Diabetic mellitus and hypertension.pptx.

diabetes mellitus and hypertension

1. DIABETES MELLITUS

2. DEFINITION As per WHO it is a heterogenous metabolic disorder characterized by chronic hyperglycemia with disturbance of carbohydrate fat and protein metabolism

3. PATHOGENESIS OF TYPE 1 DM

4. PATHOGENESIS OF TYPE 2 DM

5. HYPERTENSION

6. “Sustained increase in blood pressure” Systolic >140, Diastolic > 90 mm of Hg* Normal* < 130 <85 (120/80 +/- 10/5) Mild + 20, Moderate +40 Severe +80 Malignant - > 210/120

7. ETIOLOGICAL CLASSIFICATION Essential (Primary) Hypertension (95%) Unknown etiology. Life style, genetic, … Secondary Hypertension (5-10%) Renal – GN, RAS, Renin tumors Endocrine – Cushing, OCP, Thyrotoxicosis Myxdema , Pheochromocytoma, Acromegaly. Vascular – Coarctation of Aorta, PAN, Aortic insufficiency. Neurogenic – Psychogenic, Intracranial pressure, olyneuritis etc.

8. ETIOLOGY: Secondary - Known abnormal control. Renal disorders – Renin-Angiotensin. Sodium retention, ADH, Aldosterone. Cushings , Pheochromocytoma, Essential - Etiology is multifactorial. Increased peripheral resistance (sympathetic tone) stress, hormonal, neural. Genetic, familial, life style.

9. Pathogenesis of Renovascular HTN:  GFR Renin by JGA Angiotensin II Vasoconstriction  P. Resistance Sodium Retention  Blood Volume Aldosterone Hypertension

10. MALIGNANT HYPERTENSION: Rapidly progressive end organ damage. May complicate any type of HTN. Artery necrosis with thrombosis. Rapidly developing renal failure. Hypertensive encephalopathy. Left ventricular failure. less time  No hypertrophy …!

11. MORPHOLOGY: Large Blood Vessels – Macroangiopathy. Atherosclerosis and its complications. Small Blood Vessels – Microangiopathy. Hyperplastic arteriolosclerosis. (thick arterioles) Heart LVH, Hypertensive cardiomyopathy  IHD, MI. Kidney Benign nephrosclerosis. Eyes : Hypertensive retinopathy Brain : Haemorrhage , infarction, splinter hemorrhages & Lacunar infarcts.

12. PATHOGENESIS OF VASCULAR CHANGES. Arteriolosclerosis Rupture Aneurysm Rupture. Ischemia, Aneurysm, Rupture

13. Left Ventricular Hypertrophy: Left Ventricular Hypertrophy

14. Hyperplastic Arteriolosclerosis: Onion Skin Thickening Of arterioles. Narrow Lumen

15. Nephrosclerosis in HPTN: Artery Sclerosis Artery Sclerosis PCT hydropic deg.

16. Nephrosclerosis in HPTN: Artery Sclerosis Glom. Sclerosis Artery Sclerosis PCT hydropic deg.

17. Necrotizing arteriole: Malignant HPTN Fibrinoid Necrosis Thrombosis

18. Subarachnoid Haemorrhage: Cerebral Blood vessels Special features: Thin walled* End arteries* Cong. Aneurisms

19. Cerebral Infarction (Stroke) : Haemorrhagic Necrosis

20. Lacunar Infarct: Chronic hypertension Arteriolosclerosis of deep penetrating arterioles of brain stem. Single or multiple cavitary infarcts – lacunes. Lenticular nucleus, thalamus Slit Haemorrhages .

21. Benign Nephrosclerosis: Leathery Granularity due to minute scarring

22. CEREBRAL INFARCTION:

23. Renal Causes : Renal artery atherosclerosis Polycystic Disease Glomerulonephritis (A/C) Renal artery stenosis Renal vasculitis – SLE Renin producing tumors. Polycystic Kidney ->

24. Renal Artery stenosis - Atrophy Leathery Granularity Benign Nephrosclerosis

25. Normal Retina - Fundoscopy

26. HYPERTENSIVE RETINOPATHY: Arteriosclerosis cause the arteriole light reflex to become broad and dull – silver wire Generalized or focal retinal arteriolar constriction – pale. Superficial flame-shaped hemorrhages. Small white foci of retinal ischemia (cotton-wool spots). Yellow hard exudates, due to lipid deposition deep in the retina.

27. Hypertensive Retinopathy: Grade I – Thickening of arterioles. Grade II – Focal Arteriolar spasms. Vein constriction. (AV nipping) Grade III – Hemorrhages (Flame shape), dot-blot and Cotton wool (ischemia) and hard waxy exudates (lipid deposition). Grade IV - Papilloedema

28. Conclusions: Persistent increased blood pressure.. 95% Essential, 5% secondary - Renovascular Benign and Malignant types (>120 Diastolic) Vessel damage & Arteriolosclerosis Complicates - Atherosclerosis, Diabetes, IHD Ischemia or Infarction in end organs. Kidney, Brain, Heart & Eyes. Complications: Nephrosclerosis, renal damage, IHD, MI, Stroke & Retinopathy.