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BMA 3 > week 2 > Flashcards

week 2 Flashcards

1
Q

define amputation

A

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
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2
Q

causes of lower extremity amputation

A 
Peripheral Vascular Disease • Diabetes
• Hypertension
• Hyperlipidaemia
• Smoking
infection
injury
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3
Q

what is peripheral vascular disease

A

• Narrowing of the blood vessels outside the heart and brain
-Most commonly due to
atherosclerosis
- less commonly due to vasculitis, frostbite

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4
Q

what is atherosclerosis

A

hardening of the arteries

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5
Q

how does atherosclerosis

lead to amputation

A

atherosclerosis

  • impaired circulation
  • oedema
  • reduced circulation
  • ulcers develop (infection)
  • impaired health and immune response
  • gangrene
  • amputation
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6
Q

signs of peripheral vascular disease

A 
skin assessment;
• touch
• Ulcer assessment • pain
• hair growth • appearance • nails
• pulse
pain assessment:
- type 
- activity
ulcers assessment:
- pain
- colour
- edges
- location
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7
Q

treatment for peripheral vascular disease

A
  • Lifestyle changes
  • Treatment of existing conditions
  • Medications
  • Angioplasty
  • Vascular surgery
  • If revascularisation is not possible AMPUTATION
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8
Q

requirements for prostheses

A
  • soft tissue envelope provides interface between remaining lower extremity and prosthesis
  • sufficient mass of muscle, full thickness of skin and subcutaneous tissue
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9
Q

causes of upper extremity amputation

A
  • severe trauma (more common)
  • peripheral vascular disease
  • thermal burns and frost bite
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10
Q

whats diabetes mellitus

A

Chronic disorder of carbohydrate, fat and protein metabolism due to defective/deficient insulin

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11
Q

whats hyperglycaemia

A
  • 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

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12
Q

regulation of glucose

A

eat food (glucose)
supplied to blood stream
transported from blood to cells using insulin
glucose used by cell to make ATP

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13
Q

whats insulin

A

A hormone that allows the transport of glucose into cells, thus lowering the blood glucose level (BGL)

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14
Q

where is insulin produced

A

B cells in the pancreases

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15
Q

glucose process

A
  • 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
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16
Q

absorptive state

A
  • 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
17
Q

post absorptive state

A
  • 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
18
Q

what is type 1 diabetes

A
  • ~ 15% of patients
  • autoimmune (destruction of pancreatic  cells)
  • absolute lack of insulin
  • not preventable
19
Q

what is type 2 diabete

A
  • ~ 85% of diabetic patients
  • lifestyle and environment
  • deficient/defective insulin
  • preventable
20
Q

what is gestational diabetes

A
  • glucose intolerance first appears during pregnancy
  • 1 – 14% of pregnant women
  • resembles type 2 DM
  • hormones and weight gain
  • usually resolves after birth
21
Q

causes of type 1 diabetes

A 
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
22
Q

type 2 diabetes causes

A

• 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

23
Q

define insuline résistance

A

Decreased ability of peripheral tissues to respond to insulin
• loss of insulin post-receptor signalling
• down regulation of insulin receptors
• Obesity inhibits insulin signalling

24
Q

define insulin deficiency

A
  •  cell dysfunction
  • inadequate insulin secretion
  • Inadequate glucose uptake into cells
25
Q

difference between healthy, type 1 and type 2 diabetes

A
  • 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
26
Q

treatment type 1 diabetes

A

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)

27
Q

treatment type 2 diabetes

A
  • Diet and exercise
  • Oral hypoglycaemic agents
  • stimulate insulin release and decrease insulin resistance
  • alter carbohydrate absorption and reduce glucose load
28
Q

consequences of diabetes

A 
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
29
Q

chronic hyperglycaemia

A

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)

30
Q

whats the leading cause of lower extremity amputation

A 
diabetes
Diabetes can damage nerves and cause neuropathy and impair circulation due to high blood glucose levels
• Loss of sensation
• Impaired wound healing
• Infection

BMA 3 (8 decks)

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