Microvascular complications Flashcards
What are the 3 main microvascular weaknesses associated with diabetes?
- Retinopathy
- Nephropathy
- Neuropathy
Recall the 5 main factors affecting microvascular risk
Severity of hyperglycaemia Hypertension Genetic Hyperglycaemic memory Tissue damage
Recall the site of damage in retinopathy
Retinal arteries
Recall the site of damage in nehropathy
Glomerular arterioles
Recall the site of damage in neuropathy
Vasa vasorum
When looking at an image of the retina, what are the main things to be looking for?
Bright disc in periphery = optic disc
Dark region in centre = macula
Name the 4 different types of retinopathy
- Background
- Pre-proliferative
- Proliferative
- Maculopathy
Recall the main identifying characteristics of each type of retinopathy
- Background = lipid leakage –> hard exudate and microaneurysms
- Pre-proliferative = soft exudates
- Proliferative = vessel formation
- Maculopathy = hard exudates near macula
Describe the new vessel formation in retinopathy
- Pre-proliferative stage
- Tend to be fragile vessels
- Response to retinal ischaemia
Recall the management strategy for background retinopathy
Screening an improvement of blood glucose control
Recall the management strategy for pre-proliferative retinopathy
Pan-retinal photo-coagulation
What is pan-retinal phtocoagulation
Laser vessels to prevent rupture or new vessel formation
Recall the management strategy for proliferative retinopathy
Pan-retinal photocoagulation
Recall the management strategy for maculopathy
GRID of photocoagulation in the affected area
Recall the 3 key features of nephropathy
Hypertension
Proteinuria
Deteriorating renal function
Describe the glomerular histological changes in nephropathy
Mesangial expansion - due to ECM deposition
BM thickening
Glomerulosclerosis - increases pressure in kidney
What are the most important factors to control in diabetes in order to slow renal deterioration?
BP control and RAAS inhibition
Recall the 5 types of neuropathy
Peripheral neuropathy Mononeuropathy Mononeuritis complex Radiculopathy Autonomic neuropathy
What is the main clinical feature of peripheral neuropathy and why is it problematic?
Loss of sensation to foot - may not sense injury to foot
How does a mononeuropathy present?
Sudden motor loss - wrist/ foot drops suddenly
What is mononeuritis complex?
neuropathy with multiple neurons involved
What is radiculopathy?
Dermatomal sensational loss
Where is there a loss of function in autonomic neuropathy?
GIT, CVS + bladder
Recall 5 effects of neuropathy on the GIT
- Dysphagia
- Delayed gastric emptying
- Constipation
- Nocturnal diarrhoea
- Bladder dysfunction
Recall 2 possible effects of neuropathy on the CNS
- Postural hypotension
2. Sudden cardiac death
What examination should be done to test for autonomic neuropathy?
Measure changes in HR in response to the valsalva manoevre
How do you perform a valsalva manoevre?
Make the m blow into a syringe: should see a change in HR - look at ECG and compare RR intervals
