old persons 20/10 Flashcards
A to E approach for assessment
What are the actions of glucagon?
Increase Gluconeogenesis in liver
Increase Ketogenesis in the liver
Increase glycogenolysis and decrease glycogenesis in liver
Increase lipiolysis in adipose tissue
And the actions of insulin are opposite to these!
What ratio plays a major role in regulation of gluconeogenesis?
The insulin/glucagon ratio.
(e.g. in diabetes the active level of insulin is decreased therefore the ratio decreases, hence increasing rate of gluconeogenesis and thus helping to promote hyperglycaemia)
Triad of T1DM symptoms
Polydipsia, Polyuria, Thrist
TD1M is
Is absolute insulin defiency
Type IV hypersensitivy
Beta cell destruction
DKA type 1 or type 2?
DKA mainly affects people with type 1 diabetes, but can sometimes affect people with type 2 diabetes.
I guess those T2DM patients have relative to low insulin levels.
T2DM?
Pancreas can’t make enough insulin (relative insulin deficiency)
OR
Cells cannot use insulin properly (insulin resistance)
Why is there relative rise in glucagon when insulin is low (particularly in T1DM)?
Theres not necessarily a rise glucagon, its just that the Insulin/Glucagon ratio has decreased
Thus as Glucagon causes an increase in gluconeogensis and ketogenesis
Obviously insulin secretion is mainly influenced by glucose, but what influences glucagon secretion?
1) Blood glucose levels primarily.
(insulin can also inhibit the secretion of glucagon. In a paracrine fashion)
https://www.ncbi.nlm.nih.gov/books/NBK279127/
Why does T2DM typically not lead to DKA?
Because I guess there is not an absolute absence of insulin. Thus the insulin/glucagon ratio does not decrease too much. (As remember insulin and glucagon have opposing effects of one another)
Effects of insulin
Decrease Gluconeogenesis in liver
Decrease Ketogenesis in the liver
Decrease glycogenolysis and Increase glycogenesis in liver
Decrease lipiolysis in adipose tissue
Symptoms of T2DM?
They may present with the T1DM triad. But are most likely to present with:
-Lack of energy
-Persistent infections (genital thrush infections)
-Infections of feet
-Visual problems
-Slow healing
Diagnosis of DM?
Presence of symptoms
1) Random plasma glucose conc of greater than or equal to 11.1 mmol/L
OR
Presence of symptoms
1)Fasting plasma glucose of greater than or equal to 7.0 mmo/L
OR
Presence of symptoms
1) Plasma glucose conc of greater than or equal to 11.1 mmol/L after oral glucose tolerance test.
DKA triad of symptoms?
DKA treatment:
Signs of Vitamin D defiency?
osteomalacia (older; after fusion of epiphyses), rickets (in young)
Parotitis
Parotid gland swelling
Pain on mastication, lack of salivary secretions, pain.
Bell’s palsy?
In Stroke forehead is spared!
Fraility score
In geriatrics
When doing a history remember to do a multi systems check; e.g. bowels regularity and water works too
Writing medical notes acronym?
SOAP
Subjective:
Chief Complaint (CC)
History of Present Illness (HPI)
History
Review of Systems (ROS)
Current Medications, Allergies
Objective:
Assessment:
Plan:
https://www.ncbi.nlm.nih.gov/books/NBK482263/
Can AF cause Acute mesenteric ischaemia?
Yes, it can throw off an embolus
Acute mesenteric ischaemia symptoms + signs?
**Acute (abrupt) severe **abdominal pain
Pain constant, central, or around watershed area. Or diffuse. Can be nausea + vomitting.
Signs:
Metabolic acidosis
Acute mesenteric ischaemia treatment?
Thrombolysis = IV unfractionated Heparin
Surgery= Bypass graft
fluids + o2
Acute Diverticulitis?
When Diverticula (are outpouchings of mucosa+submucosa through the muscularis layers) become inflamed and can perforate.
SYmptoms of acute diverticulitis?
Abdominal pain at site of inflammation (usually left lower quadrant; sigmoid colon)
Fever
Bloating
Constipation
Haematochezia (blood in/with stools)
If perforated then signs of peritonitis.
Peritonitis symptoms?
Depends. But generally: Abdominal pain and lie still.
Peritonitis?
Is inflammation of the serosal membranes that line the abdominal cavity.
Causes=
Primary peritonitis = due to end stage liver disease (leads to ascites this predisposes to infection)
Secondary peritonitis = usually perforation occurs
3 areas of gallstones blockage and name?
Neck of gallbladder= biliary colic
Cystic duct= Acute cholecystitis (Murphy’s sign)
Common bile duct= Ascending Cholangitis (Charcots triad= jaundice, RUQ pain, inflammation)
