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GP 2 Flashcards

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1
Q

What is dyspepsia?

A

Indigestion - upper abdo symptoms such as heartburn/acidity/pain/discomfort/nausea/bloating

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2
Q

Symptoms of dyspepsia?

A

Epigastric pain often related to hunger, specific foods, or time of day
Bloating, fullness, heartburn

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3
Q

ALARMS symptoms in dyspepsia?

A 
Anaemia
Loss of weight
Anorexia
Recent onset/progressive
Melaena/haematemesis
Swallowing difficulty

> 55 years

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4
Q

If >55 or ALARMS signs what is management?

A

Upper GI endoscopy

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5
Q

If <55 or no ALARMS signs what is management?

A

Lifestyle advice, ITC antacids, review

If no improvement test for H.pylori - Carbon 13 breath test

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6
Q

Management if no H.pylori present and still symptoms?

A

PPI (omeprazole) or H2 blockers (ranitidine) for 4 weeks

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7
Q

Management if H.pylori present?

A

Omeprazole AND amoxicillin (or metronidazole) AND clarithromycin

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8
Q

What is GORD?

A

Gastrooesophageal reflux disorder

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9
Q

Pathophysiology of GORD?

A

Reflux of stomach contents causes symptoms i.e. heartburn or complications i.e. oesophagitis

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10
Q

Causes of GORD? (6)

A 
Lower oesophageal sphincter hypotension
Hiatus hernia
Loss of gastric peristalsis/slow emptying
Obesity
Acid hypersecretion
Smoking, alcohol, overeating
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11
Q

Symptoms of GORD? (5)

A 
Heartburn - burning retrosternal discomfort, worse on lying or after big meal
Acid/bile/water regurgitation
Belching
Painful swallowing
Can cause cough, hoarse voice
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12
Q

Complications of GORD?

A 
Oesophagitis
Benign stricture
Ulcers
Iron deficiency
Metaplasia - barrett's oesophagus (squamous to columnar change)
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13
Q

Investigations in GORD? (4)

A

Endoscopy - esp if ALARMS, refractive, palpable mass, persistent vomiting
Barium swallow may show hiatus hernia (gastro-oesophageal junction slides into chest and sphincter is less competent)
Oesophageal pH monitoring
Bloods - FBC for anaemia

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14
Q

Lifestyle changes for GORD? (6)

A

Raise bed head
Weight loss
Stop smoking
Smaller, regular meals
Avoid - hot drinks, fizzy, alcohol, citrus fruits, spicy foods, coffee, chocolate, eating before bed
Avoid NSAIDs or other gastric damaging drugs

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15
Q

Medications for GORD?

A

Antacids - magnesium trisilicate mixture
Alginates - Gaviscon
Proton pump inhibitor - lansoprazole
H2 blocker - ranitidine

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16
Q

Surgery for GORD?

A

Nissen fundoplication to increase LOS pressure

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17
Q

How do antacid containing alginates work?

A

Form a foam raft over gastric contents to reduce reflux

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18
Q

How do PPIs work?

A

Inhibits the membrane enzyme H+/K+ ATPase to inhibit gastric acid secretion

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19
Q

CI/SEs of PPIs

A

CI: can increase risk of fractures in elderly, GI infections, may mask gastric cancer symptoms
SE: abdo pain, constipation, dizziness

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20
Q

How does ranitidine work?

A

Blocks the H2 (histamine) receptors, stops cells from producing acid

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21
Q

What is IBS?

A

Irritable bowel syndrome - mixed group of abdominal symptoms for which no organic cause can be found

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22
Q

Cause of IBS?

A

Most due to disorders of intestinal motility or enhanced visceral perception

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23
Q

Diagnosis of IBS?

A 
Abdominal pain/discomfort relieved by defecation OR associated with altered stool form/frequency
AND 2 of:
Urgency
Incomplete evacuation
Abdominal bloating/distension
Mucous PR
Worse symptoms after food

Chronic >6 months

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24
Q

What can exacerbate IBS?

