- Deze samenvatting is een combinatie van de college's en het boek voeten en huid.
- In de inhoudsopgave enkele onderwerpen die worden behandeld, de samenvatting is uitgebreider.
- Gebruikt voor de opleiding Podotherapie, vak diabetes. Er staat heel veel informatie met plaatjes. De samenvatting ...
Vak: diabetes.
Leerjaar: 2021/2022.
Opleiding: Podotherapie (kan voor alle opleidingen worden gebruikt die
met diabetes te maken krijgen).
Een uitgebreide samenvatting met onderbouwende plaatjes.
Fontys Hogeschool Eindhoven.
1
,Inhoudsopgave
Hoofdstuk 1: Een diabetische voet .................................................................................................................. 6
Definitie Richtlijn DV 2017 .................................................................................................................................. 6
Feiten en getallen ............................................................................................................................................... 6
Oorzaken Diabetische Risicovoet ........................................................................................................................ 7
Ontstaan van een Charcotvoet ........................................................................................................................... 7
Perifeer Arterieel Vaatlijden (PAV).................................................................................................................... 7
Macro-angiopathie ............................................................................................................................................. 7
Micro-angiopathie .............................................................................................................................................. 8
Media- of Mönckebergsclerose .......................................................................................................................... 8
Limited Joint Mobility ......................................................................................................................................... 8
Mechanische stress ............................................................................................................................................ 9
Ontstaan van een ulcus ...................................................................................................................................... 9
Risicoclassificatie = Sims classificatie................................................................................................................ 10
Hoofdstuk 2: diabetische neuropathie .......................................................................................................... 11
Risicofactoren van de diabetische voet ............................................................................................................ 11
Wat is neuropathie ........................................................................................................................................... 12
Oorzaken diabetische neuropathie ................................................................................................................... 12
Risicofactoren voor het ontstaan van diabetische neuropathie ....................................................................... 12
Diabetische perifere neuropathie ..................................................................................................................... 12
Distale diabetische symmetrische polyneuropathie ......................................................................................... 13
Dikke en dunne vezel neuropathie .................................................................................................................... 13
Vormen van diabetische neuropathie ............................................................................................................... 13
Oppervlakkig en diep gevoel ............................................................................................................................. 14
Motorische neuropathie ................................................................................................................................... 14
Autonome neuropathie..................................................................................................................................... 14
Autonome neuropathie (AN) ............................................................................................................................ 15
AGE (advanced glucose endproduct) ................................................................................................................ 15
Ontstaan AGE’s ................................................................................................................................................. 15
Vitamine B12 tekort .......................................................................................................................................... 16
Oorzaken van een vitamine B12 tekort ............................................................................................................ 16
Behandeling vitamine B12 tekort ..................................................................................................................... 16
Teveel vitamine B12.......................................................................................................................................... 17
Vasa Nervorum ................................................................................................................................................. 17
Compressie neuropathie ................................................................................................................................... 17
Behandeling compressieneuropathie ............................................................................................................... 18
Hoofdstuk 3: Perifeer Arterieel Vaatlijden (PAV) en diabetes ........................................................................ 18
2
, Perifeer Arterieel Vaatlijden en diabetes mellitus ............................................................................................ 18
Atherosclerose .................................................................................................................................................. 18
Kenmerken van acute ischemie ........................................................................................................................ 19
Kenmerken van chronisch obstructies vaatlijden.............................................................................................. 19
Claudicatio Intermittens ................................................................................................................................... 19
Vaststellen van PAV .......................................................................................................................................... 20
Gele nagels ....................................................................................................................................................... 20
Schimmelnagels (onychomycosis) .................................................................................................................... 21
Vaatlab: Duplex-meting .................................................................................................................................... 21
Angiografie ....................................................................................................................................................... 21
Behandeling PAV .............................................................................................................................................. 21
Dotteren............................................................................................................................................................ 21
Het plaatsen van een stent ............................................................................................................................... 22
Bypass-methode ............................................................................................................................................... 22
Microangiopathie ............................................................................................................................................. 22
Diabetische nefropathie.................................................................................................................................... 22
Nier schade en ulcera ....................................................................................................................................... 23
Voetschade ....................................................................................................................................................... 23
Diabetische Retinopathie .................................................................................................................................. 23
