내분비-diabetic foot ulcer

목차

Ⅰ. Diabetic foot ulcer
1. 정의
2. Mechanism
3. Diagnosis
4. Clinical features
5. Grade
6. Complication
7. Treatment

Ⅱ. Osteomyelitis

Ⅲ. Anemia of chronic disorders (ACD)

본문내용

metoclopropamide, cisapride, domperidone, erythromycin
diabetic diarrhea (흔히 noctural0 : 소장의 연동운동 증가로 발생
Tx : brod-spectrum antobiotics, clonidine, loperamide, diphenoxylate, atropine
constipation
(3) 비뇨기계
bladder dysfunction : residual urine 증가, UTI 발생할 수 있다.
Tx : bethanechol
impotence (지속적인 것이 특징)
Tx : vacuum erection aids
intracorporeal papaverine
penile prosthetic implant
4) Insulin allergy
- IgE antibodies to insulin
- Manifestations
immediate reactions with local stinging or itching
delayed local reactions with brawny swelling lasting up to 30 h, and generalized urticaria or frank anaphylaxis.
Systemic reactions are usually seen in patients who have stopped insulin therapy for one reason or another and have then resumed treatment.
The allergic reaction may occur as early as the second injection on resumption of therapy.
- Treatment
Mild reactions - antihistamines.
severe - desensitization procedures
Once the patient is desensitized, insulin therapy should not be interrupted.
Anemia of chronic disorders (ACD)
1. 정의
① mild anemia in chronic dz
② hypoferremia
③ abundnat macrophage iron store
2. incidence : one of the most common anemia second to IDA
3. etiology
: chronic infectious, inflammatory, traumatic or neoplastic dz
4. pathogenesis : possible mechami는 in ACD
① impaired reutilization of hemoglobin iron
② decreased red cell lifespan
③ ineffective erythropoiesis
④ relative erythropoietin deficiency
⑤ impaired responsiveness of erythroid marrow to erythropoietin
5. laboratory findings of ACD
① characteristics defining ACD
ⅰ. serum iron decreased
ⅱ. serum ferritin normal or increased
② other characteristics
ⅰ. anemia usually moderate
ⅱ. red cells normocytic to microcytic
ⅲ. reticulocyte count normal to slightly elevated
ⅳ. serum TIBC normal to decreased
ⅴ. transferrin satuaartion low
ⅵ. stainable storage iron present in bone marrow
ⅶ. sideroblasts absent from the bone marrow
ⅷ. free erythrocyte protoporphyrin increased
6. diagnosis
① chronic infectious, enflammatory, or neoplastic disorder 가 존재
② hypoferremia and depressed total iron-binding capacity
③ histologically normal bone marrow biopsy with normal or increased iron stores
7. treatment
① Tx of underlying dz
② blood trandfudion : unnecessary
③ erythropoietin : 도움이 되지만 비싸다.
DDx of normocytic and microcytic anemia
Systemic inflammatory response
systemic inflammatory response syndrome(SIRS)
2 or more indications
① BT 〉38 ℃or 〈36℃
② HR 〉90/min
③ RR 〉20/min or PaCO2〈 32mmHg
④ WBC 〉12000 or WBC 〈4000 or Band form〉 10%
사망률 =7%
sepsis
=SIRS + culture proven infection
사망률=16%
septic shock
= sepsis + hypotension despite Tx with hypoperfusion(acidosis/oliguria/acute alteration of mental status)
사망률=46%
multiple organ dysfunction syndrome(MODS)
presence of altered organ function in acutely ill patient
homeostasis cannot be maintained without intervention
사망률=20-100%
IDA
ACD
ACD + IDA
SBA
serum iron
TIBC
serum ferritin
RDW
marrow Fe
↓
↑
↓
↑
-
↓
↓
N or ↑
N
+
↓
↓
N or ↑
↑
-
↑
N
↑
↑
+++

키워드

diabetic foot ulcer,   Osteomyelitis,   ACD,   하지 혈관 질환,   당뇨병성 족부병변