Picorul Diabetic

Question 1

Angiopatia diabetica

Answer 1

Microangiopatia:
Ingrosare mb bazala capilare si leziuni proliferative lumen arteriole, dispunere segmentara
-creste vascozitatea
-scade deformarea hemat
-creste coagulabilitatea

Macroangiopatia:
Ateroscleroza
Medioscleroza(MOENCKEBERG)

Question 2

Stadializarea Fountaine

Answer 2

1. Asimptomatic, simpt minoran diminuare puls pedioasa sau tib ant.
2. Claudicatie intermitenta, modif trofice IIA >200 IIB <200
3. Durere repaus si clino., nocturn, absenta puls, suflu sistolic
4. Leziuni ulcerative, gangrena uscata, durere extrema

Question 3

Neuropatia autonoma

Answer 3

Manifestari cutanate:
-scaderea secretiei sudorale
-deschidere shunturi arterio-venoase
=>supraincalzire=> charcot

Manifestari digestive:
hipotonie, constipatie, staza si litiaza biliara

Manifestari urogenitale:
Tulb mictiune, infectii, litiaza, imlotenta

Manifestari CV

Question 4

Neuroosteoartropatia Charcot

Answer 4

Neuropatie autonoma + senzitiva + traumatism + tulb. metab osos

Osteoporoza si osteoliza, fracturi, dislocari, subluxatii, articulatii

Inflamatie parti moi, tumefactie, edem, ulceratii, hiperkeratoza, calusuri

Question 5

Faza activa Charcot (6 Luni)

Answer 5

Inflamatie, tumefactie, edem osteoarticular => fracturi, subluxatii, ulceratii

Question 6

Faza tardiva Charcot (inactiva)

Answer 6

Scleroza subcondrala, artroza, osteofite, fara inflamatie, picior nefunctional

Question 7

Neuropatia senzitiva(in soseta)

Answer 7

Simptome exacerbate nocturn

Parestezii, paralizii
Anestezie, durere surda
Nesiguranta la mers
Pierderea identitatii

Question 8

Neuropatie motorie

Answer 8

Dispunerea plantara de grasime
Raport m flexori/extensori
Picior hiperexcavat, haluce valg, degete in ciocan
Mobilitate artic limitata
Modificarea biomecanicii

Question 9

Infectia pe teren ischemic

Answer 9

1. Gangrena uscata
2. Gangrena umeda
   Prin suprainfectare g uscata
3. Gangrena umeda extensiva
4. Fasceita necrozanta
5. Abces profund
6. Celulita necrozanta
7. Flegmonul fetei dorsale a piciorului

Question 10

Infectii pe teren neuropat

Answer 10

Ulcerul neuropat
frecvent plantar, nedureros, tegumente normal colorate

Question 11

Tratament picior diabetic

Answer 11

Profilactic
Tratarea f de risc:
Vasodilat, antiagregante, anticoag
Antidepresive, antiaritmice, anticonvulsivante
Talonete, orteze

Question 12

Tratament picior charcot

Answer 12

Faza activa: conservator, chirurgical doar in complicatii
-orteza, ains, bisfosfonati, calcitonina, inhibarea osteogenezei cu ultrasunete, cel stem

Faza inactiva: profilaxia ulcerelor cu incaltaminte personalizata
Deformari: ortopedic cu osteotomii, artrodeze
Ulcere: debridari
Amputatie minira sau majora