Flashcards
Module 2.08
Flashcards do conjunto (94)
- 1Obesity - DefintionChronic adverse condition due to an excess amount of body fat, as determined by BMI:
1. Overweight: BMI 25-29.9
2. Obese: BMI 30-39.9
3. Severely obese: BMI 40+ - 2Hormonal Causes of Obesity (3)1. Hypothyroidism
2. Hypercorticolism
3. Insulinoma - 3Medication causes of obesity (2)1. Corticosteroid therapy
2. Combined oral contraceptive pill - 4Obestiy - Epidemiology (2)Prevalence - 16yo+ classed as obese
Men: 24%
Women: 25% - 5Obesity complications (5)1. Type 2 diabetes
2. Hypertension
3. Non-alcoholic fatty liver disease
4. Acute coronary syndrome
5. Restrictive surgery related nausea and vomiting - 6Obestiy - Differential Diagnosis (2)1. Hypothyroidism
2. Cushing's - 7Gut derived hunger signals (2)1. Ghrelin - secreted by the stomach via X
2. endocannabinoids - 8Gut derived satiety hormones (4)1. Peptide YY
2. GLucogon-like peptide 1 (GLP1) - stimulates insulin
3. CCK - stimulates gallbladder contraction and pancreatic enzyme secretion
4. Oxyntomodulin - inhibits food intake - 9Diabetes Mellitus Type 1 - DefintionA metabolic disorder characterised by hyperglycaemia due to absolute insulin deficinecy. The condition develops are a result of pancreatic beta-cell destruction (autoimmune).
- 10Type 1 DM - Aetiolgy (3)1. Leukocyte antigen (HLA)-DR/DQ gene - increase susceptibility to/provide protection from
2. Viruses: congenital rubella syndrome, human enteroviruses
3. Coeliac disease -shares HLA-DQ2 genotype and is more common in pts with type 1 DM - 11Type 1 - DM - Symptoms (3)1. Hyperglycaemia: polyuria, polydipsia
2. Increased catebolic state: recent weight loss, muscle weakness, malaise, lack of energy
3. Symptoms of DKA: Kussmaul breathing, abdominal pain, fruity-pear drop breath - 12Type 1 - DM - Autoimmune Antigens to... (3)1. Glutamic acid decarboxylase (GAD)
2. Tyrosine-phosphatase-like molecule
3. Islet autoantigen 2 (IA-2)
4. Insulin - 13Type 1 - DM - Pathology (6)1. Autoimmune reaction.
2. Beta-cell destruction results in sub-clinical insulitis (inflammation of the beta cell)
3. When 80-90% of the beta cells are destroyed, hyperglycaemia develops.
4. Inability to utilise glucose in the peripheral muscle and adipose stimulate secretion of counter-regulatory hormones: glucagon, adrenaline, cortisol, growth hormone.
5. Glycogenlysis, Gluconeogenesis, Ketogenesis
6. Acidosis - 14Consequence of long term hyperglycaemia - pathology1. Vascular complications - glycosylation of proteins in tissue and serum and production of free radical
2. Endothelial damage - neutralising nitric oxide due to induced oxidative stress and inflammation. - This allows entry of LDLs into the endothelium vessel wall - leads to atheroma formation - 15Investigations - Bloods1. Random plasma glucose >11.1mmol/L
2. Fasting plasma glucose >7mmol/L
3. 2 hour plasma glucose >11.1mmol/L
4. HbA1c 6.5%
NB: presence of GAD, IA-2 indicates autoimmune destruction - 16Type 1 - DM - Epidemiology (3)1. 5-10% of all patients with diabetes
2. More common in europeans and less common in asians
3. Incidence increases by 3% every year - 17Type 1 - DM - Complications (3)1. DKA
2. Retinopathy
3. Neuropathy - 18DM - Type 2 - DefinitionCharacterised by peripheral insulin resistance and inadequate insulin secretion from pancreatic beta cells.
