Pancreas Flashcards

Question

Neuropathic foot

Answer 1

- PRESSURE POINTS - warm - dry skin - foot pulse palpable - ulcer is painless

Answer 2

low risk --> no sensation impairment, foot pulses present, annual checkup moderate risk --> sensation impaired and foot pulses absent but NO skin callys - annual check up by podiatrist high risk --> sensation impaired and foot pulses absent, skin callus and foot ulcer - see podiatrist

Answer 3

education, sensible footwear, podiatrist, multidisciplinary foot clinic

Answer 4

``` debridement pressure relief antibiotics where indication arterial reconstruction where indicated total contact cast and no weight bearing ```

Answer 5

- fracture and acute inflammation - red, swollen, oedematous - can be painful - skin temp 2-8 degrees higher than contralateral foot - often difficult to distinguish from infection total contact cast and no neuropathy

Answer 6

1. relative insulin deficiency 2. less BG can enter muscle 3. body perceives you are in a glucose deficient state - increase gluconeogenesis and glycogenolysis (liver) + decreased protein synthesis and increased proteolysis (in muscle) 4. presence of some insulin inhibits lipolysis - no ketone body production 5. result is osmotic diuresis --> leads to dehydration

Answer 7

1. absolute insulin deficency 2. less blood glycose utilities by muscle and cells 3. body perceives you are in a glcusoe deficient state - gluconeogeneis - glycogenolysis + excess mobilisation of free fatty acids from adipose tissue provides the substrate for ketone production in lover 4. ketons Bhydroxybutyrate, acetoacetate and acetone are excreted by the kidneys and buffered in the blood initially, eventually fails --> metabolic acidosis 5. osmotic diuresis + ketonuria causes hypovolaemia

Answer 8

- absence of significant ketones - acidosis not rpesent - high mortality - elderly - insidious onset

Answer 9

infection - 60% poor compliance - 30% drugs

Answer 10

Identify and treat the precipitant 1. fluid - 0.9% crystalloid - aim for postivie fluid balance within 3-6L with 12 hrs - switch to NaCl if postive fluid balance but osmolality rising --> 0.45% Na 2. Insulin - only start once glucose is not falling with fluid 3. prophylaxis - LMWH - Foot protection

Answer 11

1. metabolic acidosis 2. plasma glucose high 3. urinary plasma ketones

Answer 12

(dka) - Dizziness, dehydration, diuresis K- kussmauls breathing (deep fast breath to offset co2), ketotich breath A- abdominal pain (disrupts enteric nervous system)

Answer 13

``` identify precipitant agent F- fluids (crystalloid) U- urea C- creatine/cathetirise K- K+ (iv KCL) I- IV insulin N- Nasogastric tube G- glucose H- heparin ```

Answer 14

1. symtpoms of low blood glucose (neuroglycopaenic | 2. meausre plasma glucose

Answer 15

3. 0 mmol/l - autonomic - sweating, palpitations, shaking, hunger, 70-80% may have no symptoms 2. 5mmol/l - neuroglycopenic - confusion, dorwsiness, odd behaviour, speech difficulty

Answer 16

15-20g of CHO, assess response 15mins later to ensure glucose >4mmol/l, then give longer actin Process repeated

Answer 17

BM> 5mmol/l before driving, carry CHO, identifiers 2 hours at a time In the event of a hypo 1. stop the car where it is safe to do so 2. keys out the ignition, move to the passenger seat 3. check the glucose levels, and treat , wait 10 minutes, check 4. wait another 40 minutes to make sure still above 5 allow 1 hypo in 12 months Bm monitoring evidence

Answer 18

encourage high fibre, low glycaemic index sources of carbohydrates include low-fat dairy products and oily fish control the intake of foods containing saturated fats and trans fatty acids limited substitution of sucrose-containing foods for other carbohydrates is allowable, but care should be taken to avoid excess energy intake discourage use of foods marketed specifically at people with diabetes initial target weight loss in an overweight person is 5-10%

Pancreas Flashcards

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