Öz
Ulcer development in a diabetic patient's
foot can cause serious morbidity and even mortality in patients. In these
patients, a small infection can rapidly increase sepsis during the day due to
the effects of both vascular pathologies and the disorder of blood sugar
regulation, especially the mechanical problems leading to impaired load
distribution. The physiological working process of the liver is becoming more
difficult with using of painkillers and antibiotics and septic process. This
case was initially hospitalized for evaluation and treatment plan for infected
diabetic foot ulcer.
However, additional investigations
were necessary because of the icterus that is required to be detected in terms
of the primary liver problem. Clinically detectable icterus of the amputated
patient due to diabetic foot infection and impaired liver function tests have
dramatically improved with the elimination of source of infection after
amputation.
Anahtar Kelimeler
Kaynakça
- 1.Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28.
- 2.Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: A report of the task force of the foot care ınterest group of the American Diabetes Association, with endorsement by the american association of clinical endocrinologists. Diabetes Care 2008;31:1679-85.
- 3. Diyabetik ayak sorunları. Türkiye Endokrinoloji ve Metabolizma Derneği Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu 2016; 8.baskı: s:149-57.
- 4. Yan J, Li S, Li S. The role of the liver in sepsis 2014;33:498-510.
- 5. Mete B. Sepsiste böbrek ve karaciğer. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Güncel Bilgiler Işığında Sepsis Sempozyum Dizisi 2016: 51:35-43.
- 6. Chand N, Sanyal AJ. Sepsis‐ınduced cholestasis. Hepatology 2007;45:230-41.
- 7. Schirmer BD, Winters KL, Edlich R. Cholelithiasis and cholecystitis. J Long-Term Eff Med Implants 2005:15.
- 8. Brem H, Sheehan P. Evidence based protocol for diabetic foot ulcers. Plast Reconstr Surg 2006; 117:193-209.
- 9. Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T. Risk factors for major limb amputations ın diabetic foot gangrene patients. Diabetes Res Clin Pract 2006;71:272-9.
- 10. Nerone VS, Springer KD, Woodruff DM, Atway SA. Reamputation after minor foot amputation in diabetic patients: risk factors leading to limbloss. J Foot Ankle Surg 2013;52:184-7.
- 11. Sun JH, Tsai JS, Huang CH, et al. Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification. Diabetes Res Clin Pract 2012;95:358-63.
- 12. Aziz Z, Lin WK, Nather A, Huak CY. Predictive factors for lower extremity amputations in diabetic foot ınfections. Diabet Foot Ankle 2011;2. Doi:10.3402/dfa.v2i0.7463.
- 13. Pittet D, Wyssa B, Herter-Clavel C, Kursteiner K, Vaucher J, Lew PD. Outcome of diabetic foot infection streated conservatively. Arch Intern Med 1999;159:851-6.
- 14. Altay FA, Sencan I, Senturk GC, et al. Does treatment affect the levels of serum interleukin-6, interleukin-8 and procalcitonin in diabetic foot ınfection? A pilot study. J Diabetes Complications 2012;26:214-8.
- 15. Uzun G, Solmazgul E, Curuksulu H, et al. Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med 2007;213:305-12.
- 16. Hoeboer S, Groenveld A. Changes in circulating procalcitonin versus C-reactive protein in predicting evaluation of infectious disease in febrile, critically ill patients. PLos One 2013;8:1-7.
- 17. Karakas A, Arslan E, Cakmak T, Aydın I, Akgul EO, Demirbas S. Predictive value of soluble CD14, Interleukin-6 and procalcitonin for lower extremity amputation in people with diabetes with foot ulcers: A pilot study. Pakistan J Med Sci 2014;30:578.
- 18. Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes and Its Complications 2005;19:138-41.
- 19. Citron DM, Goldstein EJ, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol 2007; 45:2819-28.
- 20. Bowering K, Embil John. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Foot Care 2013;37:145-9.
