L5: DM & Others Systems Flashcards
1
Q
Outline
A
2
Q
Mechanism by Which DM Causes Complications
A
3
Q
DM Effect on Other Systems
A
4
Q
what are the factors by which DM Causes Complications?
A
5
Q
Effect of Accumulation of advanced glycosylation end products
A
Vascular permeability, procoagulant activity, adhesion molecule expression
6
Q
Effect of Hyperglycemia
A
- ↓ NO production.
- ↑ Production of reactive oxygen species (ROS).
- Activation of protein kinase C increases the production of pro inflammatory
7
Q
Effect of Dyslipidemia
A
- Increase insulin resistance which have major role in atherosclerosis
- Free fatty acids attenuate prostacyclin bioavailability by inhibiting prostacyclin synthase.
8
Q
Effect of Production of vasoconstrictor mediators
A
- angiotensin II and endothelin-1 —-> which causes vascular smooth muscle growth
9
Q
Effect of Impairing fibrinolytic capacity
A
in atherosclerotic lesions, ↑coagulation
tendency
10
Q
GIT Complications of DM
A
- Mouth
- Esophagus
- Gastroparesis
- Diabetic Enteropathy
- Others
11
Q
Mouth Complications in DM
A
12
Q
Esophegeal Complications of DM
A
Gastroesophageal reflux disease (GERD)
13
Q
Pathogenesis of DM-Induced GERD
A
- Caused by autonomic neuropathy
- Delayed gastric emptying.
14
Q
Manifestations of DM-Induced GERD
A
- Dysphagia, Odynophagia, and Chest Pain.
- About one-third of diabetic patients.
15
Q
TTT of DM-Induced GERD
A
Strict diabetic control.
Six small meals.
A low fat diet (<40 g per day)
Prokinetic agents (metoclopramide, Domperidone).
16
Q
Stomach Complications of DM
A
Gastroparesis is defined as delayed gastric emptying
17
Q
Pathogenesis of DM-Induced Gastroparesis
A
Caused by autonomic neuropathy
18
Q
Manifesttaions of DM-Induced Gastroparesis
A
Nausea, vomiting, bloating
Postprandial fullness, anorexia
Early satiety, heartburn
Poor diabetic control
Recurrent post prandial hypoglycemia
19
Q
Dx of DM-Induced Gastroparesis
A
- The presence of residual food in the stomach after an overnight fast during upper gastrointestinal endoscopy supports the diagnosis.
- The traditional “gold standard” to establish the diagnosis of gastroparesis is scintigraphic measurement of gastric emptying.
20
Q
TTT of DM-Induced Gastroparesis
A
21
Q
Intestinal Compliactaions of DM
A
Diabetic Enteropathy
22
Q
Pathophysiology of Diabetic Enteropathy
A
unclear but multiple factors are probably involved
- autonomic neuropathy, infections, Bacterial overgrowth, Exocrine pancreatic insufficiency
23
Q
Manifestations of Diabetic Enteropathy
A
- Diarrhea: watery & painless, at night, may be associated with fecal incontinence.
- Bouts of diarrhea can be episodic with intermittent normal bowel habits or even alternating with periods of constipation in addition steatorrhea can occur due to bacterial overgrowth
24
Q
Management of Diabetic Enteropathy
A
25
Liver Complications of DM
Nonalcoholic steatosis
Nonalcoholic steatohepatitis
Glycogen hepatopathy: poor controlled type 1 DM.
26
Gall Bladder Complications of DM
Acute and chronic cholecystitis (including emphysematous cholecystitis )
Gall stones
27
Pancreas Complications of DM
Pancreatic exocrine dysfunctions.
28
Skin Complivations of DM
29
Skin Infections in DM
- Fungal: Candidal intertrigo and paronychia, dermatophytes causing powdery white lesions especially between toes.
- Bacterial → furuncle, carbuncle, abscess & cellulitis.
30
Pruritis in DM
Especially pruritus vulva due to infections & glucosuria
31
Delayed Wound Healing in DM
Infection, ischemia, and impaired immunity.
32
Skin Ulcers in DM
Vascular and neuropathic ulcers
33
Carotenemia in DM
Yellow skin and nails D.2 ↓ Conversion of carotene to Vit A in liver.
