This document summarizes the evaluation and management of disorders of the adrenal glands, focusing on primary hyperaldosteronism. It describes the clinical presentation of primary hyperaldosteronism and the initial biochemical evaluation. It outlines the diagnostic algorithm, including confirmation with suppression testing and distinguishing between subtypes. It discusses distinguishing aldosterone-producing adenomas from idiopathic hyperaldosteronism and evaluating indeterminate cases with adrenal vein sampling or imaging. Surgical treatment with laparoscopic adrenalectomy is recommended for unilateral macroadenomas, while bilateral disease is usually treated medically.
Therapeutic apheresis involves separating blood components outside the body to remove substances causing disease symptoms. There are two main types: donor apheresis produces blood components, while therapeutic apheresis treats diseases by removing toxins, antibodies, lipids, etc. from the blood. Therapeutic plasma exchange is commonly used to treat various autoimmune and inflammatory conditions by removing pathogenic substances from plasma. Guidelines provide evidence-based recommendations on appropriate uses of therapeutic apheresis. Conditions like Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and myasthenia gravis often respond well to therapeutic apheresis.
This document discusses three patient cases presenting with resistant hypertension. Case 1 involves a 49-year-old female with obesity and resistant hypertension who shows signs of primary aldosteronism based on blood tests. Case 2 is a 53-year-old female with a 10-year history of resistant hypertension, low potassium levels, and imaging showing a lesion on her left adrenal gland. Case 3 is a 55-year-old male with resistant hypertension and normal potassium who was confirmed to have primary aldosteronism based on salt loading tests, but no adrenal lesion was seen on imaging. All three patients underwent adrenal vein sampling to further evaluate their condition.
1. Radiocontrast agents, also known as contrast media, are substances used to improve the visibility of internal organs and structures during medical imaging. The most common types are iodine-based agents used for computed tomography and angiography, and gadolinium-based agents used for magnetic resonance imaging.
2. Contrast-induced nephropathy (CIN) refers to acute kidney injury caused by radiocontrast agents in patients with underlying renal impairment or risk factors. Preventing CIN involves identifying at-risk patients, minimizing contrast volume, using iso-osmolar or low-osmolar agents, intravenous hydration before and after exposure, and holding nephrotoxic drugs like metformin.
3
Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury. The risk of developing CIN is highest in patients with preexisting chronic kidney disease, diabetes, or those receiving a high volume of contrast agent. Nonionic, low-osmolar contrast agents have been shown to reduce the risk of CIN compared to ionic, high-osmolar agents. Preventive strategies focus on minimizing contrast volume, adequate hydration, and avoiding nephrotoxic medications.
This study investigated the frequency of contrast-induced nephropathy (CIN) in hospitalized cancer patients undergoing contrast-enhanced CT scans. The study found that CIN occurred in 20% of patients overall. Patients who had chemotherapy were more likely to develop CIN than those who did not, and undergoing CT within 45 days of the last chemotherapy treatment was an independent risk factor. Receiving bevacizumab/irinotecan chemotherapy or having hypertension were also associated with higher risks of CIN. The study concluded that the incidence of CIN may be high in cancer patients undergoing CT soon after chemotherapy and that chemotherapy and certain other factors can increase the risk of CIN in this population.
re-view of physiology of adrenal cortex. congenital adrenal hyperplasia. Disorder of adrenocortical insufficiency - primary and secondary adrenocortical insufficiency.pathology of primary insufficiency. hypoaldosteronism. ACTH stimulation test.
multi day ACTH stimulation test.
Therapeutic apheresis involves separating blood components outside the body to remove substances causing disease symptoms. There are two main types: donor apheresis produces blood components, while therapeutic apheresis treats diseases by removing toxins, antibodies, lipids, etc. from the blood. Therapeutic plasma exchange is commonly used to treat various autoimmune and inflammatory conditions by removing pathogenic substances from plasma. Guidelines provide evidence-based recommendations on appropriate uses of therapeutic apheresis. Conditions like Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and myasthenia gravis often respond well to therapeutic apheresis.
