Diabetic Gangrene Diagnosis and Factors

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What is the most likely diagnosis for the patient?

Pitting oedema

Diabetic gangrene of the left foot (correct)

Peripheral vascular disease

Diabetic neuropathy

Which factor contributed to the development of gangrene in this patient?

Smoking 20 cigarettes a day

Neglecting foot care advice (correct)

Frequent drinking bouts

Neglecting insulin dosage

What was the patient's employment status?

Employed in a diabetic clinic

Unemployed due to diabetes

Unemployed (correct)

Employed as a labourer

What was the patient's attitude towards insulin therapy?

Confused about correct dosage Signup and view all the answers

What was the patient's attitude towards advice given in the diabetic clinic?

'Often neglected' the advice Signup and view all the answers

What was observed on examination of the left hallux and second and third toes?

'Obviously gangrenous' and infected Signup and view all the answers

What was observed regarding pulses in the right lower limb?

All pulses were present Signup and view all the answers

How was sensation to vibration and fine touch over both feet described?

Diminished for both vibration and fine touch Signup and view all the answers

What was observed regarding ankle pulses on the left side?

Not palpable but could be picked up using Doppler probe Signup and view all the answers

What was observed regarding pitting edema over the dorsum of the foot?

Pitting edema present over dorsum of foot Signup and view all the answers

What is the effect of nicotine on blood vessels?

It produces vasospasm at an arteriolar level Signup and view all the answers

What effect does inhaled carbon monoxide from smoking have on the blood?

It forms carboxyhaemoglobin, reducing the oxygen-carrying capacity of the blood Signup and view all the answers

What is a characteristic change associated with poorly controlled diabetes?

Diabetic retinopathy Signup and view all the answers

How does diabetic neuropathy increase the risk of infection?

By allowing unnoticed trauma to the skin, leading to bacterial ingress into ischaemic soft tissues Signup and view all the answers

What is a likely initial treatment for the patient?

Emergency hospital admission and bringing diabetes under control with insulin and diet adjustment Signup and view all the answers

What factor makes major amputation unlikely in the first instance?

Presence of peripheral pulses indicating a local phenomenon due to factors described earlier Signup and view all the answers

What is a potential consequence if the patient continues smoking and ignoring his diabetes?

Development of further diabetic complications necessitating a more proximal amputation Signup and view all the answers

How does poorly controlled diabetes predispose to infection of poorly vascularized tissues?

By increasing risk of unnoticed trauma allowing ingress of bacteria into ischaemic soft tissues Signup and view all the answers

What would be the consequence of inhaled carbon monoxide from smoking on oxygen-carrying capacity of blood?

Reduces the oxygen-carrying capacity of the blood by forming carboxyhaemoglobin, persisting long after smoking ceases Signup and view all the answers

What can be inferred about diabetic retinopathy in this case?

There was no evidence of diabetic retinopathy in fundoscopy despite poorly controlled diabetes Signup and view all the answers

How does smoking contribute to thrombosis?

It increases platelet adhesiveness and encourages thrombosis. Signup and view all the answers