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Endocrine > Surgical Complications of DM > Flashcards

Surgical Complications of DM Flashcards

1
Q

What happens to BG levels with hospitalization or inflammation?

A

Cortisol levels increase, causing insulin resistance

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2
Q

Can DM be reversed by diet?

A

Yes

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3
Q

What percent of calories should be plant based? What is the actual amount obtained?

A

80%

12%

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4
Q

What is the major difference between ED visits and office visits for DM?

A

Office visits allow for more time for evaluation

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5
Q

Why is the CV exam so important with DM pts?

A

the biggest comorbidity

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6
Q

What is the best question to ask patients to assess mobility/functional status?

A

Can you walk around the block?

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7
Q

What is the MOA of clopidogrel?

A

ADP inhibitor

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8
Q

Over what age is a cardiac risk factor?

A

70 yo

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9
Q

What rhythms are a risk criteria for an MI?

A

Anything other than NSR

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10
Q

What are the three major things to do to workup DM emergently preoperatively?

A
  • Baseline vitals
  • EKG
  • Blood work
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11
Q

What are the four major postoperative issues with DM?

A
  • Infections
  • Wound care
  • Glucose control
  • Gastroparesis
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12
Q

What are the two major factors that increase infection susceptibility with DM pts?

A
  • Reduced vascular perfusion

- Increased glucose for pathogens

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13
Q

What is the effect of hyperglycemia on the complement cascade?

A

Inhibition

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14
Q

What is the relation between sternal infections and hyperglycemia?

A

Sugars over 200 mg/dL increased the incidence of sternal wound infections

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15
Q

What is the error rate of accuchecks?

A

10%

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16
Q

What is the effect of intensive insulin therapy post op?

A

Increased mortality

17
Q

What is the BG level that is the goal of post op DM pts?

A

Less than 180 mg/dL

18
Q

True or false: you usually stop oral DM II drugs prior to surgery?

A

True

19
Q

What is the major complication of metformin?

A

Lactic acidosis

20
Q

What are the major side effects of first and second generation sulfonylureas?

A

Hypoglycemia for both

Disulfiram effect in 1st gen

21
Q

What are the diseases that can prevent absorption of insulin SQ?

A

sepsis

IVFs

22
Q

What happens to peripheral circulation with sepsis (not shock)?

A

Vasoconstriction

23
Q

What is the danger of administering SQ and IV insulin?

A

IV will work now, and SQ can work later when perfusion increases. This is a risk for hypoglycemia

24
Q

What is the major GI effect of DM? What is the effect of this with intubation?

A
  • Gastroparesis

- Increased risk of aspiration

25
Q

What is the MOA of metoclopramide?

A

D2 receptor antagonist

also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist.

26
Q

What are the complications that can arise from post op MI with DM?

A

PEs

Arrhythmias

27
Q

What is the consequence of fatter liver?

A
  • Decreased metabolism of drugs, even following operation

- Increased risk of cirrhosis

28
Q

What is the effect of DM on contrast-induced nephropathy? How do you prevent this?

A

High risk

Hydrate and give N-acetylcysteine

29
Q

What is the MOA of N-acetylcysteine?

A

Glutathione donor to protect liver from free radical damage

30
Q

What is Fournier’s gangrene?

A

A horrendous infection of the genitalia that causes severe pain in the genital area and progresses from erythema to necrosis of tissue. Gangrene can occur within hours.

31
Q

What is the treatment for Fournier’s gangrene?

A

Need emergent surgical debridement–abx will not suffice

32
Q

What are the meds that can worsen hyperglycemia in the hospital?

A

Steroids

TPN

33
Q

What is the effect of DM on the administration of local anesthesia?

A

May not need anything, or will need to alter dose to prevent nerve damage

34
Q

What should you do if a DM pt has a BG level less than 70 mg/dL prior to a surgery?

A

Give 100-200 ccs of D5 or D10

35
Q

What should you do if a DM pt has a BG level greater than 250?

A

Give SQ insulin

36
Q

What should you do if a DM pt has a BG level greater than 70-250?

A

Give regular IVF

37
Q

What are the inflammatory processes that are downregulated with hyperglycemia? (4)

A
  • Less rolling/adherence
  • Phagocytosis
  • Macrophage activation
  • Complement cascade

Endocrine (32 decks)

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