This document discusses three patient cases presenting with resistant hypertension. Case 1 involves a 49-year-old female with obesity and resistant hypertension who shows signs of primary aldosteronism based on blood tests. Case 2 is a 53-year-old female with a 10-year history of resistant hypertension, low potassium levels, and imaging showing a lesion on her left adrenal gland. Case 3 is a 55-year-old male with resistant hypertension and normal potassium who was confirmed to have primary aldosteronism based on salt loading tests, but no adrenal lesion was seen on imaging. All three patients underwent adrenal vein sampling to further evaluate their condition.
1. Radiocontrast agents, also known as contrast media, are substances used to improve the visibility of internal organs and structures during medical imaging. The most common types are iodine-based agents used for computed tomography and angiography, and gadolinium-based agents used for magnetic resonance imaging.
2. Contrast-induced nephropathy (CIN) refers to acute kidney injury caused by radiocontrast agents in patients with underlying renal impairment or risk factors. Preventing CIN involves identifying at-risk patients, minimizing contrast volume, using iso-osmolar or low-osmolar agents, intravenous hydration before and after exposure, and holding nephrotoxic drugs like metformin.
3
Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury. The risk of developing CIN is highest in patients with preexisting chronic kidney disease, diabetes, or those receiving a high volume of contrast agent. Nonionic, low-osmolar contrast agents have been shown to reduce the risk of CIN compared to ionic, high-osmolar agents. Preventive strategies focus on minimizing contrast volume, adequate hydration, and avoiding nephrotoxic medications.
This study investigated the frequency of contrast-induced nephropathy (CIN) in hospitalized cancer patients undergoing contrast-enhanced CT scans. The study found that CIN occurred in 20% of patients overall. Patients who had chemotherapy were more likely to develop CIN than those who did not, and undergoing CT within 45 days of the last chemotherapy treatment was an independent risk factor. Receiving bevacizumab/irinotecan chemotherapy or having hypertension were also associated with higher risks of CIN. The study concluded that the incidence of CIN may be high in cancer patients undergoing CT soon after chemotherapy and that chemotherapy and certain other factors can increase the risk of CIN in this population.
re-view of physiology of adrenal cortex. congenital adrenal hyperplasia. Disorder of adrenocortical insufficiency - primary and secondary adrenocortical insufficiency.pathology of primary insufficiency. hypoaldosteronism. ACTH stimulation test.
multi day ACTH stimulation test.
Prof. a. el sebaeii.fluid management in patients with akiwessam1071
Acute renal failure (ARF) is common in intensive care units (ICUs) and is associated with high mortality. Early fluid management is important to prevent and treat ARF. While aggressive hydration and maintaining adequate blood pressure can help prevent ARF, both overhydration and underhydration should be avoided as they can worsen renal function. No intravenous fluid is ideal, and fluid choice and management should be tailored to the individual patient based on their fluid status and needs. Early initiation of renal replacement therapy should be considered for patients with complications from ARF such as fluid overload or electrolyte abnormalities.
Contrast induced nephropathy (CIN) is agenerally reversible form of acute kidney injury (AKI) that occurs soon after the administration of radiocontrast media.
The adrenal cortex produces three major classes of steroids:
glucocorticoids,
(2) mineralocorticoids, and
(3) adrenal androgens.
Consequently, normal adrenal function is important for
-modulating intermediary metabolism and immune responses through glucocorticoids;
blood pressure, vascular volume, and electrolytes through mineralocorticoids;
secondary sexual characteristics (in females) through androgens.
The adrenal axis plays an important role in the stress response by rapidly increasing cortisol levels.
Adrenal disorders include hyperfunction (Cushing's syndrome) and hypofunction (adrenal insufficiency) as well as a variety of genetic abnormalities of steroidogenesis.
In this multinational, randomized, controlled trial in patients with chronic kidney disease who were undergoing angiography, researchers found no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over oral placebo for the prevention of death, need for dialysis, or persistent kidney impairment at 90 days or for the prevention of contrast-associated acute kidney injury or other secondary end points.
LVEDP-guided hydration reduces the risk of CI-AKI and major adverse events at 6 months compared to standard hydration. In a randomized controlled trial of 350 patients with chronic kidney disease undergoing cardiac catheterization, the incidence of CI-AKI was lower in those receiving LVEDP-guided intravenous fluids (8%) compared to standard hydration (23%). LVEDP-guided hydration also reduced the composite of death, myocardial infarction, or need for renal replacement therapy at 6 months. No safety issues were reported with LVEDP measurement or fluid administration in this trial.
Perioperative Optimisation of Coagulation and HaemostasisAndrew Ferguson
This document provides a partial curriculum map and clinical scenarios for training in anaesthetics. It outlines objectives, scenarios, and key information related to haemostasis and management of bleeding and coagulopathy. The scenarios involve a patient with sepsis and shock undergoing emergency surgery, a patient on warfarin requiring surgery after injuries, and a trauma patient with bleeding and shock. Treatment options discussed include managing coagulopathy, reversing anticoagulants like warfarin, massive transfusion protocols, and use of blood products and coagulation factors.
This document discusses the relationship between kidney disease and cardiovascular disease. It notes that chronic kidney disease (CKD) is an independent risk factor for mortality in patients with coronary artery disease. Even mild elevations in creatinine are associated with increased risk of cardiovascular events. Acute kidney injury, including contrast-induced nephropathy (CIN), is the third leading cause of in-hospital acute renal failure. CIN risk increases with factors like diabetes, older age, decreased kidney function, and higher contrast volume. CIN is linked to worse clinical outcomes like longer hospital stays, increased mortality, and progression to chronic kidney disease. Prevention strategies aim to reduce CIN risk through measures like hydration and medications like sodium bicar
This document provides an overview of apheresis, including:
- The components of blood and methods of separating them through centrifugation or filtration.
- Definitions of plasmapheresis, cytapheresis, and indications for apheresis procedures.
- Considerations for dosing of plasmapheresis/exchange and anticoagulation with citrate.
- Potential complications of apheresis like hypocalcemia and how to treat it, as well as disease states that may benefit from procedures like Guillain-Barré syndrome and myasthenia gravis.
This document summarizes the results of treating 3 pediatric patients with homozygous familial hypercholesterolemia using cascade filtration plasmapheresis. Over the course of 35-50 treatment sessions, LDL-C levels significantly decreased by an average of 70.8% acutely and 57.9% for total cholesterol. Xanthomas resolved in the 2nd and 3rd patients. Technical difficulties such as puncture issues or low blood flow occurred in some sessions but were minor. Cascade filtration plasmapheresis was found to be an effective treatment for lowering lipid levels and resolving symptoms in these pediatric patients with homozygous familial hypercholesterolemia.
Haemodialysis related ascites prof. mohamed sobhFarragBahbah
This document discusses nephrogenic ascites, a condition where patients with end-stage renal disease develop refractory ascites. It defines nephrogenic ascites and notes the condition is diagnosed by excluding other causes of ascites through tests and imaging. The document outlines the clinical presentation, poor prognosis, and various treatment options for nephrogenic ascites that have been attempted, including fluid restriction, peritoneal dialysis, peritoneovenous shunt placement, and renal transplantation, with transplantation found to be the most effective treatment.
Contrast-induced nephropathy (CIN) is a type of acute kidney injury caused by iodinated contrast media used in medical imaging procedures. The document defines CIN and discusses its risk factors, pathophysiology, prevention, and management. It summarizes that CIN risk increases with reduced kidney function, diabetes, and other comorbidities. Prevention focuses on identifying at-risk patients, using lower contrast volumes and iso-osmolar agents when possible, and intravenous fluid administration before and after the procedure. Sodium bicarbonate and N-acetylcysteine may provide additional protective effects. For higher risk patients, alternative imaging should be considered to avoid CIN.