- 19Diabetes Mellitus - Macrovascular complications1. Coronary heart disease
2. Cerebrovascular disease
3. Vascular disease - 20Diabetes Mellitus - Microvascular complications (3)1. Retinopathy
2. Nephropathy
3. Neuropathy - 21Diabetes Type 2 diagnosis1. Fasting glucose: >=7.0mmol/L
2. Random glucose >=11.1mmol/L
+ symptoms of hyperglycaemia - 22DM - Type 2 - Aetiology (3)1. Genetic predisposition
2. Physical inactivity
3. Overweight/obese - 23Insulin resistance affects... (3 Organs/tissue)1. Liver
2. Muscle
3. Adipocytes
NB: characterised by complex derrangements in the cellular receptors, intra-cellular glucose kinase function and other intracellular metabolic processes - 24DM - Type 2 - Symptoms (5)1. Nocturia/polyuria
2. Increased thirst
3. Unexplained weight loss
4. Infections/slow wound healing
5. Blurred vision - 25Diabetic retinopathy (5)1. dilation of the retinal venules and formation of retinal capillary microaneurysms
2. increased vascular permeability
3. vascular occlusion and retinal ischaemia
4. proliferation of new blood vessels on the surface of the retina
5. Haemorrhage and contraction of fibrovascular proliferation and vitreous - 26Insulin resitance + inadequate insulin resistance - consequences (pathology) (2)Elevates levels of FFA and pro-inflammatory cytokines into the plasma:
1. Decreased glucose transport into muscle cells
2. elevated hepatic glucose production
3. Increased fat breakdown - 27Why does obesity cause type 2 diabetes?Abdominal fat causes low-level chronic inflammation which can damage the body overtime without causing symptoms or signs. This plays a role in insulin resistance.
- 28Why does physical inactivty lead to type 2 diabetes?Muscles play a role in maintaining blood glucose levels and refill glycogen stores once used using glucose from the blood. Exercise helps absorb more glucose into muscles without the need for insulin. The more muscle mass, the more glucose it can burn to control blood glucose.
- 29DM - Type 2 - Diagnosis (6)1. Symptoms + Random glucose concetration (>=11.1mmol/L)
2. Fasting Venous plasma glucose >=7.0mmol/L
3. Oral glucose tolerance test: venous plasma glucose >=11.1mmol/L , 2 hours after bolus
4. HbA1c
5. Urinalysis
6. Ophthalmoscopy - diabetic retinopathy - 30DM - Type 2 - Medical Mx (4)1. Metformin (Biguanides)
2. Sulphonylureas
3. Thiazolidinediones
4. Insulin - 31DM - Type 2 - Surgical Mx1. Gastric bypass
2. Gastric band - 32DM - Type 2 - Epidemiology (2)1. Prevelance: 4.5% (UK)
2. higher amongst black people - 33HyperthyroidismOveractivity of the thyroid gland, resulting in rapid heartbeat and increase metabolism.
Excess production of T4 - 34Primary Hyperthyroidism - TFT (2)TSH Low
T3 and T4 High - 35Causes of Primary Hyperthyroidism (3)1. Grave's Disease
2. Toxic multinodular goitre
3. Toxic adenoma - 36Grave's DiseaseAutoimmune thyroid condition associated with hyperthyroidism. TSH antibodies cause hyperthyroid sndrome.
Symptoms: Thyroid goitre (thyroid enlargement), thyroid ophthalmopathy (inflammation of the extra-occular muscles) and pretibial myxoedema
Female 20-50yo (HLA DR2/3) - 37Toxic multinodular goitreBenign nodules develop with age and may become hyperfunctioning.
