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Y3R5: Medicine I 🩺 > L5: DM & Others Systems > Flashcards

L5: DM & Others Systems Flashcards

1
Q

Outline

A
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2
Q

Mechanism by Which DM Causes Complications

A
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3
Q

DM Effect on Other Systems

A
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4
Q

what are the factors by which DM Causes Complications?

A
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5
Q

Effect of Accumulation of advanced glycosylation end products

A

Vascular permeability, procoagulant activity, adhesion molecule expression

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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
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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.
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8
Q

Effect of Production of vasoconstrictor mediators

A
  • angiotensin II and endothelin-1 —-> which causes vascular smooth muscle growth
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9
Q

Effect of Impairing fibrinolytic capacity

A

in atherosclerotic lesions, ↑coagulation
tendency

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10
Q

GIT Complications of DM

A
  • Mouth
  • Esophagus
  • Gastroparesis
  • Diabetic Enteropathy
  • Others
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11
Q

Mouth Complications in DM

A
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12
Q

Esophegeal Complications of DM

A

Gastroesophageal reflux disease (GERD)

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13
Q

Pathogenesis of DM-Induced GERD

A
  • Caused by autonomic neuropathy
  • Delayed gastric emptying.
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14
Q

Manifestations of DM-Induced GERD

A
  • Dysphagia, Odynophagia, and Chest Pain.
  • About one-third of diabetic patients.
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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).

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16
Q

Stomach Complications of DM

A

Gastroparesis is defined as delayed gastric emptying

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17
Q

Pathogenesis of DM-Induced Gastroparesis

A

Caused by autonomic neuropathy

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18
Q

Manifesttaions of DM-Induced Gastroparesis

A

 Nausea, vomiting, bloating
 Postprandial fullness, anorexia
 Early satiety, heartburn
 Poor diabetic control
 Recurrent post prandial hypoglycemia

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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.
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20
Q

TTT of DM-Induced Gastroparesis

A
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21
Q

Intestinal Compliactaions of DM

A

Diabetic Enteropathy

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22
Q

Pathophysiology of Diabetic Enteropathy

A

unclear but multiple factors are probably involved

  • autonomic neuropathy, infections, Bacterial overgrowth, Exocrine pancreatic insufficiency
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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
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24
Q

Management of Diabetic Enteropathy

A
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25
Q

Liver Complications of DM

A

 Nonalcoholic steatosis
 Nonalcoholic steatohepatitis
 Glycogen hepatopathy: poor controlled type 1 DM.

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26
Q

Gall Bladder Complications of DM

A

 Acute and chronic cholecystitis (including emphysematous cholecystitis )

 Gall stones

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27
Q

Pancreas Complications of DM

A

Pancreatic exocrine dysfunctions.

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28
Q

Skin Complivations of DM

A
29
Q

Skin Infections in DM

A
  • Fungal: Candidal intertrigo and paronychia, dermatophytes causing powdery white lesions especially between toes.
  • Bacterial → furuncle, carbuncle, abscess & cellulitis.
30
Q

Pruritis in DM

A

Especially pruritus vulva due to infections & glucosuria

31
Q

Delayed Wound Healing in DM

A

Infection, ischemia, and impaired immunity.

32
Q

Skin Ulcers in DM

A

Vascular and neuropathic ulcers

33
Q

Carotenemia in DM

A

Yellow skin and nails D.2 ↓ Conversion of carotene to Vit A in liver.

34
Q

Acanthosis Nigricans in DM

A

Velvety hyperpigmented plaques in neck, back and body folds

35
Q

Necrobiosis lipoidica diabeticorum in DM

A

 Painful violaceous plaque with central yellowish area surrounded by brownish border

 Usually on Chin of the leg.

 Central ulceration may occur.

36
Q

Diabetic Dermopathy in DM

A

 Painless reddish papules

 Usually on the Chin of the tibia heal leaving atrophic scarred hyperpigmented macules.

37
Q

Bullosis diabeticorum in DM

A

 Non-inflamed painless bullae with sterile fluid
 On the chin of tibia
 Heal within 2-3 weeks without residual scarring.

38
Q

Granuloma annularein DM

A

 Ring shaped papules with depressed centers usually on dorsum of the hand and arm.

39
Q

Diabetic thick skin

A

 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
Q

Hyperlipidemia in DM (Skin Changes)

A

 Eruptive xanthoma: yellow papules or nodules usually on extensor surfaces.

 Xanthelasma: yellow plaques that usually appear on the medial aspects of the eyelids.

41
Q

Skin & Antidiabetic Medications

A

Insulin: Lipoatrophy and lipohypertrophy.

Sulphonylureas: Drug eruptions.

42
Q

Hand Complications in DM

A
  • 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
Q

MSK Complications in DM

A
  • Hand
  • Shoulder
  • LL
  • Spine
43
Q

Shoulder Complications in DM

A

 Adhesive capsulitis
 Frozen shoulder
 Calcific periarthritis
 Limited joint mobility

44
Q

Lower Limb Complications in DM

A

 Neuropathic arthropathy
⇒ Diabetic Charcot joint: foot and ankle.

 Diabetic Amyotrophy

 Diabetic muscle infarction

 Osteoarthritis

45
Q

Spine Complications in DM

A

Osteoarthritis

46
Q

Genital Complications of DM in men

A
  • Impotence “neurogenic, vasogenic, and psychogenic”.
  • Loss of testicular sensation.
47
Q

Genital Complications of DM in Women

A
48
Q

Neurological Complications in DM

A
  • Cerebral
  • Spinal Cord
  • Peripheral Nerves
49
Q

Cerebral Complication in DM

A

 Comas of different types
 Cerebral atherosclerosis & thrombosis.
 Rhinocerebral Mucormycosis.

50
Q

Spinal Cord Complications DM

A

Post column: Pyramidal tract: diabetic lateral Lordosis.

51
Q

Peripheral Nerves in DM

A

 Diabetic peripheral symmetrical neuropathy.
 Proximal neuropathy: diabetic Amyotrophy.

52
Q

Eye Complications of DM

A
53
Q

CVS Complications in DM

A
54
Q

Renal Complications of DM

A
55
Q

Why Does Diabetes Increasre the risk of Infections?

A

 Abnormalities in cell mediated immunity and phagocytic function

 Hyperglycemia

 Diminished vascularity and autonomic dysfunction.

56
Q

Effects of Infections on DM

A

 Increasing insulin resistance leading to bad glycemic control.

 Precipitation of diabetic ketoacidosis

57
Q

NBs on DM

A
58
Q

What are common infections in DM?

A
59
Q

Prevention of Diabetic Infections

A
  • Good glycemic control, good hygiene and vaccination with pneumococcal and influenza vaccines
60
Q

TTT of Diabetic Infections

A

A. Proper diagnosis and early start of antimicrobial.

B. Use insulin during infection period if patient is on oral treatment.

61
Q

Classification of Diabetes in Pregnancy

A

 Pregestational diabetes: either type 1 or type 2 diabetes.

 Gestational diabetes: carbohydrate intolerance that begin in pregnancy.

62
Q

Risk Factors of Developing Gestational Diabetes

A
63
Q

Effects of Pregnancy on Diabetec State

A
64
Q

Effects of Diabetes on Pregnancy State

A
65
Q

Whom to screen for Gestational DM?

A
  • Universal screening for all pregnant women is better than screening women who have at least one risk factor for development of gestational diabetes.
66
Q

How to Screen for Gestational DM?

A
67
Q

Managment of Gestational DM

A
68
Q

Diet in Gestational DM

A

Y3R5: Medicine I 🩺 (39 decks)

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