糖尿病足神经病理学-课件

Pathophysiology of DiabeticNeuropathyZhijie Xi,MDGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Pathophysiology of DiabeticZh1Diabetic Peripheral Neuropathy Can Progress Over TimeSymptoms(numbness,prickling,pain)ReflexesPressure Sensation(Monofilament)Vibratory SensationNerve Conduction AbnormalitiesSubclinicalClinicalTimeSignsOnset ofClinical DiseasesSymptoms may occur any time and intermittentlyPatients may or may not have symptoms of diabetic peripheral neuropathyPatients frequently do not report symptoms to their physicians until the symptoms are severeThe majority of signs of diabetic peripheral neuropathy are not evident at the onset of diabetesDiabetic Peripheral Neuropathy2Symptoms and Signs of Diabetic Peripheral NeuropathySymptomsNumbness or loss of feeling(asleep or“bunched up sock under toes”sensation)Prickling/TinglingAching PainBurning PainLancinating PainUnusual sensitivity or tenderness when feet are touched(allodynia)SignsDiminished vibratory perceptionDecreased knee and ankle reflexesReduced protective sensation such as pressure,hot and cold,painDiminished ability to sense position of toes and feetSymptoms and signsprogress from distal to proximal over timeSymptoms and Signs of Diabetic3Diabetic Peripheral Diabetic Peripheral Neuropathy Severity ScaleNeuropathy Severity ScaleRatingDescription0No neuropathy1Subclinical diabetic peripheral neuropathy2aClinical diabetic peripheral neuropathy with symptoms,mild to moderate2bClinical diabetic peripheral neuropathy insensate foot,loss of feeling/negative symptoms3Disability/late stageDiabetic Peripheral NeuropathyEffects of Diabetic Effects of Diabetic Peripheral NeuropathyPeripheral NeuropathyEffects of Diabetic Peripheral5NeuropathyMotorSensoryAutonomic nociception Proprioception,Unawarenessof foot positionReduced sweatingDry skinFissures andcracksMuscle wastingFoot weaknessPostural deviationDeformities,stressand shear pressuresTraumaStress on bones&jointsPlantar pressureCallus formationInfectionUlcerNeuropathyMotorSensoryAutonomi6糖尿病足神经病理学-课件7糖尿病足神经病理学-课件8糖尿病足神经病理学-课件9糖尿病足神经病理学-课件10糖尿病足神经病理学-课件11糖尿病足神经病理学-课件12Simple Tests of Large-Fiber Function Simple Tests of Large-Fiber Fu13The PNS is comprised of both neurons and SCs The PNS is comprised of both n14Pathways Implicated in Diabetic Neuropathy PathogenesisPathways Implicated in Diabeti15Bioenergetic Mechanisms of Nerve Injury in Diabetes Bioenergetic Mechanisms of Ner16Peripheral Mechanisms Contributing to Neuropathic Pain in Diabetic Neuropathy Peripheral Mechanisms Contribu17