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Year 2 Endocrinology > Microvascular complications > Flashcards

Microvascular complications Flashcards

1
Q

What are the sites of microvascular complications

A

Retinal arteries
Glomerular arterioles
Vasa nervorum

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2
Q

What are examples of microvascular complications

A 
Severity of hyperglycaemia
Hypertension
Genetic
Hyperglycaemic memory
Tissue damage through originally reversible and later irreversible alterations in proteins
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3
Q

What is the mechanism of glucose damage

A

Hyperglycaemia leads to oxidative stress leading to inflammatory signaling cascades that lead to local activation of proinflam cytokines leading to inflammation leading to nephropathy/retinopathy/neuropathy

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4
Q

What are hard exudates

A

When proteins come out of the vessels - yellow and lipid rich

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5
Q

What happens if you don’t treat background retinopathy

A

Cotton wool spots aka soft exudates appear, and this represents retinal ischaemia

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6
Q

What happens in proliferative retinopathy

A

There are visible new vessels on the disk or elsewhere in the retina

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7
Q

What is seen in background diabetic retinopathy

A

Hard exudates, microaneurysms and blot haemorrhages

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8
Q

What is maculopathy

A

When there are hard exudates near the macula

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9
Q

What is especially bad in maculopathy

A

It can threaten direct vision

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10
Q

What is the background management of diabetic retinopathy?

A

Improve control of blood glucose and warn patients that warning signs are present

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11
Q

What is the management for pre proliferative retinopathy

A

It suggests general ischaemia so if left alone, will grow new vessels. It needs pan retinal photocoagulation

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12
Q

What is the management for proliferative retinopathy

A

It can bleed so needs pan retinal photocoagulation

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13
Q

What is the management of diabetic maculopathy

A

Fire laser to the macula as there is only problem here - only need a grid of photocoagulation

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14
Q

What can happen in diabetic nephropathy if not treated early on?

A

Progressively increasing proteinuria and deteriorating kidney function

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15
Q

What is diabetic nephropathy associated with

A

Hypertension and classic histological features

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16
Q

What are glomerular changes in diabetic nephropathy

A
  • mesangial expansion
  • basement membrane thickening (v important- cells become rigid affecting kidney)
  • glomerulosclerosis
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17
Q

How many patients with T1DM will get diabetic nephropathy?

A

20-40% after 30-40 years

18
Q

How many patients with T2DM will get diabetic nephropathy?

A

Similar to T1DM: 20-40% after 30-40 years however the likelihood depends on different factors

19
Q

What affects the likelihood of a patient with T2DM developing diabetic nephropathy?

A

Age at development of disease (may die from heart attack before even getting a problem with nephropathy)
Racial factors
Age at presentation
Loss due to cardiovascular morbidity

20
Q

What are clinical features of diabetic nephropathy

A
  • progressive proteinuria
  • increased BP
  • deranged renal function
21
Q

What are the different proteinuria ranges for normal, microalbuminuric, assymptomatic, and nephrotic

A

Normal: <30mg/24hrs
Microalbuminuric: 30-300mg/24hrs
Assymptomatic: 300-3000mg/24hrs
Nephrotic: >3000mg/24hrs

22
Q

What are strategies for intervention for diabetic nephropathy

A

Diabetic control
Blood pressure control
Inhibition of the activity of RAS system
Stop smoking

23
Q

Why is albumin also measured as well as GFR to detect renal disease

A

Because GFR can stay the same when microalbumin can be detected to go up and this is an early sign of a problem with kidneys and therefore increases chance for intervention

24
Q

What are the negative effects of angiotensin 2

A 
Vasoactive effects
Mediation of glomerular hyperfiltration
Increased tubular uptake of proteins
Induction of pro fibrotic cytokines
Stimulation of glomerular and tubular growth
Podocyte effects
Induction of pro inflammatory cytokines
Generation of ROS &amp; NF-kB
Stimulates fibroblast proliferation
Up regulation of adhesion molecules on endothelial cells
Up regulation of lipoprotein receptors
25
Q

Where does ACE work?

A

Making angiotensin 1 into angiotensin 2

26
Q

What are the vasa nervorum?

A

Small vessels supplyning nerves

27
Q

What is neuropathy

A

When the vasa nervorum gets blocked

28
Q

What are different types of diabetic neuropathy

A 
Peripheral polyneuropathy
Mononeuropathy
Mononeuritis multiplex
Radiculopathy
Autonomic neuropathy
Diabetic amyotrophy
29
Q

In which group of people is peripheral neuropathy most common?

A

Tall people

or patients with poor glucose control

30
Q

What is the danger to patients in peripheral neuropathy

A

Patients will not sense an injury to the foot eg stepping on a nail

31
Q

What are signs of peripheral neuropathy?

A

Loss of ankle jerks
Loss of vibration sense - using a tuning fork
Multiple fractures on foot xray - charcot’s joint

32
Q

What is a sign of mononeuropathy?

A

Usually sudden motor loss
Wrist drop, foot drop
Cranial nerve palsy
Double vision due to 3rd nerve palsy

33
Q

What happens in pupil sparing third nerve palsy?

A

Eye is usually down and out - 6th nerve pulls eye out and 4th pulls it down but the pupil does respond to light

34
Q

Why does pupil still respond to light in third nerve palsy due to diabetes

A

Parasympathetic fibres on the outside thus they do not easily lose blood supply in diabetes

35
Q

What is different between third nerve palsy due to aneurysm compared to due to diabetes

A

Aneurysm - press on parasympathetic fibres first so causes fixed dilated pupil

36
Q

What is mononeuritis muliplex?

A

A random combination of peripheral nerve lesions

37
Q

What is radiculopathy

A

Pain over spinal nerves, usually affecting a dermatome on the abdomen or chest wall.

38
Q

What is autonomic neuropathy

A

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

39
Q

What are GI problems that can be due to autonomic neuropathy

A 
GI tract:
difficulty swallowing
delayed gastric emptying
constipation / nocturnal diarrhoea
Bladder dysfunction
40
Q

What are tests that you can do to test for autonomic neuropathy

A

Measure changes in heart rate in response to Valsalva manoevre
Normally there is a change in heart rate
Look at ECG and compare R-R intervals

41
Q

What are problems that can be due to autonomic neuropathy

A 
GI tract:
difficulty swallowing
delayed gastric emptying
constipation / nocturnal diarrhoea
Bladder dysfunction
Postural hypotension
can be disabling: collapsing on standing.
Cardiac autonomic supply
case reports of sudden cardiac death

Year 2 Endocrinology (21 decks)

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