week 2

Question 1

define amputation

Answer 1

partial or total removal of a body part

• Where revascularisation is not possible “(three ds death danger damn nuisance)”
• Where tissue has died
• More common in lower extremities

Question 2

causes of lower extremity amputation

Answer 2

Peripheral Vascular Disease • Diabetes
• Hypertension
• Hyperlipidaemia
• Smoking
infection
injury

Question 3

what is peripheral vascular disease

Answer 3

• Narrowing of the blood vessels outside the heart and brain
-Most commonly due to
atherosclerosis
- less commonly due to vasculitis, frostbite

Question 4

what is atherosclerosis

Answer 4

hardening of the arteries

Question 5

how does atherosclerosis

lead to amputation

Answer 5

atherosclerosis

• impaired circulation
• oedema
• reduced circulation
• ulcers develop (infection)
• impaired health and immune response
• gangrene
• amputation

Question 6

signs of peripheral vascular disease

Answer 6

skin assessment;
• touch
• Ulcer assessment • pain
• hair growth • appearance • nails
• pulse
pain assessment:
- type 
- activity
ulcers assessment:
- pain
- colour
- edges
- location

Question 7

treatment for peripheral vascular disease

Answer 7

• Lifestyle changes
• Treatment of existing conditions
• Medications
• Angioplasty
• Vascular surgery
• If revascularisation is not possible AMPUTATION

Question 8

requirements for prostheses

Answer 8

• soft tissue envelope provides interface between remaining lower extremity and prosthesis
• sufficient mass of muscle, full thickness of skin and subcutaneous tissue

Question 9

causes of upper extremity amputation

Answer 9

• severe trauma (more common)
• peripheral vascular disease
• thermal burns and frost bite

Question 10

whats diabetes mellitus

Answer 10

Chronic disorder of carbohydrate, fat and protein metabolism due to defective/deficient insulin

Question 11

whats hyperglycaemia

Answer 11

• high blood glucose level (BGL)

* inability of cells to take in glucose from the blood due to a lack of or defect in the hormone insulin

Question 12

regulation of glucose

Answer 12

eat food (glucose)
supplied to blood stream
transported from blood to cells using insulin
glucose used by cell to make ATP

Question 13

whats insulin

Answer 13

A hormone that allows the transport of glucose into cells, thus lowering the blood glucose level (BGL)

Question 14

where is insulin produced

Answer 14

B cells in the pancreases

Question 15

glucose process

Answer 15

• after eating trigger B cells to release insulin
• 1st phase (within 2 mins, lasts 10-15 mints)
• 2nd phase (lasts until blood glucose level back to normal)
• insulin binds to insulin receptors on target cells
• ## lowers blood glucose

Question 16

absorptive state

Answer 16

• increase blood glucose level (1st and 2nd phase release of insulin)
• glucose transport into muscle cells for ATP production
• excess converted to glycogen in muscle and liver
• production of glucose by liver inhibited

Question 17

post absorptive state

Answer 17

• decrease blood glucose level (Pancreases releases glycogen from a cells)
• strode glycogen borked down to glucose
• liver make glucose from amino acids
• increase fatty acid synthesis

Question 18

what is type 1 diabetes

Answer 18

• ~ 15% of patients
• autoimmune (destruction of pancreatic  cells)
• absolute lack of insulin
• not preventable

Question 19

what is type 2 diabete

Answer 19

• ~ 85% of diabetic patients
• lifestyle and environment
• deficient/defective insulin
• preventable

Question 20

what is gestational diabetes

Answer 20

• glucose intolerance first appears during pregnancy
• 1 – 14% of pregnant women
• resembles type 2 DM
• hormones and weight gain
• usually resolves after birth

Question 21

causes of type 1 diabetes

Answer 21

Absolute lack of insulin
• immune mediated or idiopathic
•
Autoimmune disease
• spontaneous or triggered
• T cells destroy  cells
autoimmune response
•
Genetic susceptibility
• protein markers on  cell
 cell
•
Glucose cannot enter cell

Question 22

type 2 diabetes causes

Answer 22

• Insulin resistance and/or insulin deficiency
 cell
• lifestyle and environment combined with genetics
• not autoimmune • Genetic factors
Insulin
• not linked to same markers as Type 1 DM
• Glucose cannot enter if cells are not responding to insulin

Question 23

define insuline résistance

Answer 23

Decreased ability of peripheral tissues to respond to insulin
• loss of insulin post-receptor signalling
• down regulation of insulin receptors
• Obesity inhibits insulin signalling

Question 24

define insulin deficiency

Answer 24

•  cell dysfunction
• inadequate insulin secretion
• Inadequate glucose uptake into cells

Question 25

difference between healthy, type 1 and type 2 diabetes

Answer 25

* Healthy * Insulin released in response to rise in BGL and glucose taken into cell using insulin and GLUTs * Type 1 DM * Insulin not secreted from pancreas due to autoimmune destruction of  cells * Type 2 DM * Insulin deficiency or resistance *  cell dysfunction/stress

Question 26

treatment type 1 diabetes

Answer 26

Insulin • increases glucose uptake by body cells (decrease BGL) • decreases blood amino acids, free fatty acids and ketones • different formulations (ultra short, short, long-acting)

Question 27

treatment type 2 diabetes

Answer 27

* Diet and exercise * Oral hypoglycaemic agents * stimulate insulin release and decrease insulin resistance * alter carbohydrate absorption and reduce glucose load

Question 28

consequences of diabetes

Answer 28

``` Clinical manifestations • increased thirst (polydipsia) • increased urination (polyuria) • increased hunger (polyphagia) Consequences of uncontrolled hyperglycaemia • Acute • diabetic ketoacidosis (Type 1 DM) • non-ketotic hyperosmolar coma (Type 2 DM) • Chronic • vascular complications • neuropathies ```

Question 29

chronic hyperglycaemia

Answer 29

Macrovascular • damage to large blood vessels of brain, heart and extremities • cardiovascular disease and stroke • Microvascular • abnormal thickening of basement membrane of capillaries • retinopathy (eyes) • nephropathy (kidneys)

Question 30

whats the leading cause of lower extremity amputation

Answer 30

``` diabetes Diabetes can damage nerves and cause neuropathy and impair circulation due to high blood glucose levels • Loss of sensation • Impaired wound healing • Infection ```