A

Menstruation
Stress
Gastroenteritis

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25
Signs of IBS?
May have generalised abdo tenderness | Pt is younger woman
26
Tests for IBS?
Exclude other diagnoses - FBC, ESR, CRP, LFT, coeliac serology Colonoscopy if unsure May need Ca125 to exclude ovarian Ca
27
Management of IBS? (4)
Healthy diet - fibre, lactose, starch, caffeine, alcohol may worsen Bisacodyl laxative Loperamide for diarrhoea Antispasmodics - mebeverine
28
What is coeliac disease?
T cell mediated autoimmune disease of the small bowel
29
Pathophysiology of coeliac disease?
Prolamin intolerance i.e. gliadin (gluten proteins) causes villous atrophy and malabsorption
30
Associated conditions with coeliac?
``` HLA DQ9/8 - other autoimmune disease Dermatitis herpetiformis (severe itching, red raised patches that often blister) ```
31
Symptoms of coeliac disease? (11)
``` Diarrhoea Stinking stools/steatorrhoea Abdominal pain Bloating Nausea, vomiting Apthous ulcers Angular stomatitis Weight loss Fatigue Osteomalacia Failure to thrive ```
32
Diagnosis/investigation of coeliac disease? (4)
Bloods - low Hb, low B12, low ferritin Antibodies - alpha gliadin, tissue transglutaminase, IgA anti-endomysial (most specific) Endoscopy and biopsy SYMPTOMS/SIGNS REVERSE ON GLUTEN FREE DIET
33
What is seen on endoscopy/biopsy in coeliac?
Duodenal biopsy shows subtotal VILLOUS ATROPHY, INTRA EPITHELIAL WBCs, CRYPT HYPERPLASIA
34
Treatment of coeliac disease? (3)
Lifelong gluten free diet Can prescribe gluten free bread, pasta, flour Verify diet by anti-endomysial antibody monitoring
35
Complications of coeliac disease? (6)
``` Anaemia T cell lymphoma Malignancy - gastric, oesophageal, bladder Myopathies Neuropathies Osteoporosis ```
36
What is ulcerative colitis?
Relapsing and remitting inflammatory disorder of the colonic mucosa
37
Distribution of UC?
Just the rectum (proctitis) or extend to part of the sigmoid or whole colon - never proximal to ileocaecal valve
38
Cause of UC?
Unknown. Some genetic risk | Smoking is protective
39
Pathology of UC?
Haemorrhagic granular colonic MUCOSA, possibly with pseudopolyps formed by inflammation Punctate ulcers into lamina propria but not usually transmural
40
Symptoms of UC? (5)
``` Episodic/chronic diarrhoea possibly with blood and mucus Crampy abdo pain Bowel frequency Urgency Fever, malaise, weight loss ```
41
Signs of UC?
If acute may be fever, tachycardia, tender abdomen
42
Extraintestinal signs of UC? (6)
``` Clubbing Apthous ulcers Erythema nodosum Conjunctivitis, episcleritis, iritis Large joint arthritis Ankylosing spondylitis ```
43
Tests for UC?
Blood - FBC, U+E, LFT, ESR, CRP, cultures Stool MC+S Abdo XR Colonoscopy and biopsy
44
What is seen on abdo XR in UC?
Mucosal thickening and colonic dilatation
45
What is seen in colonoscopy biopsy in UC? (5)
``` Inflammatory infiltrate Goblet cell depletion Glandular distortion Mucosal ulcers Crypt abscesses ```
46
Complications of UC? (5)
``` Perforation Haemorrhage Toxic colon dilatation Venous thrombosis Colonic cancer ```
47
How is mild UC treated? (<4 stools, small bleeding) (2)
5-aminosalicylic acid (5-ASAs) - sulfasalazine for remission induction/maintenance Prednisolone low dose 2 wks helps remission induction
48
How is moderate UC treated? (4-6 stools, moderate bleeding) (3)
Oral prednisolone high dose for 2 weeks | Lower dose for 4 weeks with sulfasalazine and steroid enemas
49
How is severe UC treated? (>6 stools, unwell, large bleeding) (5)
ADMIT for NBM and fluids Hydrocortisone IV Rectal hydrocortisone Daily testing, consider transfusion Transfer to prednisolone high dose and sulfasalazine if improving
