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notes to flashcards year 2 - LCRS1 > microvascular complications > Flashcards

microvascular complications Flashcards

1
Q

what are the sites of microvascular complications?

A
  • retinal arteries
  • glomerular arteries
  • vasa nervorum (blood vessels that supply nerves)
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2
Q

what can microvascular complications come about or be exacerbated by?

A
  • severity of hyperglycaemia (worse hyperglycaemia, worse damage)
  • hypertension
  • genetic
  • hyperglycaemic memory (poor diabetes control with give inc, risk)
  • tissue damage through originally reversible and later irreversible alterations in proteins
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3
Q

what are the mechanisms of glucose damage?

A
  • polyol pathway
  • AGEs
  • protein kinase C
  • hexosamine
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4
Q

where is the macula and what is it involved in?

A
  • colour vision and acuity

- located centrally

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5
Q

what are the characteristics of background diabetic retinopathy?

A
  • hard exudates
  • microaneurysms (small blood vessels bulge)
  • blot haemorrhages (blots of blood)
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6
Q

what is pre-proliferative diabetic retinopathy?

A

cotton wool spots (soft exudates) - retinal ischaemia

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7
Q

what is proliferative retinopathy?

A

visible new vessels on disc or elsewhere in retina

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8
Q

what is maculopathy?

A
  • same as background but near macula
  • hard exudates nea near macula
  • threaten direct vision
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9
Q

how do you manage each type of retinopathy?

A
  • background: improve blood glucose control, warn pt
  • pre-proliferative: suggests general ischaemia. to stop progression to proliferative need pan-retinal photocoagulation
  • proliferatuve: pan-retinal photocoagulation
  • maculopathy: grid-retinal photocoagulation (just at macula)
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10
Q

what are the features of diabetic nephropathy?

A
  • hypertension
  • progressive inc. proteinuria and deteriorating kidney fucntion
  • classic histological features
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11
Q

what are the glomerular histological features?

A
  • mesangial expansion
  • BM thickening
  • glomerulosclerosis (hardening of capillaries)
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12
Q

what happens if there is no retinopathy?

A

any CKD cannot be due to diabetes

they come together

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13
Q

what is the epidemiology of diabetes patients with CKD

A

T1DM: 20-20% have CKD after 30-40 years
T2DM: same but difficult to determine

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14
Q

what are the clinical features?

A
  • progressive proteinuria (hallmark for CKD)
  • inc. BP
  • deranged renal function - GFR dec
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15
Q

what are the interventions?

A
  • diabetic control: lower HbA1C, lower microvascular complications
  • BP control (will slow down deterioration of kidney function)
  • inhibition of RAS (ACE inhibitors reduce rate of decline of creatinine and so kidney function)
  • stop smoking
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16
Q

what are the effects of angiotensin 2?

A
  • vasoactive effects
  • mediation of glomerular hyperfiltration
  • inc. tubular uptake of proteins
  • stimulation of glomerular and tubular growth
  • induction of pro inflammatory cytokines
  • stimulates fibroblast proliferation
  • up regulation of lipoprotein receptors
17
Q

what causes neuropathy?

A

when small vessels supplying vasa nervorum get blocked

18
Q

what are the types of neuropathy?

A
  • peripheral neuropathy

- mononeuropathy

19
Q

describe peripheral neuropathy

A
  • affects peripheral nerves
  • affects longest nerves that supply feet, results in loss of sensation
  • more common in tall people and people w/ poor glucose control
20
Q

how is peripheral neuropathy investigated?

A
  • monofilament examination

- tracks loss of sensation

21
Q

what are the characteristics of peripheral neuropathy?

A
  • loss of ankle jerks
  • loss of vibration sense
  • multiple fractures on x-rays (Charcot’s joints)
22
Q

describe mononeuropathy

A
  • only one nerve blocked
  • usually sudden motor loss resulting in wrist and foot drop
  • 3rd nerve palsy, get double vision
23
Q

what is mononeuritis multiplex?

A
  • many nerves affected

- random combo of peripheral nerve lesions

24
Q

what is radiculopathy?

A
  • dermatomes affected
  • pain over spinal nerves
  • usually dermatomes on abdoment or chest wall
25
Q

what is autonomic neuropathy?

A
  • loss of SNS and PNS nerves to GIT, bladder and CVS
26
Q

what are the features of autonomic neuropathy?

A
  • GIT: dysphagia, delayed gastric emptying, constipation, bladder dysfunction
  • postural hypotension
  • cardiac autonomic supply (can have sudden cardiac death)
27
Q

what clinical test procedure should you carry out in autonomic neuropathy?

A
  • measure changes in HR in response to valsalva manoeuvre
  • should have change in HR
  • look at ECG and compare R-R interval
28
Q

what is diabetic amyotrophy?

A

inflammation and loss of pain

diabetic foot

notes to flashcards year 2 - LCRS1 (58 decks)

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