endocrine system characterised by a deficiency of insulin or an inability of the body cells to respond to insulin – hyperglycaemic state
Type 1 diabetes IDDM definition
Characterised by an inadequate production of insulin by the beta cells within the pancreas (due to an autoimmune destruction of the beta cells) resulting in hyperglycaemia due to the insufficient insulin production.
Type 2 NIDDM definition
Characterised by a decrease in the production of insulin as well as a diminished tissue sensitivity to insulin (insulin resistance). Either too few insulin receptors or faulty insulin receptors.
Homeostasis of BGL
-through negative feedback cycles, balanced between regulation of insulin and counterregulatory hormones such as glucagon.
Action of insulin on maintaining BSL homeostasis
- Insulin the primary regulator (released by beta cells in pancreas) in response to low BSL
- insulin acts on liver to facilitate uptake of glucose and its conversion to glycogen
Action of Glucagon on maintaining BSL homeostasis
-released by alpha cells in pancreas - counter regulatory hormone which increases blood glucose levels by accelerating conversion of glycogen in liver to glucose
Causes of hypoglycaemia
- excessive insulin action without adequate carbs
- insulin OD - poor understanding/eyesight
- diet
- excessive exercise
Why do hypoglycaemic pts present with tachycardia, pale, sweating, agitated?
- the brain metabolises sugars for energy and is unable to utilise fats/proteins available therefore the brain is starved for fuel and altered conscious/unconsciousness occurs
- reduced blood glucose causes a counter regulatory catecholamine release and sympathetic response
Signs and symptoms of hypoglycaemia
altered conscious tachycardia seizure drunk behaviour sweat confusion hypothermia fatigue weakness muscle tremor headache
Diabetic ketoacidosis definition
serious complication of type 1 diabetes resulting from an absolute insulin deficiency leading to a hyperglycaemic state and metabolic acidosis
Causes of diabetic ketoacidosis
- first time presentation
- decrease or omission of insulin, poor compliance/education
- infection
- increased glucose, decreased exercise without decreased food
- stressful events i.e infection, stroke, AMI, trauma
Patho of diabetic ketoacidosis
stressor
- insulin deficiency
- severe hyperglycaemia
- cells become starved of glucose
- breakdown of proteins and lipids
- production of glucose and ketones
- osmotic diuresis (due to glucose breakdown) and an acidotic state (due to ketone production)
- dehydration
- shock, coma, death
Honk/HHNK definition
An acute complication of type 2 diabetes resulting from a relative insulin deficiency leading to a hyperglycaemic, hyperosmolar state
Seizure definition
a sudden, uncontrolled event or episode of excessive electromechanical activity within the brain. It may alter behaviour, consciousness, movement, perception, sensation.
Definition of convulsion
episode of excessive and abnormal motor activity hence seizures can occur without convulsions and convulsions can be caused by other conditions
Definition of epilepsy
a disease process without discernible aetiology where an individual is subject to sudden, recurrent episodes of sensory disturbance, loss of consciousness or convulsions assoc with abnormal electrical activity in the brain
Classifications of generalised seizures
nearly simultaneous activation of entire cerebral cortex
- tonic clonic - LOC, tonic phase (rigid) followed by clonic phase (rhythmic jerking)
- absence - LOC with no loss of postural tone. Staring.
- myoclonic: brief shock like muscular contractions that may be generalised or limited to one of the extremities
- tonic: prolonged strained contraction of the body with deviation of head and eyes
- clonic: repetitive clonic jerks
- atonic: sudden loss of muscle tone which may be assoc with brief LOC
Classifications of partial seizures
electrical discharges within a localised region of the cerebral cortex
- simple: localised activity with no LOC - may involve any part of body; motor or sensory
- complex: localised seizures which have an effect on conscious state and motion
Causes of seizures
hypoxia hyperthermia hypoglycaemia head injury epilepsy drugs pregnancy infection
Post ictal complications
- altered conscious
- protection - aggressive pt
- airway mx
- hypoxia
- trauma
- hyper/hypothermic
- lethargic
- incontinent
- recurrent seizures
- long term brain injury
Pharma of Midaz on seizures
Acts on GABA receptor (post synaptic)
-increases affinity of GABA binding to GABA A receptors which enhances chloride channel opening - neuronal inhibition
Definition of anaphylaxis
A severe, life threatening systemic allergic hypersensitivity reaction to a previously encountered antigen. Characterised by: bronchospasm/oedema, peripheral vasoconstriction, increased peripheral permeability, contraction of extra vascular smooth muscle
Definition of allergic reaction
hypersensitivity reaction to a previously encountered antigen resulting in a non-systemic, non-life threatening localised reaction
Patho of anaphylaxis
Antigen exposure - activation of immune system - susceptible individuals produce IgE antibodies which bind to IgE receptors on cell membranes of Basophils and Mast Cells – next exposure to antigen - degranulation of mast cells and basophils - release of chemical mediators - systemic responses (bronchospasm, oedema, increased capillary permeability, peripheral vasodilation, contraction of extravascular smooth muscle) - relative fluid loss - clinical manifestations (angioedema, hypotension, abdo pain, bronchospasm, diarrhoea, CPC skin, urticaria) - shock, coma, death
Pharma of Adrenaline in Anaphylaxis
Increases monophosphate production in cell which stabilises mast cells, decreasing inflammatory mediator release.
Alpha: increased peripheral vasoconstriction - increased VR - increased CO and BP
-reduced peripheral vasodilation which increases VR
-reduced angio-oedema
-reduced urticaria (hives)
Beta 2: bronchodilation -interrupts positive feedback mechanism
Sepsis definition
characterised by whole body inflammatory state (systemic inflammatory response syndrome) and presence of known or suspected infection
Criteria for sepsis
temp less than 36 over 38
HR over 90
BP less than 90
RR over 20
Definition of SIRS
systemic inflammatory response to an underlying disorder/infection
Septic shock definition
A form of shock that results from a serious systemic bacterial infection - vasodilation - hypotension
Patho of Sepsis
- systemic bacterial infection
- release of inflammatory mediators
- peripheral vasodilation
- increased capillary permeability
- interstitial oedema
- reduced venous return
- reduced CO
- hypotension and inadequate tissue perfusion
Disseminated Intravascular Coagulation (DIC)
A pathological process characterised by the widespread activation of the clotting cascade that results in the formation of blood clots in the microvasculature throughout the body. this leads to compromised blood flow to tissues and can lead to multiple organ damage.