50
How is severe UC that is not improving treated? (2)
Rescue therapy - ciclosporin or infliximab | Surgery - colectomy
51
What is Crohn's disease?
Chronic inflammatory GI disease
52
Pathology of Crohn's?
TRANSMURAL granulomatous inflammation affecting the GI tract from mouth to anus Skip lesions - unaffected areas between disease (UC is continuous)
53
Cause of Crohn's?
Unknown. Smoking increases risk, genetics
54
Symptoms of Crohns? (5)
``` Diarrhoea/urgency Abdo pain Weight loss/FTT Fever, malaise, anorexia Vomiting ```
55
Signs of Crohns?
Apthous ulcers Abdo tenderness Perianal abscesses/fistulae/SKIN TAGS Anal strictures
56
Extraintestinal signs of Corhns? (5)
``` Clubbing Erythema nodosum Large joint arthritis Ankylosing spondylitis Conjunctivitis, episcleritis, iritis ```
57
Complications of Crohns? (7)
``` Small bowel obstruction Toxic dilatation - rarer than UC Abscesses Fistulae Perforation Haemorrhage Colon cancer ```
58
Tests for Crohns? (6)
``` Bloods - FBC, ESR, CRP, U+E, LFT, ferritin, folate, B12 Stool MC+S Colonoscopy and biopsy Small bowel enema, barium enema MRI to assess extent and fistulae ```
59
What is seen on colonoscopy and biopsy in Crohns? (6)
``` Deep fissured ulcers - transmural Skip lesions Narrowed lumen Inflammatory infiltrate Granulomas with or without langhans giant cells Lymphoid hyperplasia ```
60
How are mild attacks (systemically well) treated in Crohns?
Prednisolone high for 1 week, lower for 4 and wean off
61
How is severe Crohns treated?
ADMIT for NBM, fluids IV hydrocortisone, rectal hydrocortisone Metronidazole IV Daily testing, consider transfusion If improving transfer to oral prednisolone
62
How to treat severe Crohns that is not improving?
Infliximab, adalimumab | Surgery if refractive
63
Other drugs that may be given in Crohns? Useful in <50%
Azathioprine, methotrexate - steroid sparing | Sulfasalazine MAY work
64
How does sulfasalazine work? CI, SEs
Decreases inflammation, inhibits prostaglandin formation SE: reversible infertility in men, rash, headache (rarely pancreatitis, hepatitis) CI: asthma, risk of hepatic toxicity
65
How do infliximab/adalimumab work? CI, SEs
TNF alpha inhibitors, counter granuloma formation and WC infiltration CI: sepsis, liver disease SE: rash, infections
66
What is osteoarthritis?
Commonest joint condition. | Disease of synovial joints, usually primary but may be secondary i.e. to obesity
67
Structures involved in osteoarthritis?
The whole joint structure inc. cartilage, ligaments, capsule | Localised disease usually knee or hip
68
Pathogenesis of OA?
Loss of articular cartilage | Remodelling of underlying bone due to mechanical damage/inflammation/metabolic defect
69
In whom is OA most common?
Females >50
70
Symptoms of localised OA? (6)
``` Usually KNEE or HIP pain on movement Crepitus Worse at end of day Background pain at rest Stiffness AFTER rest Joint instability ```
71
Symptoms of generalised OA? (7)
``` Commonly DIP joints, thumb meta-carpals, knees Heberden's nodes - DIP Bouchards nodes - PIP Joint tenderness Derangement Bony swelling Decreased ROM Synovitis ```
72
Investigations in OA?
Bloods - ESR, CRP | XR/MRI
73
What does XR show in OA?
Loss of joint space Osteophytes Subarticular sclerosis Sunchondral cysts
74
Management of OA? (6)
Exercise, weight loss Analgesia - paracetamol, topical NSAIDs, codeine Intra-articular steroid injections MDT - Physio, OTs Heat/cold packs, stretching Surgery - joint replacement for hip or knee
75
MDT advice to give in OA?
