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Endocrine 2 > Vascular Complications of DM > Flashcards

Vascular Complications of DM Flashcards

1
Q

When does atherosclerosis begin in DM and those without DM?

A

-for both groups aatherosclerosis begins in childhood.

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2
Q

What groups of individuals always end up getting bypassed?

A
  • Diabetics d/t multi-vessel disease

- Left main disease b/c it supplies blood to LAD and circ.

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3
Q

Pathophysiology of Nephropathy

A
  • lesions occurring in a diabetic kidney
  • Hammers the kidney
  • Basement membrane thickens
  • glomerular sclerosis (hardening allows protein/glucose to slip through more easily
  • -all cause impaired blood flow, nodular lesions, and kidneys slowly die
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4
Q

Earliest stages of Nephropathy what do we see?

A

-microalbuminuria–dip stick is most sensitive, by the time you pick proteins up on this test its irreversible.

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5
Q

What are two specific lesions encountered in nephropathy ?

A
  • Glomerularsclerosis (Kimmelsteil-Willson): nodular lesions in glomerular capillaries causing decreased flow and function.
  • Renal Artery Stenosis: narrowing of flow to the kidneys, kidney thinks it needs to send out renin activating the Renin-angiotensin-aldosterone system leading to peripheral vasoconstriction and increased blood volume leading to 2ry HTN.
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6
Q

What is the key indicator of diabetic nephropathy?

A

-microalbuminuria

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7
Q

The progression of nephropathy can be slowed by?

A
  • tight glucose control
  • blood pressure control
  • Protein restriction in diet
  • smoking cessation
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8
Q

Medications for Nephropathy?

A
  • ACEI- keep blood pressure down, protecting the kidney
  • CI in those with renal artery stenosis
  • every DM needs to be on an ACEI
  • ARBS (Angiotensin II receptor blockers) - have antiproteinuric effect
  • may consider calcium channel blocker or beta blocker but we dont use these, may mask signs of hypoglycemia, may cause sugars to increase.
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9
Q

When to screen for nephropathy in T1D and T2D?

A
  • T1D we screen starting 5 years after dx

- T2D start screening at time of dx

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10
Q

Retinopathy

  • leading cause of what?
  • what is the incidence of this in T1D and T2D?
  • what is one of the very first signs?
  • what are the two types and what do you see on fundoscopic exam?
A
  • leading cause of blindness
  • T1D 100% incidence after 20years, T2D is 60%
  • Very first signs is blurriness of vision
  • Types:
  • Non-proliferative: microaneurysms, hard exudates (lipids & proteins), cotton wool spots (ischemic areas)
  • proliferative” neovascularization, neovascular glaucoma, retinal detachment (floaters), senile cataracts
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11
Q

Retinopathy:

  • how often do diabetics get screened?
  • Tx
A
  • annually

- Tight glucose control, aggressive tx of HTN, statin decrease lipid deposition, laser photocoagulation, vitrectomy

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12
Q

Peripheral Neuropathy

  • pathophysiology
  • what is one of the first signs of this?
  • distributional appearance of neuropathy
  • signs
  • what order do we lose sensation?
A

Patho: thickening of the walls of vessels that supply the nerve leading to ischemia, segmental demyelination leading to slower nerve conduction.

  • first sign is usually loss of vibratory sensation on their toes
  • glove and stocking distribution
  • Signs:
  • pain, numbness, hyperesthesias, paresthesias(burning, itching, tingling), sensory loss of proprioception and vibratory sense.
  • Abnormal gait
  • hammer toes

Order: Vibration, pain, temperature

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13
Q

Neuropathy:

  • neuro foot exam includes?
  • Tx
  • which type of neuropathy is most common?
A
  • neuro foot exam includes:
  • monofilimant test
  • reflexes
  • vibratory sensation
  • proprioception
  • Tx: TCA for pain and sensory issues
  • Neurontin(best and safest) & Cymbalta (SSNRI)`

-most common is somatic neuropathy

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14
Q

Autonomic Neuropathy:
-what are some examples?

  • Tx
  • CNs and limbs?
A
  • Gastric dysmotility or Gastroparesis
  • -delayed emptying
  • -constipation
  • -N/v
  • -diarrhea
  • ED
  • Orthostatic Hypotension
  • Cardiac rhythm disturbances
  • Bladder= retention/incontinence

Tx:

  • Ortho Hypotension: Fludrocortisone
  • Gastraparesis: Erythromycin(causes diarrhea, given to end constipation), Imodium(to stop the diarrhea)
  • ED: Viagra or Cialis
  • CN: III, IV, VI, VII
  • Femoral, sciatic, or peroneal neuropathy
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15
Q

Macrovascular

-major 3 complications

A

-CVD, Cerebrovascular disease, peripheral arterial disease

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16
Q

Atherosclerosis

  • pathophysiology
  • this is an _____ disease?
  • what is an atheroma?
A
  • LDL engulfed by Mfs, accumulation of foam cells, fibrofatty lesion formed in intimal lining of the large and medium sized arteries. Thickening of the lining of the vessel also occurs.
  • this is an INFLAMM disease
  • atheroma: fibrofatty plaque (Mf, LDL, CT)
17
Q

Manifestations of Diabetes and Atherosclerosis

A
  • narrowing of the vessel and producing ischemia, sudden vessel obstruction d/t plaque rupture leading to thrombosis and formation of emboli.
  • aneurysm formation d/t weakening of the vessel wall.
  • ischemia and infarction
  • “Silent ischemia” diabetics have poor innervation of the hear so they dont present with classic MI sx. Angina doesnt usually occur until 70-80% blockage
18
Q

Coronary Artery Disease

-preventative tx

A

-tx: Aspirin, statin (reduce inflamm), BS control, HTN (ACEI & ARBS), tobacco cessation, exercise, avoid carbs
BP: 120/80 optimal, 130/80 minimal goal

19
Q

Preventative Tx of CVD, Peripheral, and Cerebral Disease

A
  • Smoking cessation
  • Management of Obesity
  • Hyperlipidemia (LDL less than 100, HDL less than 40, Triglycerides less than 150)
  • Lifestyle modifications (DIET)
  • exercise
  • glycemic control
20
Q

What is a common sign of peripheral vascular disease?

What are the most common sites off PVD?

A
  • intermittent claudication/ angina of the legs (intense localized pain)
  • most common is femoral and popliteal
21
Q

What are some common signs of PVD?

A
  • shiney, no hair, pallor, pulseless, cold, painful/achy, cant move leg well, no O2 or blood going to the extremity
  • This leg will die, requires immediate care.
22
Q

Signs of Venous Occlusion signs

A

-hot, swollen, red, huge, tender to touch, can feel pulses, most likely die of PE.

23
Q

What is ABI?

  • how to calculate
  • why do we do this?
  • why might DM have falsely normal ABI?
  • Whats a normal reading?
A
  • Ankle Brachial Index
  • Calculate: SBP Ankle/SBP ARM
  • establish quality of arterial blood flow
  • falsely normal b/c they are calcified, dont have any bounce.
  • normal reading is anything greater than .90

can be falsely high in DM

Endocrine 2 (10 decks)

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