Hoofdstuk 4: mechanische stress .................................................................................................................. 23
Gevolgen mechanische stress ........................................................................................................................... 23
De gevolgen voor de huid ................................................................................................................................. 24
Pre-ulcus ........................................................................................................................................................... 24
Doel richtlijn DV ................................................................................................................................................ 24
Richtlijn: Pre-ulcus ............................................................................................................................................ 24
Blaar of bullea .................................................................................................................................................. 25
Behandeling pre-ulcus ...................................................................................................................................... 25
Combinatie bloedblaar en eelt.......................................................................................................................... 25
Combinatie eelt en bloedblaar is anders .......................................................................................................... 25
Mechanische stress kan leiden tot een ulcus .................................................................................................... 25
Kenmerken neuropathische ulcera ................................................................................................................... 26
Neuro ischemische ulcera ................................................................................................................................. 26
Ischemische ulcera ............................................................................................................................................ 26
Complicatie ....................................................................................................................................................... 26
Plantaire drukproblemen .................................................................................................................................. 26
Het plantaire vetkussen .................................................................................................................................... 27
Flexibel vetkussen ............................................................................................................................................. 27
Effect schoenen op vetkussen .......................................................................................................................... 27
3
, Een atrofisch dun vetkussen ............................................................................................................................. 27
Gevolgen voor de huid bij diabetisch autonome neuropathie ....................................................................... 27
Gevolgen van LMJ ............................................................................................................................................. 28
Mechanische stress (externe factoren) ............................................................................................................. 28
Delphistudie over eelt ...................................................................................................................................... 29
Hoofdstuk 5: diabetes en huidproblemen ..................................................................................................... 29
Doel................................................................................................................................................................... 29
Indeling diabetische voet .................................................................................................................................. 29
De neuropathische voet .................................................................................................................................... 29
Neuro-ischemische voet .................................................................................................................................... 30
Risicostadia huidproblemen.............................................................................................................................. 30
Behandeling van de intacte huid ...................................................................................................................... 30
Specifieke huidproblemen en diabetes ............................................................................................................. 30
Oorzaken van niet genezen ............................................................................................................................. 30
De huid is anders bij diabetes ........................................................................................................................... 31
Typische huidproblemen en diabetes ............................................................................................................... 31
Diabetische dermatopathie .............................................................................................................................. 31
Suikerplekken .................................................................................................................................................... 31
Diabetische bullae ............................................................................................................................................ 31
Diabetische bullae (bullosis diabeticorum) ....................................................................................................... 32
Neucrobiosis lipoidica diabeticorum ................................................................................................................. 32
Teleangiëctasieën ............................................................................................................................................. 32
Necrobiosis lipoidica diabetocorum .................................................................................................................. 32
Achrochordon (skin tags) .................................................................................................................................. 32
Standaard voor huidverzorging ........................................................................................................................ 32
Hoofdstuk 6: charcotvoet.............................................................................................................................. 33
De Charcotvoet ................................................................................................................................................. 33
Oorzaken voor het ontstaan van een Charcotvoet ........................................................................................... 33
Incidentie Charcotvoet ...................................................................................................................................... 34
Etiologie ............................................................................................................................................................ 34
Klinisch beeld .................................................................................................................................................... 34
Predisposities voor CN zijn: ............................................................................................................................... 34
Osteopenie als oorzaak van CN ........................................................................................................................ 34
RANKL-cellen..................................................................................................................................................... 35
Klinisch beeld van acute Charcotvoet ............................................................................................................... 35
Diagnostiek van een acute rode, gezwollen voet ............................................................................................. 35
De acuut rode voet ........................................................................................................................................... 36
Warme (acute) fase .......................................................................................................................................... 37
4
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