``` Physio for exercises, splints OT for aids i.e. walking stick Chiropodist for foot care Social worker for benefits, housing Orthopaedics for surgery ```
76
What is rheumatoid arthritis?
Most common disorder of connective tissue
77
Cause of RA?
Immunological | Triggered by environmental factors in patients with a genetic predisposition
78
How does RA present? (6)
``` Commonly in middle aged females Symmetrical small joint involvement - pain, stiffness, swelling, functional loss EARLY MORNING STIFFNESS Joint deformity and damage Can be monoarthritis Systemic - malaise, pain ```
79
Signs of RA?
Predominantly peripheral joints Joint effusions Soft tissue swelling
80
Investigations of RA? (3)
FBC - anaemia, ESR/CRP high Rheumatoid factor and anti-CCP antibodies XR
81
What does XR show in RA?
Early - normal osteoporosis or soft tissue sweling | Later - loss of joint space, erosions, joint destruction
82
Management of RA? (4)
MDT - physio, OT, surgery, nurse Exercise and splints NSAIDs and paracetamol Corticosteroid joint injections DMARDS - methotrexate, sulfasalazine, rituximab Surgery - joint fusion/excision/replacement
83
Complications of RA? (5)
``` Disability Depression Osteoporosis Infections Amyloidosis ```
84
Features of RA in the hands? (4)
``` Ulnar deviation of the fingers Z deformity of thumb Swan neck (extended PIP, flexed DIP) and boutonniere (flexed PIP, extended MCP and DIP) deformities of the fingers ```
85
Non joint features of RA?(6)
``` Rheumatoid nodules on forearms Vasculitis Sjogrens, episcleritis, scleritis Mononeuritis/peripheral neuropathy Pleural effusions, lung nodules Pericarditis ```
86
Indications of warfarin? (3)
Prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation, Prophylaxis after insertion of prosthetic heart valve, Prophylaxis and treatment of venous thrombosis and pulmonary embolism, TIAs
87
Target INR for warfarin?
2-3 (2.5) | If recurrent VTE, 3.5 (higher dose warfarin)
88
Length of warfarin treatment after VTE?
Provoked - 3 months | Unprovoked - 6 months
89
Treatment of CHADSVASC scores 0, 1, >2?
0 - no antithrombotic, or aspirin 1 - aspirin or warfarin/NOAC >2 - warfarin/NOAC
90
Contraindications for warfarin? SEs?
48 hrs post partum, significant bleeding Haemorrhagic stroke SE: haemorrhage, nausea, hepatic damage
91
Mechanism of warfarin?
Warfarin decreases the body's ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. Vitamin K is needed to make clotting factors and prevent bleeding.
92
What are the vitamin K dependent clotting factors?
II, VII, IX and X | 2 7 9 10
93
Causes of hyperthyroidism? (4)
``` Graves disease Thyroiditis Toxic nodular goitre Drugs - amiodarone Postpartum ```
94
Presentation of hyperthyroidism? (14)
``` Weight loss Diarrhoea Heat intolerance Irritability Hyperactivity Tremor Palpitations Atrial fibrillation Hyperhidrosis Infertility, ED Alopecia Eye signs Amenorrhoea Pretibial myxoedema ```
95
How may hyperthyroidism present in the elderly?(4)
Confusion Dementia Apathy Dementia
96
Eye signs in hyperthyroidism? (6)
``` Lid lag Lid retraction Exopthalmos Proptosis Double vision Opthalmoplegia of upward gze ```
97
Tests for hyperthyroidism? (6)
``` Low TSH High T3 and T4 May be anaemia, hypercalcaemic, high ESR Check thyroid autoantibodies Isotope scan Check eyes ```
98
What is Graves disease?
Most common form of hyperthyroidism - may also be hypo | Associated with smoking
99
Pathophysiology of Graves disease?
Autoimmune Antibodies to the TSH receptor are produced, activating thyrotropin receptors causing smooth thyroid enlargement and increased hormone production
100
