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Y3R5: Medicine I 🩺 > L6: Diabetic Foot > Flashcards

L6: Diabetic Foot Flashcards

1
Q

Def of Diabetic Foot

A
  • Infection, ulceration or destruction of deep tissues associated with neurological abnormalities & various degrees of peripheral vascular diseases in the
    lower limb (based on WHO definition)
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2
Q

Epidemeology of Diabetic Foot

A
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3
Q

Pathophysiology of Diabetic Foot

A
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4
Q

Pathogenesis of Neuropathy

A
  • Changes in the vasa nervosa
  • Metabolic disorders with release of nerve toxic substance ( e.g. end glycation product)
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5
Q

what types of nerves does neuropathy affect?

A
  • Motor Nerves
  • Autonomic nerves
  • Sensory nerves (most important)
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6
Q

Motor nerves affection in neuropathy (Diabetic Foot)

A

wasting of small muscles of the foot ——> foot deformities —–> abnormal pressure area

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7
Q

Autonomic nerves affection in neuropathy (Diabetic Foot)

A
  • Dryness of the skin and loss of sweat and oil secretion which leads to excessive callus formation and skin cracks.
  • Loss of neurogenic component of inflammatory response blunted inflammatory response and less severe signs of a severe infections.
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8
Q

Sensory nerves affection in neuropathy (Diabetic Foot)

A
  • Sensory loss of superficial and deep sensation is the
    most important part of sensory affection
  • Patients are unaware of trauma to the foot (loss of
    protective mechanism) pressure sores over weight bearing points of the foo
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9
Q

Pathogenesis of Ischemia in DM

A
  • Accelerating atherosclerosis in diabetic patients
  • Usually atherosclerosis affects small size arteries (anterior tibial, posterior tibial and dorsalis pedis)
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10
Q

Pathophysiology of infection in DM

A

Peripheral Neuropathy
- Sensory and autonomic neuropathy provides site of
entry of organisms and blunt neurogenic immune
response.

Metabolic
- Hyperglycemia a state of immuno-suppression

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11
Q

Diabetic foot microbiology

A
  • Usually in limb threatening diabetic foot infections there is polymicrobial bacterial infection with gram positive, gram negative, and anaerobic bacterial
    infection .
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12
Q

Clinical Picture of Diabetic Foot

A
  • Trophic ulcers (either ischemic or neuropathic)
  • Dystrophic changes
  • Gangrene & previously amputated toes or foot
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13
Q

Compare between Ischemic & Neuropathic Ulcers in terms of:

  • Site
  • Temperature
  • Sensation
  • Pulse
  • Pain
  • Deformity
A
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14
Q

Examination of Diabetic Foot

A
  • Dermatological
  • Neurological
  • Vascular
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15
Q

Dermatological assessment of Diabetic Foot

A
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16
Q

Neurological assessment of Diabetic Foot

A
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17
Q

Vascular assessment in Diabetic Foot

A

Dorsalis pedis and posterior tibial artery examination

18
Q

Investigations in Diabetic Foot

A
  • DM
  • CBC
  • Culture & Sensitivity
19
Q

Imaging studies in Diabetic Foot

A
  • Plain X ray
  • MRI scan
  • Bone scan and radio-active labeled leukocyte scan
  • Pedobarography
20
Q

Plain X ray in Diabetic Foot

A

it is the basic study in all patients with diabetic foot it can show:

  • osteomyelitis, bone fractures, joint dislocations
  • foreign bodies
  • gas due to gas forming infections
  • soft tissue inflammatory hypertrophy
21
Q

MRI in Diabetic Foot

A
  • very sensitive in detecting the extent of soft tissue infection and bone and joint involvement
22
Q

Bone scan and radio-active labeled
leukocyte scan Diabetic Foot

A

are of low clinical importance

23
Q

Pedobarography in Diabetic Foot

A

Computerized method to detect points of high pressure in patients with neuropathic ulcers

24
Q

Vascular scan in Diabetic Foot

A
  • Duplex Scan
  • Angiography
  • MRA
25
Q

Duplex scan in Diabetic Foot

A
  • can be done to evaluate blood vessels in non-limb threatening infections and in follow up
26
Q

Angiography in Diabetic Foot

A
  • It is done when planning for vascular reconstruction in case of ischemic diabetic infections
27
Q

MRA in Diabetic Foot

A
  • Is used in case of severe renal impairment and severe dye hypersensitivity which is not uncommon in diabetics
28
Q

Diabetic Foot Ulcer Control

A
29
Q

Metabolic Control for Foot Ulcer

A
  • In all stages tight Glycemic control is important.
  • Insulin therapy based
  • Control of BP, Dyslipidemia & Cessations of Smoking is required.
30
Q

Mechanical Control for Foot Ulcer

A
  • Off-loading —-> neuroischemic ulcers healing
31
Q

Educational Control for Foot Ulcer

A
  • Routine foot care for all diabetics.
  • Prophylactic diabetes foot ware & trauma Prevention education to high risk patient.
  • Education regarding early sign of infection & immediate reporting.
  • Rehabilitation & Psycho-social support in patient with major Amputation
32
Q

Vascular Control for Foot Ulcer

A
  • In severe ischemic foot attempts to improve vascular perfusion by angioplasty or bypass surgery
33
Q

TTT of Diabetic Foot

A
  • TTT pf neuropathic ulcer
  • TTT of infection
34
Q

TTT of Neuropathic ulcers

A
35
Q

TTT of infections in diabetic foot

A
36
Q

what is the corner stone in treatment of diabetic foot infection?

A

Surgical drainage

37
Q

Foot Care in Diabetic Foot

A
38
Q

Joints can be affected by neuropathy resulting in the so called Charcot foot —–> It is painless progressive degenerative arthropathy

A

..

39
Q

Causes of Neuropathic Arthropathy (Charcot Joint)

A

loss of proprioceptive and pain sensation —–> loss of foot architecture & deformity —-> abnormal press diabetic foot

40
Q

CP of Neuropathic Arthropathy (Charcot Joint)

A
  • Swelling and deformity
  • Signs of inflammation.
  • Profound unilateral swelling
  • Increase in localized temp
  • Erythema
  • Joint effusion
  • Unequal dorsalis pedis artery
41
Q

MAnagement of Neuropathic Arthropathy (Charcot Joint)

A

Radiology:
- X-ray & MRI

Therapy:
- Diabetic control
- Bisphosphonate therapy
- Off loading
- Surgery

Y3R5: Medicine I 🩺 (39 decks)

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