week 2 Flashcards
define amputation
partial or total removal of a body part
- Where revascularisation is not possible “(three ds death danger damn nuisance)”
- Where tissue has died
- More common in lower extremities
causes of lower extremity amputation
Peripheral Vascular Disease • Diabetes • Hypertension • Hyperlipidaemia • Smoking infection injury
what is peripheral vascular disease
• Narrowing of the blood vessels outside the heart and brain
-Most commonly due to
atherosclerosis
- less commonly due to vasculitis, frostbite
what is atherosclerosis
hardening of the arteries
how does atherosclerosis
lead to amputation
atherosclerosis
- impaired circulation
- oedema
- reduced circulation
- ulcers develop (infection)
- impaired health and immune response
- gangrene
- amputation
signs of peripheral vascular disease
skin assessment; • touch • Ulcer assessment • pain • hair growth • appearance • nails • pulse pain assessment: - type - activity ulcers assessment: - pain - colour - edges - location
treatment for peripheral vascular disease
- Lifestyle changes
- Treatment of existing conditions
- Medications
- Angioplasty
- Vascular surgery
- If revascularisation is not possible AMPUTATION
requirements for prostheses
- soft tissue envelope provides interface between remaining lower extremity and prosthesis
- sufficient mass of muscle, full thickness of skin and subcutaneous tissue
causes of upper extremity amputation
- severe trauma (more common)
- peripheral vascular disease
- thermal burns and frost bite
whats diabetes mellitus
Chronic disorder of carbohydrate, fat and protein metabolism due to defective/deficient insulin
whats hyperglycaemia
- high blood glucose level (BGL)
* inability of cells to take in glucose from the blood due to a lack of or defect in the hormone insulin
regulation of glucose
eat food (glucose)
supplied to blood stream
transported from blood to cells using insulin
glucose used by cell to make ATP
whats insulin
A hormone that allows the transport of glucose into cells, thus lowering the blood glucose level (BGL)
where is insulin produced
B cells in the pancreases
glucose process
- after eating trigger B cells to release insulin
- 1st phase (within 2 mins, lasts 10-15 mints)
- 2nd phase (lasts until blood glucose level back to normal)
- insulin binds to insulin receptors on target cells
- ## lowers blood glucose
absorptive state
- increase blood glucose level (1st and 2nd phase release of insulin)
- glucose transport into muscle cells for ATP production
- excess converted to glycogen in muscle and liver
- production of glucose by liver inhibited
post absorptive state
- decrease blood glucose level (Pancreases releases glycogen from a cells)
- strode glycogen borked down to glucose
- liver make glucose from amino acids
- increase fatty acid synthesis
what is type 1 diabetes
- ~ 15% of patients
- autoimmune (destruction of pancreatic cells)
- absolute lack of insulin
- not preventable
what is type 2 diabete
- ~ 85% of diabetic patients
- lifestyle and environment
- deficient/defective insulin
- preventable
what is gestational diabetes
- glucose intolerance first appears during pregnancy
- 1 – 14% of pregnant women
- resembles type 2 DM
- hormones and weight gain
- usually resolves after birth
causes of type 1 diabetes
Absolute lack of insulin • immune mediated or idiopathic • Autoimmune disease • spontaneous or triggered • T cells destroy cells autoimmune response • Genetic susceptibility • protein markers on cell cell • Glucose cannot enter cell
type 2 diabetes causes
• Insulin resistance and/or insulin deficiency
cell
• lifestyle and environment combined with genetics
• not autoimmune • Genetic factors
Insulin
• not linked to same markers as Type 1 DM
• Glucose cannot enter if cells are not responding to insulin
define insuline résistance
Decreased ability of peripheral tissues to respond to insulin
• loss of insulin post-receptor signalling
• down regulation of insulin receptors
• Obesity inhibits insulin signalling
define insulin deficiency
- cell dysfunction
- inadequate insulin secretion
- Inadequate glucose uptake into cells
difference between healthy, type 1 and type 2 diabetes
- Healthy
- Insulin released in response to rise in BGL and glucose taken into cell using insulin and GLUTs
- Type 1 DM
- Insulin not secreted from pancreas due to autoimmune destruction of cells
- Type 2 DM
- Insulin deficiency or resistance
- cell dysfunction/stress
treatment type 1 diabetes
Insulin
• increases glucose uptake by body cells (decrease BGL)
• decreases blood amino acids, free fatty acids and ketones
• different formulations (ultra short, short, long-acting)
treatment type 2 diabetes
- Diet and exercise
- Oral hypoglycaemic agents
- stimulate insulin release and decrease insulin resistance
- alter carbohydrate absorption and reduce glucose load
consequences of diabetes
Clinical manifestations • increased thirst (polydipsia) • increased urination (polyuria) • increased hunger (polyphagia) Consequences of uncontrolled hyperglycaemia • Acute • diabetic ketoacidosis (Type 1 DM) • non-ketotic hyperosmolar coma (Type 2 DM) • Chronic • vascular complications • neuropathies
chronic hyperglycaemia
Macrovascular
• damage to large blood vessels of brain, heart and extremities
• cardiovascular disease and stroke
• Microvascular
• abnormal thickening of basement membrane of capillaries
• retinopathy (eyes)
• nephropathy (kidneys)
whats the leading cause of lower extremity amputation
diabetes Diabetes can damage nerves and cause neuropathy and impair circulation due to high blood glucose levels • Loss of sensation • Impaired wound healing • Infection