34
Acanthosis Nigricans in DM
Velvety hyperpigmented plaques in neck, back and body folds
35
Necrobiosis lipoidica diabeticorum in DM
Painful violaceous plaque with central yellowish area surrounded by brownish border
Usually on Chin of the leg.
Central ulceration may occur.
36
Diabetic Dermopathy in DM
Painless reddish papules
Usually on the Chin of the tibia heal leaving atrophic scarred hyperpigmented macules.
37
Bullosis diabeticorum in DM
Non-inflamed painless bullae with sterile fluid
On the chin of tibia
Heal within 2-3 weeks without residual scarring.
38
Granuloma annularein DM
Ring shaped papules with depressed centers usually on dorsum of the hand and arm.
39
Diabetic thick skin
Fingers and hands: inability to do non-Islamic praying.
Scleroderma diabeticorum: marked thickening of the skin in posterior aspect of the neck and upper back.
40
Hyperlipidemia in DM (Skin Changes)
Eruptive xanthoma: yellow papules or nodules usually on extensor surfaces.
Xanthelasma: yellow plaques that usually appear on the medial aspects of the eyelids.
41
Skin & Antidiabetic Medications
Insulin: Lipoatrophy and lipohypertrophy.
Sulphonylureas: Drug eruptions.
42
Hand Complications in DM
- **Carpal tunnel syndrome**
D.D of carpal tunnel syndrome: Acromegaly - DM - Hypothyroidism - Rh. Arthritis - Pregnancy -
contraceptive pills
- **Dupuytren's contracture**
- **Flexor tenosynovitis**
- **Diabetic sclerodactyly**
- **Limited joint mobility**
- **Trigger finger**
42
MSK Complications in DM
- Hand
- Shoulder
- LL
- Spine
43
Shoulder Complications in DM
Adhesive capsulitis
Frozen shoulder
Calcific periarthritis
Limited joint mobility
44
Lower Limb Complications in DM
Neuropathic arthropathy
⇒ Diabetic Charcot joint: foot and ankle.
Diabetic Amyotrophy
Diabetic muscle infarction
Osteoarthritis
45
Spine Complications in DM
Osteoarthritis
46
Genital Complications of DM in men
- Impotence "neurogenic, vasogenic, and psychogenic".
- Loss of testicular sensation.
47
Genital Complications of DM in Women
48
Neurological Complications in DM
- Cerebral
- Spinal Cord
- Peripheral Nerves
49
Cerebral Complication in DM
Comas of different types
Cerebral atherosclerosis & thrombosis.
Rhinocerebral Mucormycosis.
50
Spinal Cord Complications DM
Post column: Pyramidal tract: diabetic lateral Lordosis.
51
Peripheral Nerves in DM
Diabetic peripheral symmetrical neuropathy.
Proximal neuropathy: diabetic Amyotrophy.
52
Eye Complications of DM
53
CVS Complications in DM
54
Renal Complications of DM
55
Why Does Diabetes Increasre the risk of Infections?
Abnormalities in cell mediated immunity and phagocytic function
Hyperglycemia
Diminished vascularity and autonomic dysfunction.
56
Effects of Infections on DM
Increasing insulin resistance leading to bad glycemic control.
Precipitation of diabetic ketoacidosis
57
NBs on DM
58
What are common infections in DM?
59
Prevention of Diabetic Infections
- Good glycemic control, good hygiene and vaccination with pneumococcal and influenza vaccines
60
TTT of Diabetic Infections
A. Proper diagnosis and early start of antimicrobial.
B. Use insulin during infection period if patient is on oral treatment.
61
Classification of Diabetes in Pregnancy
Pregestational diabetes: either type 1 or type 2 diabetes.
Gestational diabetes: carbohydrate intolerance that begin in pregnancy.
62
Risk Factors of Developing Gestational Diabetes
63
Effects of Pregnancy on Diabetec State
64
Effects of Diabetes on Pregnancy State
65
Whom to screen for Gestational DM?
- Universal screening for all pregnant women is better than screening women who have at least one risk factor for development of gestational diabetes.
66
How to Screen for Gestational DM?
67
Managment of Gestational DM
68
Diet in Gestational DM