Features of Graves?
Hyperthyroidism Diffuse goitre +/- thyroid bruit Eye disease, pretibial myxoedema, oncholysis
101
What is a thyroid storm?
Severe hyperthyroid - confusion, agitation, tachycardia, AF, heart failure/CV collapse, coma
102
Causes of thyroid storm? (4)
Recent thyroid surgery/radioiodine Infection MI Trauma
103
Management of thyroid storm? (6)
``` Sedate Propanolol Digoxin Carbimazole Hydrocortisone Treat infection ```
104
Management of hyperthyroidism? (4)
Beta blockers propanolol Carbimazole - most relapse Radioiodine - most hypothyroid after Surgery - thyroidectomy if large goitre/refractive
105
Carbimazole mechanism? CI, SEs
Stops iodine conversion into usable form, so thyroid hormones not produced CI: severe blood disorders due to bone marrow suppression SE: bone marrow suppression, haemolytic anaemia, severe skin reaction
106
Symptoms of hypothyroidism? (11)
``` Tired/sleepy Lethargic Low mood Cold intolerance Weight gain Constipation Menorrhagia Hoarse voice Decreased memory/cognition Myalgia Weakness ```
107
Signs of hypothyroidism? (11)
``` Bradycardic Reflexes slow Ataxia Dry thin hair/skin Yawning (drowsy, coma) Cold Ascites, oedema, effusions Round puffy face/obese Depression Immobile Congestive heart failure ```
108
Investigations for hypothyroidism?
TSH high | T4 low
109
Causes of hypothyroidism? (5)
``` Primary atrophic hypothyroidism Hashimotos thyroiditis - rarely hyperthyroid first IODINE DEFICIENCY Post thyroidectomy/radioiodine Drugs - carbimazole, amiodarone, lithium ```
110
Associations of hypothyroidism?
Type 1 DM, Addisons Turners, Downs Cystic fibrosis
111
Hypothyroid problems in pregnancy? (6)
``` Eclampsia Anaemia Prematurity LBW Stillbirth PPH ```
112
Management of hypothyroidism?
``` Levothyroxine lifelong (if elderly/ill, lower dose) ```
113
Complication of hypothyroidism? (3)
Hypothyroid coma Heart disease Dementia
114
What is diabetes mellitus?
Common syndrome caused by lack of or decreased effectiveness of endogenous insulin
115
Primary metabolic derangement in diabetes?
Hyperglycaemia
116
What is type 1 diabetes?
Usually adolescent onset, caused by insulin deficiency from autoimmune destruction of insulin secreting pancreatic beta cells Cytoplasmic islet cell antibodies (CIA)
117
Cause of type 1 diabetes?
HLA D3 and D4 linked Autoimmune beta cell destruction Possible - lack of breastfeeding, CMV/coxsackie exposure
118
Presentation of type 1 diabetes?
``` Polydipsia Polyuria Weight loss Bacterial/fungal infection Blurred vision Ketoacidosis ```
119
Secondary causes of diabetes? (4)
Drugs - steroids, anti retrovirals, thiazides Pancreatitis, pancreatic surgery/trauma Cushings disease, hyperthyroid, acromegaly Pregnancy
120
What is LADA?
Latent autoimmune diabetes of adults - form of type 1 DM, slower progression and present later in life
121
Pathogenesis of type 2 diabetes?
Decreased insulin secretion (beta cell dysfunction) and increased insulin resistance
122
Cause of type 2 diabetes? (5)
``` Genetics - Asians, 80% concordance in twins (30% in type 1) Age - although can occur in teens Obesity Lack of exercise Alcohol and calorie excess ```
123
How does type 2 diabetes present?
Asymptomatic | With complications - MI, peripheral neuropathy
124
What is MODY?
Maturity onset diabetes of the young - autosomal dominant, affects young people with positive family history
125
How is diabetes diagnosed?
Symptoms AND raised venous glucose detected once, or raised glucose on 2 separate occasions Fasting >/=7mmol/L Random >/=11.1mmol/L HbA1c >/=49mmol/L (glycosylated Hb over 3 months)
126
