Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y2 ENDOCRINOLOGY > Micro and macro vascular complications of diabetes > Flashcards

Micro and macro vascular complications of diabetes Flashcards

1
Q

What are the three sites of diabetes related microvascular complications?

A

Retinal arteries (retinopathy), renal glomerular arterioles (nephropathy), vasa nervosum (neuropathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the relationship between HbA1c and microvascular complications

A

Extent of hyperglycaemia (as determined by HbA1c levels) is strongly associated with increased risk of developing micro vascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What HbA1c level should those with diabetes aim for to prevent development of microvascular comlications?

A

<53 mmol/mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Aswell as HbA1c (glycemic levels) what is the other main factor that contributes to risk of microvascular complications?

A

Hypertension. Both HbA1c and BP control required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Other than HbA1c and BP, what are the other factors related to microvascular complications?

A

Duration of diabetes, smoking, genetic factors, hyperlipidaemia, hyperglycaemic memory (previously high HbA1c levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline the general mechanism of damage to the microvasculature?

A

Oxidative stress (high lipid/ glucose) leads to increased formation of mitochondrial superoxide free radicals in the endothelium. This leads to generation of AGEs (advanced glycation end products) which results in activation of inflammatory pathways f damaging the endothelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is diabetic retinopathy?

A

Damage to the blood vessels in the retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is annual retina screening offered to all diabetes patients?

A

The early stages of diabetic retinopathy are asymptomatic. Screening needed to detect retinopathy at a stage where it can still be treated before causing visual disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What stage of diabetic retinopathy is the only stage that can be treat?

A

Background retinopathy (first stage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Outline the mechanism of diabetic retinopathy

A
  • activation of many pathways in the presence of hyperglycaemia
  • leads to dysfunction in the endothelium
  • leads to retinal ischaemia
  • this produces factors which increase permeability -> macular oedema, neovascularisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 4 stages of diabetic retinopathy?

A

1- background retinopathy.
2 - pre-proliferative retinopathy
3- proliferative retinopathy
4- maculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the characteristic of background retinopathy (as seen on a retinal screen)?

A

Hard exudates – cheese colour, lipid (leaked fluid and associated proteins) appear near end of vessels. Microaneurysms (dots) and blot haemorrhages (paint splatters)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the characteristics of pre-proliferative retinopathy (as seen on a retinal screen)?

A

Cotton wool spots aka soft exudates (fuzzier), these are representative of retinal ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the characteristics of proliferative retinopathy (as seen on a retinal screen)?

A

Visible new vessels (neovascularisation) on retinal disc or elsewhere in the retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the characteristics of maculopathy (as seen on a retinal screen)?

A

Hard exudates/oedema near the macula, same disease as background retinopathy but near macula therefore can threaten direct vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is diabetic retinopathy treated?

A

Improve HbA1c
Improve BP control
Continued annual surveillance and feedback to person living w/diabetes
Pan-retinal photocoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is pan-retinal coagulation?

A

Burn vessels off to stop neovascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When would grid laser therapy be offered to someone with diabetic retinopathy?

A

When there’s neovascularisation around the macula

19
Q

What treatment is given for maculopathy?

A

anti-VEGF (vascular endothelial growth factor) injections directly into the eye to treat oedema. Grid photocoagulation

20
Q

Diabetic nephropathy is characterised by what four things?

A

Hypertension
Progressively increasing proteinuria
Progressively deteriorating kidney function
Classic histological features

21
Q

Why is diabetic nephropathy clinically important?

A

Associated with progression to end-stage renal failure, associated with increased risk of cardiovascular events

22
Q

Outline the basic mechanism of diabetic nephropathy

A

Hyperglycaemia and hypertension as a result of diabetes leads to glomerular hypertension resulting in proteinurea and a decline in glomerular filtration rate

23
Q

What are the consequences of diabetes with kidney disease?

A

Increases risk of macro vascular complications -> congestive heart disease, acute MI, cerebral vascular accident, peripheral vascular disease

24
Q

What are the histological features of diabetic nephropathy?

A

Glomerular changes such as mesangial expansion, basement membrane thickening, glomerulosclerosis

25
Q

What things modify risk of someone with diabetes developing nephropathy?

A

Age at development of disease, age at presentation, ethnic differences (African-Caribbean)

26
Q

What positive tests are indicative of diabetic nephropathy?

A

Progressive proteinuria, increased BP, deranged renal function (eGFR) and peripheral oedema in advanced stage

27
Q

What is the first line of treatment for diabetic nephropathy?

A

Aim for tighter glycaemic control, reduce BP - usually through ACEi or ARB, stop smoking, start an SGLT2 inhibitor if T2DM

28
Q

Why is blocking RAS useful for diabetic nephropathy?

A

Reduces:
Mediation of glomerular hyperfiltration, increased tubular uptake of proteins, induction of pro-fibrotic cytokines, stimulation of glomerular and tubular growth, fibroblast proliferation, upregulation of adhesion molecules on endothelial cells

29
Q

What is the most common cause of neuropathy and therefore amputation?

A

Diabetes

30
Q

What causes neuropathy?

A

Blockage of the vasa nervorum

31
Q

What are the risk factors associated with development of diabetic neuropathy?

A
  • Age
    • Duration of diabetes
    • Poor glycaemic control
    • Height (longer nerves in lower limbs of tall people)
    • Smoking
    • Presence of diabetic retinopathy
32
Q

How is diabetic foot disease managed?

A

Regular inspection of feet, good footwear, avoid barefoot walking

33
Q

What are the clinical features associated with diabetic neuropathy?

A

Loss of sensation, loss of propioception in toes/legs

34
Q

What is mononeuropathy?

A

Neuropathy of a single nerve - usually sudden motor loss e.g. wrist drop. Cranial nerve palsy: e.g double vision due to third nerve palsy (eye looks down and out)

35
Q

What is autonomic neuropathy?

A

Loss of sympathetic and parasympathetic nerves to GI tract, bladder and cardiovascular system.

36
Q

What are the modifiable risk factors of macro vascular diabetes complications?

A

Dyslipidaemia, hypertension, smoking, diabetes, central obesity

37
Q

What are the non-modifiable risk factors associated with macrovascular diabetes complications?

A

Age, sex, birth weight, Genes

38
Q

What are the three types of macro vascular complications of diabetes?

A

Cerebrovascular disease, ischaemic heart disease, peripheral vascular disease

39
Q

How does treatment targeted at macro vascular complications of diabetes differ from treatment for micro vascular?

A

In macrovascular, treatment targeted to hyperglycaemia alone has minor effects, requires management of multiple risk factors

40
Q

What are the multiple risk factors that need to be managed alongside hyperglycaemia to treat macro-vascular complications of diabetes?

A

Smoking status, blood pressure, lipid profile, weight, annual urine microalbuminuria screen

41
Q

Why is Acanthosis nigiricans associated with Type 2 diabetes?

A

Associated with insulin resistance, excess insulin causes skin cells to reproduce at a rapid rate

42
Q

What questions allows us to distinguish between erectile dysfunction due to testosterone deficiency or due to diabetes?

A

Loss of early morning erections/libido. Loss of erections due to diabetes

43
Q

To decrease lipid profile and reduce risk of macro vascular complications what should be prescribed?

A

A statin

44
Q

To decrease risk of micro or macro-vascular complications in a diabetes patient with microalbuminurea what should be prescribed?

A

An ACE inhibitor

Y2 ENDOCRINOLOGY (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions