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Diabetes and Surgery PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Diabetes and surgery".

This medical PowerPoint presentation tells how diabetes can increase the risk of complications during and after surgery, so people with diabetes should take extra precautions before and after surgery.

Tags : Diabetes, surgery, endocrinology, endocrinology PowerPoint presentation

Published on : Apr 18, 2023 | Views : 996 | Downloads : 2

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Slide 1-

Diabetes and surgery
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Diabetes mellitus (DM), also known as simply diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period
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any one of the following- Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl) Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) two hours after a 75 g oral glucose load as in a glucose tolerance test Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/l (200 mg/dl) Glycated hemoglobin (Hb A1C) ≥ 6.5%.
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Serious long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes.
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Type 1 DM results from the body's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.
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Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.
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Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop a high blood glucose level. Type 1 diabetes must be managed with insulin injections. Type 2 diabetes may be treated with medications with or without insulin.
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Surgical complications of Diabetes are due to 1) Micro vascular changes involving the capillaries of retina, kidneys, and peripheral nerves. 2) Macro vascular changes characterized by atherosclerotic lesions of the coronary and peripheral arterial circulation. 3) Diabetic neuropathy. 4) Infection in glucose loaded tissue.
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Surgical complications in Diabetic Patient • Bacterial infections like abscesses, carbuncles, chronic balanitis, and diabetic foot. Emphysematous Cholecystitis, Emphysematous Pyelonephritis, Necrotising fasciitis and Fournier’s gangrene Fungal infections like candidiasis, Mucormycosis. • Sexual dysfunctions
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Diabetic foot • Most feared and devastating complication of diabetes • Most common cause for leg amputations • The classic pathological triad of the diabetic foot is vascular disease, neuropathy and infection
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Wagner’s classification for diabetic foot • Grade 0 : High risk foot. No ulceration • Grade 1 : Superficial ulceration • Grade 2 : Deep ulceration penetrating up to tendon, bone or joint • Grade 3 : Osteomyelitis or deep abscess • Grade 4 : Localized gangrene (Toes or fore foot) • Grade 5 : Extensive gangrene (mid foot or hind foot) requiring major amputation
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Neuropathic foot • Sensory, autonomic and motor neuropathy contribute to the pathogenesis of Neuropathic foot. • Motor weakness leads to atrophy of the small muscles of the foot with an imbalance between the flexors and extensors. This results in clawing of the toes and prominent metatarsal heads. High foot pressure develops under the metatarsal heads. • Dry, brittle skin (as a result of autonomic neuropathy) and high foot pressure lead to callus formation. The callus can cause tissue damage and ulceration.
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Diagnosis and assessment of diabetic foot Thorough neurological examination to detect sensory, motor or autonomic nerve deficit. H/o rest pain, intermittent claudication. Examination of peripheral pulses, capillary filling. Doppler study. Estimation of blood glucose, Hb.TLC,DLC, urea, creatinine and lipids. • X‐ray to detect osteomyelitis
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Management of diabetic foot Infections are treated by wound debridement, proper antibiotic, multiple insulin injections to achieve good control of blood glucose. Exercise, cessation of smoking. Use drugs like pentoxyphylline, aspirin, and thrombolytic agents to improve blood supply. Angioplasty, bypass, stenting, atherectomy and laser ablation of atherosclrotic plaque
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Attempt to convert wet gangrene to a dry one by repeated dressings and proper antibiotics. Once gangrene sets in, decide for amputation.
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Surgery in diabetic patients • Diabetic patients are prone to develop sudden hyperglycemia or hypoglycemia during surgery. So, frequent monitoring of blood glucose is necessary. • Short acting insulin is given during surgery and in the immediate postoperative period. • They are admitted a few days ahead of surgery.
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Oral hypoglycemic drugs are stopped a few days before major surgery and insulin is started, to bring about better control of blood sugar. Insulin is continued for a few days in the postoperative period also. • Wound healing is likely to be delayed
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Q1-Dibetes mellitus is defined when in glucose tolerence test ( 75 g glucose followed by blood sugar measurement, after 2 hr) is A. less than 140 mg/dl B. between 140-200 C. >200 mg/dl D.180 mg /dl
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2.Long term complication of DM is- a.Heart disease b. renal disease c. diabetic foot d. all above
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3.Most common cause for leg amputation- a.venous ulcer b.trauma c.Buerger disease d. diabetic foot
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4.Grade 3 diabetic foot ( wager classification)- a.superficial ulcer b.deep ulcer exposing bone, joint,tendon c.osteomyelitis d. gangrene
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5. A diabetic pt on oral hypoglycemic agent is planned for surgery, which one is true- a. oral hypoglycemic drug should not be stopped b.oral hypoglycemic agent should be stopped few days before surgery and long acting insulin should be started pre and post op c.oral hypoglycemic agent should be stopped few days before surgery and short acting insulin should be started pre and post op for few days
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6. In diabetic patient level of Glycated haemoglobin (HB A1C) is more than 8.0% 6.5% 4.5% d. 9.2%