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Year 2 LCRS Endocrinology > Microvascular complications > Flashcards

Microvascular complications Flashcards

1
Q

What are the sites of micorvascular complications in Diabetis?

A
  1. Retinal ateries
  2. Nephrophathy –> damage of Glomerular arterioles
  3. Neuropathy –> Damage of Vasa nervorum (tiny blood vessels that supply nerves)
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2
Q

What are the factors that influence the development of microvascular complications?

A
  • Severity of Hyperglycaemia
    • –> the higher the sugar, the higher the risk
  • Hypertenstion
  • Genetic
  • Hyperglycaemic memory –> good controll is important at early stage
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3
Q

What is the machanism microvascular complications with high glucose levels?

A

High glucose –> increase production of cytokines –> inflammation

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4
Q

What is the most cimmonest cause of blindness in people of working age?

A

Diabetic retinopathy

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5
Q

What are the changes that can be seen in diabetic retinopathy?

A

Backround:

  • Hard exudates (cheese colour, lipid)
    • proteins leaving
  • Microaneurysms (“dots”)
    • sprouting of vessels
  • Blot haemorrhages

Pre-proliverative

  • retinal ischaemia, seen by
    • •Cotton wool spots also called soft exudates (white, bright spots on retina)

Proliverative

  • new vessels formed
  • visible on disc or elsewhere in the eye
    • may effect vision
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6
Q

What is maculopahty?

A

•Hard exudates near the macula

–> can threaten vision

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7
Q

What are hard exudates?

A

Lipid deposits in the retina

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8
Q

What is the management of backround diabetic retinopathy?

A
  • improve control of blood glucose!!!
  • warn patient that warning signs are present
  • screening every year
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9
Q

What are the different stages in diabetic retinopathy?

A
  1. Backround
  2. Pre-prolaverative
  3. Prolaferative
  4. Maculopathy
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10
Q

What is the management plan for someone with pre-proliferative diabetic retinopathy?

A
  • Pre-proliferative (cotton wool spot)
  • Suggests general ischaemia
  • If left alone, new vessels WILL grow
  • Needs: Pan retinal photocoagulation –> laser to prevent new vessels from forming
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11
Q

How do you manage proliferative retinopahty in diabetic retinopathy?

A
  • Proliferative (visible new vessels)
  • Also needs:

-Pan retinal photocoagulation –> laser therapy

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12
Q

How do you manage maculopathy in diabetic retinopathy?

A
  • Only have problem around macula
  • Needs only a GRID of photocoagulation –> around the macula
  • (NOT pan retinal photocoagulation)
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13
Q

What are the signs of someone with diabetic retinopathy?

A
  • Hypertension
  • Progressively increasing proteinuria
  • Progressively deteriorating kidney function
  • Classic histological features
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14
Q

What happens to someone with CKD and Diabetis?

A

They are at substantial risk of dying! (from macrovascular / Cardiac complications)

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15
Q

What are the glumerular changes in diabetic nephropathy?

A
  1. Mesangial expansion
    • mesangial cells= specialised pericytes in kidney
  2. Basement membrane thickening !!!
  3. Glomerulosclerosis
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16
Q

How do high glucose levels and Hypertension lead to CKD?

A

Cytokine mediated changes –> Inflammation

17
Q

What is the prevalence of CKD in Type 1 and 2 DM?

A

In T1: 20-30% after 30-40 years

In T2: probably the same but many people die before that from macrovascular complications

18
Q

What are the clinical features of Diabetic Nephropathy

A
  1. Progessive proteinuria
  2. hypertension
  3. Renal function
19
Q

How do you treat a patient with diebetic nephrophathy?

A
  1. Diabetic control!!!
  2. Reducing BP
  3. VIa: Inhibition of RAS system (ACE inhibitors) (maybe also Angiotensin 2 receptor antagonist
  4. Stop Smoking
20
Q

What are the Vasa nervorum?

A

Blood vessels that supply the nerve

21
Q

What different types of diabetic neuropathy are there?

A
  1. Peripheral
    • most common
  2. Mononeuropathy
    • only one nerve effected
  3. Mononeuritis multiplex
    • areas of nerve
  4. Radiculopathy
    • dermatomes
  5. Autonomic neuropathy
  6. Diabetic amyotrophy
    • painful condition
22
Q

What are the characterisitcs of peripheral neuropathy?

When does it occur?

What is the problem with it?

A
  • Longest nerves supply feet
  • More common in tall people
  • Loss of sensation
  • Danger is that patients will not sense an injury to the foot (eg.Stepping on a nail)
23
Q

Where does peripheral neuropahty occur?

A
  • in tall people
  • with poor blood glucose controll
24
Q

What are the clinical signs of peripheral neuropathy?

A
  • Loss of ankle jerks
  • loss of vibration sense (using tuning fork)
  • multiple fractures on foot X-ray (Charcot’s joint) –> tender red areas, can leave permanent deformities
25
Q

What is mononeuropathy?

What are the clinical features?

A

Loss of a single peripheral nerve leading to (depending on site o lesion)

  • Usually sudden motor loss
  • wrist drop, foot drop
  • Cranial nerve palsy:
    • –> double vision due to 3rd nerve palsy (pupil is “down and out” ) but pupils are light responsive (PNS fibres still work)
26
Q

Explain the Pupil sparing third nerve palsy

A
  • parasympathetic fibres on outside.
  • Thus they do not easily lose blood supply in diabetes

(would be different in space taking lesion)

27
Q

What is mononeuritis multiplex?

A

•A random combination of peripheral nerve lesions

–> can be very painful

28
Q

What is Radiculopathy?

A

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

29
Q

What is Autonomic neuropathy?

A

•Loss of sympathetic and parasympathetic nerves to GI tract, bladder, cardiovascular systemdue to diabetic neuropathy

  1. GI tract:
    • •difficulty swallowing
  • delayed gastric emptying
  • constipation / nocturnal diarrhoea
  • Bladder dysfunction
30
Q

What are the clinical signs of autonomic neuropathy?

A
  1. Postural hypotension
    • can be disabling: collapsing on standing.
  2. Cardiac autonomic supply
    • case reports of sudden cardiac death
  3. Measure changes in heart rate in response to Valsalva manoevre –> increase Intra-thoracic pressure
  • Normally there is a change in heart rate
  • Look at ECG and compare R-R intervals

Year 2 LCRS Endocrinology (15 decks)

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