Mean age of presentation: 6yo
Cardiovascular features predominate - 38Toxic adenomaGrowth of thyroid nodules
Most nodules are palpable and the rest of the thyroid is atrophic and impalpable. - 39Secondary Hyperthyroidism - TFT1. High TSH
2. High T3 and T4 - 40Secondary hyperthyroidism - causes (3)1. TSH - secreting pituitary adenoma
2. Thyroid hormone-resistance syndrome
3. Gestational thyrotoxicosis - 41Subclinical hyperthyroidism - TFTs1. T4 and T3 normal
2. TSH low - 42Hyperthyroidism - Symptoms (5)THYROIDISM
1. Tremor
2. Heart rate up
3. Yawning (fatigued)
4. Restlessness
5. Oligomenorrhoea/Amenorrhoea
6. Irritability
7. Diarrhoea
8. Intolerance to heat
9. Sweating
10. Muscle wasting/loss of weight - 43Grave's Disease - Extra features (4)1. Eyes: ophthalmoplegi, conjunctival oedema, papiloedema
2. Pretibial myxedema
3. Thyroid acropachy - dermopathy/clubbing
4. Goitre + bruit - 44Thyrotoxicosis storm/crisis - presentation (3)1. Fever >38.5C
2. Tachycardic
3. Delirium/coma/seizures - 45Thyrotoxicosis Crisis TxPropylthiouricil
Fluid resuscitation
Treat precipitating cause - 46Hyperthyroidism - Tx1. Carbimazole (Thionamides) - inhibit the production of thyroid hormones.
2. Radio-iodine
3. Sub-total/Near total thyroidectomy (98% cure rate) - 47Hyperthyroidism - Epidemiology (3)1. More common in women (2%), men (1%)
2. 60% to do with Grave's disease
3. Incidence: 0.77/1000 women (0.14 - men) - 48Hyperthyroidism - Complications (3)1. Hypothyroidism
2. AF
3. Congestive heart failure - 49Hyperthyroidism - Differential Diagnosis (2)1. Inflammatory eye conditions
2. Phaechromocytoma - 50Hypothyroidism - DefintionIs a clincial state resulting from the under-prodiction of thyroidism hormone.
- 51Primary Hypothyroidism - TFTs1. Raised TSH
2. Low T3 and T4 - 52Secondary Hypothyroidism - TFTs1. Low TSH
2. Low T3 and T4 - 53Causes of Primary Hypothyroidism (1)1. Autoimmune thyroiditis (Hashimoto's disease)
- 54Secondary Hypothyroidism - Causes (2)Failure of the pituitary gland to secrete TSH
1. Pituitary tumour
2. Haemochromotosis - 55Hypothyroidism - Symptoms (10)1. Tiredness/lethargy
2. Intolerance to the cold
3. Dry skin and hair
4. Slowing of interlectual activity - memory loss, difficulty concetrating
5. Constipation
6. weight gain
7. Menorrhagia
8. impaired hearing due to fluid build up in the middle ear
9. reduced libido
10. Deep hoarse voice - 56Hypothyroidism - Signs (4)1. Bradycardic
2. Cold peripheries
3. Delayed tendon reflex
4. Dry coarse skin and hair - 57Hypothyroidism - TxThyroxine (levothyroxine) - S/E: osteoporosis and AF
- 58Hypothyroidism - Epidemiology (3)1. Affects women 9x more than men
2. Peak incidence 30-50yo
3. Most common cause worldwide - iodine deficiency - 59Hypothyroidism - Differential Diagnosis (3)1. Depression
2. alzheimers
3. anaemia - 60Short Bowel diseaseDefined anatomically (<250cm SI due to substantial bowel resection)
Results in diarrhoea and malabsorption (especially fats), deficiency in ADEK and B12. Hyperoxaluria (causing renal stones) and bile salt depletion (gallstones). - 61Re-feeding syndromeA life-threatening metabolic complication of re-feeding via any route after prolonged period of starvation. As the body turns to fat and protein metabolism in the starved state, there is a drop in circulating insulin. Also there is depletion of intracellular phosphate stores.
