Kenapa DM bisa bikin Ulkus dan CKD/AKI dan anemia

Insulin kurang atau gagal memasukan glukosa ke dalam sel (melalui GLUT 4)

Glukosa menumpuk dalam darah

Kerusakan pada arteri (arteriopathy→ atherosclerosis)

Neuropati + iskemi → Kerusakan di arteri yang ada di kaki → ulkus diabetikum. Karena ada
damage, supply darah kurang (karena blockage/sumbatan) → necrosis yg reaksi inflam itu
jg?

The ​indications​ for limb ​amputations​ are generally considered as the three Ds: dead
limb, deadly limb and a damn nuisance of a limb.

Kerusakan di arteri yang ada di ginjal → atherosclerosis → activate RAAS system → systemic
hypertension → hyperfiltration → glomerular damage (glomerulosclerosis) → proteinuria →
nephrotic syndrome (proteinuria → low albumin, swelling)

Diabetik Nefropathy

Di IPD ga jelasin dr awal gt lho lgsg gini:

Manfestasi patologis nefropati DM adl GLOMERULOSKLEROSIS dengan penebalan membran
basalis di glomerulus dan ekspansi mesangial.

Bntr” oh katanya sel” mesangialnya bakal produksi matrix gt makanya jd expanded karena
inflamnya ya? O

Mesangial expansion why?

Glucose stimulates an​ increase in synthesis of most collagens and matrix glycoproteins
normally expressed within the mesangium. Abnormal glycosylation of matrix proteins interferes
with their degradation and turnover. ​Periods of hyperinsulinemia and alterations in
angiotensin II ​induce changes in the phenotype of mesangial cells and the composition of matrix
they secrete. Together, glucose, insulin, and angiotensin II conspire to produce an unrelenting
increase in accumulation of mesangial matrix, with altered composition and function.
Pedal pulse ​palpation​ should be on the barefeet of the patient. The ​dorsalis pedis should be
palpated ​using two to three fingers across the dorsum of the ​foot​ ​approximately 1 cm
proximal to the depression between the first and second metatarsals (Scott, 2013).
​Ask for a history of intermittent claudication and rest pain, which suggest peripheral
arterial disease.​19​ ​Palpate the posterior tibial artery and dorsalis pedis artery​ in
both feet and record pulsations as absent or present.​20
The ​femoral artery should also be palpated and auscultated for the presence of bruit.​ The
plantar aspects of the feet should be felt for the presence of any bony prominence or callus.
 Wagner Classification and Treatment
Description Treatment
Grade Skin intact but bony deformities Shoe modifications with serial exams
0 lead to "foot at risk"
Grade Superficial ulcer Office debridement and contact casting
1
Grade Deeper, full thickness extension Operative formal debridement and contact
2 casting
Grade Deep abscess formation or Operative formal debridement and contact
3 osteomyelitis casting
Grade Partial Gangrene of forefoot Local vs. larger amputation
4
Grade Extensive Gangrene Amputation
5
Grading ulkus diabetikum (Wagner)

Patof”daftar masalah
-ulkus DM grade 2
-anemia nirmositik hipokrom
-CKD grade
-DM

DIAGNOSTIC CRITERIA AKI → RIFLE

GRADING AKI

Prognosis

Indikasi trf
-PRC
-whole blood
-TC
Active bleeding in patients with:
o generalized, microvascular active, major or dangerous bleeding or in those who have been
transfused > 1 blood volume or with documented DIC (threshold platelets/microL = 50,000). A
threshold value of up to 100,000 platelets/microL may be appropriate in those with more
minor or less active bleeding.
o acute liver failure (no threshold level set)
o bleeding and a qualitative platelet defect (congenital or acquired) (no threshold level set)
o autoimmune thrombocytopenia with major and/or dangerous bleeding (e.g. severe intestinal,
ocular or intracranial hemorrhage) (no threshold level set)

-TC apheresis
-FFP
 -cryoprecipitate
Cryoprecipitate transfusion may be indicated in the following circumstances:
In patients with:
o generalized microvascular, non-surgical bleeding with fibrinogen <100 mg/dL
o factor deficiencies if the specific factor is unavailable
dorsalis pedis, tibialis poste