What is metabolic syndrome?
``` Central obesity and 2 of: BP >130/85 Triglycerides >1.7mmol/L HDL < Fasting glucose >5.6 or DM ```
127
General advice for diabetes? (4)
Lifestyle - exercise, diet, smoking Statin Control BP Foot care
128
Diet recommended in diabetes? (4)
Low saturated fats Low sugar High starch Moderate protein
129
Do diabetics need to inform DVLA?
Yes | Do not drive if hypoglycaemic spells - loss of doing this may lead to loss of licence
130
Advice for insulin users?
Self adjust dose if exercise/ill/increased calories Avoid binge drinking Glucogel if needed
131
Main types of SC insulin therapy? (4)
Ultrafast acting - novorapid - start of meal or just after Variable 4-12hr peak - Isophane insulin Premixed insulin - Novomix - 30% short acting 70% long Long acting - recombinant human insulin analogues - insulin glargine used at bedtime
132
Common insulin regimens? (3)
BD biphasic - twice daily premixed QDS - ultra fast before meals, bedtime long acting OD nocte - long acting
133
Methods of insulin delivery?
Disposable pens - vary injection site (outer thigh, abdomen) to avoid fatty change Insulin pump
134
Pharmacological treatment for type 2 diabetes?
``` Metformin (biguanide) Gliclazide (sulfonylurea) Insulin or Glitazone (thiazolidinediones) DPP-4 inhibitors (sitagliptin) SGLT-2 inhibitors (gliflozin) GLP-1 mimetic (exenatide) ```
135
How does metformin work? CI, SEs
Metformin is a biguanide, increases insulin sensitivity CI: acute metabolic acidosis inc. DKA, caution in renal damage SE: GI upset, weight loss
136
How does gliclazide work? CI, SEs
Gliclazide is a sulfonylurea, increases insulin secretion CI: ketoacidosis SEs: HYPOGLYCAEMIA, weight gain
137
How does glitazone work? CI, SEs
Glitazone is a thiazolidinedione, reduces peripheral insulin resistance and lowers blood sugar CI: congestive heart failure, osteoporosis SEs: fractures, fluid retention, weight gain
138
How does sitagliptin work? CI, SEs
Inhibits dipeptidylpeptidase-4 to increase insulin secretion and lower glucagon secretion CI: ketoacidosis SEs: headache, constipation, dizzy
139
How does gliflozin work? CI, SEs
Inhibits sodium glucose co-transporter 2 in the kidney so glucose resorption is reduced, urinary glucose exrection increased CI: ketoacidosis, CV disease - risk of hypotension SE: constipation, hypotension, HYPOGLYCAEMIA
140
How does exenatide work? CI, SEs
Activated glucagon-like peptide 1 receptor to increase insulin secretion, suppress glucagon, and slow gastric emptying CI: ketoacidosis, severe GI disease SE: weight loss, GI upset
141
What is diabetic ketoacidosis?
Ketoacidosis is an alternative metabolic pathway to carbohydrate metabolism, normally used in starvation states, produces acetone Occurs in type 1 diabetes as there is excess glucose but lack of insulin so it can't be utilised, creating starvation state
142
Presentation of DKA? (5)
``` Gradual drowsiness, coma Vomiting and dehydration Abdo pain Ketotic pear drop breath Kussmal breathing - deep sighing hyperventilation ```
143
Triggers of DKA? (6)
``` Infection Surgery MI Pancreatitis Drugs - chemo, antipsychotics Wrong insulin dose/non compliance ```
144
Diagnosis of DKA?
Acidaemia <7.3 blood pH Hyperglycaemia Ketonaemia
145
Management of DKA? (6)
ABC approach Bolus saline Test for pH, bicarb, glucose, ketones, U+Es Fluids and insulin IV Reassess blood, possible K+ replacement Start glucose fluids to prevent hypoglycaemia
146
What is a hyperglycaemic hyperosmolar coma? HONK
Hyperglycaemia without ketosis/acidosis | Usually type 2
147
What causes hyperglycaemic hyperosmolar state?