When re-feeding begins, levels of insulin rise in response to the carbohydrate load, causing intracellular uptake of phosphate - hypophosphataemia - 62Hypophosphataemia/Hypokalaemia /hypomagnesiumaemia - Consequences (5)1. rhabdomyalsis
2. Red and white cell dysfunction
3. respiratory insufficiency
4. shock/seizures
5. sudden death - 63MDT in re-feeding syndrome1. Nutritionist
2. Specialist nurse
3. Consultant
4. Psychiatrist - 64Addison's DiseaseAdrenal insifficency
- 65Unintentional weight loss - causes (9)9 D's:
1. dementia
2. depression
3. Disease
4. Dysphagia
5. Diarrhoea
6. Drugs
7. Dentition
8. Dysgeusia
9. Don't know - 66VitC - UsesMake collagen
- 67Vit C deficiency - DiseaseScurvy
- 68Vit C - deficiency Symptoms (5)1. poor wound healing
2. spotty skin
3. mucosal bleeding
4. depression
5. tiredness - 69Vitamin B1Thiamine
1. RNA and DNA production
2. generation of energy from carbohydrates
3. Nerve function - 70Vitamin B2Riboflavin
1. involved in the electron transport chain, Kreb's cycle
2. Beta oxidation - catebolism of FA - 71Vitamin B3Niacin
1. NAD/NADP - 72Vitamin B5Pantothenic Acid
1. Oxidation of FA, Carbs, CoA
2. Synthesis of FA, ketones, phospholipids, steroid hormones, neurotranmitters, antibodies - 73Vitamin B6Pyridoxine
1. amino acid metbaolism
2. synthesis of neurotransmitter - 74Vitamine B7Biotin
1. CoA - 75Vitamin B9Folic Acid
1. nucleic acid and amino acid mtabolism
2. Normal cell division
3. RBC production - 76Vitmain B12Cobalamin
1. RBC production
2. Nerve sheaths and protein production - 77Vitamin B1 - deficiencyDry Beriberi - peripheral nervous system - weakness and pain in limbs
Wet Beriberi - Cardiovascular and other body parts - irregular heart beat, oedema
Wernicke's encepholpathy - 78Vitamin B9 DeficiencyMacrocytic anaemia
- 79Vitamin B12 DeficiencyMacrocytic anaemia.
Loss of gastric parietal cells and decreased intrinsic factor results in pernicious anaemia - 80Wernicke's Encephalopathy - pathologyPresence of neurological symptoms caused by biochemical lesions of the central nervous sytem after exhaustion of B Vitamine reserves - inparticular thiamine
- 81Wernicke's Encephalopathy triad1. Ophthalmoplegia - Extra-ocular/eye movement abnormailities (most commonly the lateral rectus)
2. Ataxia - imbalance, cerebellar signs
3. confusion - mental changes - 82Korsakoff's syndromes - symptoms (6)1. Anterograde amnesia - no new memories
2. Retrograde amnesia - severe loss of memory
3. Confabulation - invented memories
4. Minimal content in conversations
5. Lack of insight
6. apathy - lose interest quickly - 83Vitamin DEssential for the remodelling of bone and along with calcium has an important role in mineralising calcium so that it is hard
- 84Vitamin D - deficiencyChildren: Rickets
2. Adults: osteomalacia/osteoporosis - 85Vitamin KRequired for clotting factors
2, 7, 9, 10 - 86Vitamine K deficiency1. Bruising
2. Bleeding tendancy - 87Vitamin AComponent of visual pigment and helps maintain speicalised epithelia in the eye
- 88Vitamin A deficiency1. night blindness
2. xeropthalmia - dry eyes
3. BITOTs spots - conjunctival foam patches) - 89Vitamin a toxicityIron deficiency can affect vitamin A uptake and a stressed liver may be more susceptible to vitamine A toxcity
- 90Protein-energy malnutrition (PEM) - causes1. sepsis
2. cirrhosis
3. advanced CKD
4. malabsorption - 91Three types of PEM1. Kwashiorkor
2. Marasmus
3. Marasmic kwashirkor - 92Kwashiorkorprotein malnutrition predominant - oedema presen in this form because the diet is almost entirely composed of carboydrates
Fatty liver develops - 93Marasmusdeificent calorie intake - growth failure is more severe in this form
- 94marasmic Kwashiorkormarked protein deficiency and calories insuffieciency signs present - most severe form of malnutrion
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