Öz
Bir diyabetli hastanın ayağında
ülser gelişmesi hastalarda ciddi morbidite ve hatta mortaliteye neden
olabilmektedir. Bu hastalarda yük dağılımında bozukluğa yol açan mekanik
problemler başta olmak üzere hem vasküler patolojiler hem de kan şekeri
regülasyonu bozukluğunun etkisiyle küçük bir enfeksiyon odağı günler içinde
hızla sepsise ilerleyebilmektedir. Kullanılan ağrı kesici ve antibiyotiklerin karaciğere
olumsuz etkisi ve septik tablonun da katkısı ile karaciğerin fizyolojik çalışma
süreci zorlaşmaktadır. Bu vakanın öncelikli olarak enfekte diyabetik ayak
ülserine yönelik değerlendirme ve tedavi planı için hastaneye yatışı
yapılmıştır. Bununla birlikte primer karaciğer problemi açısından
değerlendirilmeyi gerekli kılacak kadar şiddetli sarılığı olması ek
araştırmaları gerekli kılmıştır. Diyabetik ayak enfeksiyonu nedeniyle ampütasyon
yapılan hastanın operasyon öncesi klinik olarak saptanabilen sarılığı ve bozulmuş
olan karaciğer fonksiyon testleri ampütasyon sonrası enfeksiyon odağının yok
edilmesiyle dramatik şekilde düzelmiştir.
Anahtar Kelimeler
Kaynakça
- 1.Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28.
- 2.Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: A report of the task force of the foot care ınterest group of the American Diabetes Association, with endorsement by the american association of clinical endocrinologists. Diabetes Care 2008;31:1679-85.
- 3. Diyabetik ayak sorunları. Türkiye Endokrinoloji ve Metabolizma Derneği Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu 2016; 8.baskı: s:149-57.
- 4. Yan J, Li S, Li S. The role of the liver in sepsis 2014;33:498-510.
- 5. Mete B. Sepsiste böbrek ve karaciğer. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Güncel Bilgiler Işığında Sepsis Sempozyum Dizisi 2016: 51:35-43.
- 6. Chand N, Sanyal AJ. Sepsis‐ınduced cholestasis. Hepatology 2007;45:230-41.
- 7. Schirmer BD, Winters KL, Edlich R. Cholelithiasis and cholecystitis. J Long-Term Eff Med Implants 2005:15.
- 8. Brem H, Sheehan P. Evidence based protocol for diabetic foot ulcers. Plast Reconstr Surg 2006; 117:193-209.
- 9. Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T. Risk factors for major limb amputations ın diabetic foot gangrene patients. Diabetes Res Clin Pract 2006;71:272-9.
- 10. Nerone VS, Springer KD, Woodruff DM, Atway SA. Reamputation after minor foot amputation in diabetic patients: risk factors leading to limbloss. J Foot Ankle Surg 2013;52:184-7.
- 11. Sun JH, Tsai JS, Huang CH, et al. Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification. Diabetes Res Clin Pract 2012;95:358-63.
- 12. Aziz Z, Lin WK, Nather A, Huak CY. Predictive factors for lower extremity amputations in diabetic foot ınfections. Diabet Foot Ankle 2011;2. Doi:10.3402/dfa.v2i0.7463.
- 13. Pittet D, Wyssa B, Herter-Clavel C, Kursteiner K, Vaucher J, Lew PD. Outcome of diabetic foot infection streated conservatively. Arch Intern Med 1999;159:851-6.
- 14. Altay FA, Sencan I, Senturk GC, et al. Does treatment affect the levels of serum interleukin-6, interleukin-8 and procalcitonin in diabetic foot ınfection? A pilot study. J Diabetes Complications 2012;26:214-8.
- 15. Uzun G, Solmazgul E, Curuksulu H, et al. Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med 2007;213:305-12.
- 16. Hoeboer S, Groenveld A. Changes in circulating procalcitonin versus C-reactive protein in predicting evaluation of infectious disease in febrile, critically ill patients. PLos One 2013;8:1-7.
- 17. Karakas A, Arslan E, Cakmak T, Aydın I, Akgul EO, Demirbas S. Predictive value of soluble CD14, Interleukin-6 and procalcitonin for lower extremity amputation in people with diabetes with foot ulcers: A pilot study. Pakistan J Med Sci 2014;30:578.
- 18. Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes and Its Complications 2005;19:138-41.
- 19. Citron DM, Goldstein EJ, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol 2007; 45:2819-28.
- 20. Bowering K, Embil John. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Foot Care 2013;37:145-9.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Vaka sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 10 Sayı: 3 |
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