Sugary food Drugs - steroids, thiazides illness or infection
148
Presentation of hyperglycaemic hyperosmolar state?
Dehydration | Danger of occlusive events - focal CNS signs, DIC, leg ischaemia
149
Management of hyperglycaemic hyperosmolar state?
Rehydrate Replace potassium Small amount of insulin LMWH prophylaxis
150
What are the major complications of diabetes?
Diabetic nephropathy Diabetic retinopathy Diabetic neuropathy Vascular disease
151
How to prevent microvascular complications in diabetes?
Good hyperglycaemic control Treat BP, cholesterol (STATIN) Stop smoking, exercise, lose weight
152
What is BP target in diabetes?
<140/80
153
Most common cause of death in diabetes?
Vascular disease - MI (more likely to be silent), stroke | Statin, control BP, aspirin if previous stroke/MI
154
How to reduce risk of vascular event? (3)
Statin, control BP, aspirin if previous stroke/MI
155
How to protect the kidneys from nephropathy?
ACE inhibitor or ARB - inhibit RAAS and lowers glomerular pressure Possible spironolactone
156
Mechanism of nephropathy in diabetes? (4)
Afferent arteriole more dilated than efferent High GMR and forces Cell hypertrophy and thickened basement membrane Glomerular sclerosis Causes microalbuminuria
157
What eye problems occur in diabetes? (3)
Diabetic retinopathy (background, pre-proliferative, proliferative) Maculopathy Cataracts Rubeosis iridis - new vessels on iris
158
How is diabetic retinopathy managed? (3)
Annual screening Laser photocoagulation - stops angiogenic factors from the ischaemic retina Possibly give aspirin
159
Mechanism of diabetic retinopathy?
Hyperglycaemia and hypertension causes high retinal blood flow Causes microvascular occlusion, haemorrhages, hypoxia and new vessel formation New vessels can proliferate, bleed, fibrose and detach the retina
160
How does diabetic retinopathy present?
Painless gradual loss o central vision Cataracts Floaters
161
What causes diabetic neuropathy?
Hyperglycaemia damages Schwann cells | Microvascular damage of nerve blood vessels
162
Types of diabetic neuropathy? (3)
Sensory polyneuropathy - glove and stocking paraesthesia Mononeuritis multiplex - III and VI CNs Autonomic neuropathy - hypotension
163
Management of neuropathic pain?
Amitriptyline Gabapentin Pregabalin
164
How does diabetic foot develop? (4)
Sensory deficit Decreased awareness of injury Motor deficit - distortion of weight Autonomic deficit - poor control of sweating, vascular supply
165
Typical presentation of diabetic foot?
``` Painless punched out ulcer Thick callous Infection - abscess, cellulitis Absent ankle jerk Deformity - pes cavus, claw toes, loss of arch, rocker bottom foot ```
166
Investigations of diabetic foot? (4)
Degree of sensory loss Ischaemia - foot pulses absent, cold foot, do Doppler pressure measurements X ray - deformity i.e. Charcot's joint caused by unimpeded mechanical stress Infection - swabs, cultures
167
Management of diabetic foot? (4)
Regular chiropody Therapeutic shoes Abx if infection Possible surgery - excision and drainage, vascular reconstruction, amputation if deep/rapid spreading infection
168
Serious complications of diabetic foot?
Gangrene Osteomyelitis Needs amputation
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How does insulin work?
Made in the beta cells in the pancreas islets of Langerhans Promotes absorption of glucose from the blood into the liver and muscle to be stored as glycogen GLUCAGON promotes stored glycogen to be turned into glucose and used for energy

3A REVISION (17 decks)

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