Contrast-induced nephropathy (CIN) is an acute kidney injury caused by radiocontrast media used in medical imaging. It is usually reversible and defined as an increase in serum creatinine of at least 0.3 mg/dL or 50% within 48 hours of contrast administration. Risk factors include pre-existing chronic kidney disease, diabetes, and higher contrast doses. Prevention focuses on hydration with isotonic saline before and after exposure, using low- or iso-osmolar contrast agents, and avoiding nephrotoxic drugs. Management involves treating the acute kidney injury while prevention remains the best approach to reducing risks of CIN.
The document discusses endocrine hypertension and provides an overview of the endocrine system and what high blood pressure and prehypertension are. It defines hypertension and discusses classifications of blood pressure. It notes that hypertension has no cure but can be prevented and managed. It provides prevalence statistics and discusses types of hypertension including primary, secondary, essential, and idiopathic hypertension. It describes some specific causes of secondary hypertension like pheochromocytoma, aldosterone, Cushing's syndrome, and renal issues. It outlines the renin-angiotensin system and discusses management of hypertension through lifestyle changes and drug treatments.
Hyperviscosity syndrome (HVS) is a condition caused by an increase in the viscosity of blood, making it thicker and less able to flow easily. This can lead to organ dysfunction. HVS occurs when there is an abnormal increase in certain blood components like red blood cells, white blood cells, platelets or proteins. Common causes include polycythemia, leukemia, myeloma and other blood disorders. Patients may experience symptoms like bleeding, visual changes, neurological issues, respiratory problems and renal impairment. Diagnosis involves blood tests, imaging and assessing the underlying condition causing the increased viscosity. Treatment focuses on treating the underlying cause, stabilizing the patient, and procedures like plasmapheresis, hydration and phlebot
Cushing syndrome occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce too much cortisol.
Too much cortisol can cause some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes.
Treatments for Cushing syndrome can return your body's cortisol levels to normal and improve your symptoms. The earlier treatment begins, the better your chances for recovery.
Dialysis principal, modalities, its role as renal replacement therapy (R.R.T.).
Indications for dialysis, other R.R.T. options how to choose, and their limitations.
HD technique, terminology; e.g. dry weight, U.F., Dialysis prescription, Dialysis adequacy.
HD monitoring, complications, management.
HD session case management.
Laboratory investigations are an important aid for oral and maxillofacial surgeons. This document discusses various hematological, biochemical, and microbiological tests that are relevant for presurgical evaluation and management. Key hematological tests covered include complete blood count, coagulation tests, and electrolyte levels. Biochemical tests discussed include tests assessing kidney and liver function. Together, laboratory evaluations can help diagnose diseases and allow for optimized presurgical planning and postoperative care of patients.
Urgent Hemodialysis Sessions Impacts and Outcome Omar Kamal
This study evaluated 30 patients who received urgent hemodialysis sessions at a single center over 14 days. The patients presented with indications including pulmonary edema, hyperkalemia, and uremic encephalopathy. Preliminary diagnoses included acute kidney injury (AKI), AKI on chronic kidney disease (CKD), end-stage renal disease (ESRD), and ESRD on hemodialysis. Final diagnoses for some patients changed. The majority received multiple hemodialysis sessions, with outcomes being improvement in 5 patients and ongoing dialysis in 23 patients. The study recommends pre-dialysis care for CKD patients and early hemodialysis initiation for AKI to avoid life-threatening complications.
The document discusses statin therapy and its potential side effects. It notes that while statins are effective for lowering LDL cholesterol and reducing cardiovascular risk, they have been associated with small increased risks of new-onset diabetes, muscle symptoms, and mild liver enzyme elevations in some patients. However, it finds no clear evidence of increased risks of cognitive impairment, renal or hepatic dysfunction, or hemorrhagic stroke with statin use. Overall, the benefits of statins in reducing cardiovascular events far outweigh these potential risks.
Fat embolism syndrome is a complication that can occur after long bone fractures, with onset of symptoms between 12-72 hours. It involves the blockage of small blood vessels in the lungs and other organs by fat globules, and can lead to respiratory distress, hypoxemia, neurological symptoms and petechial rash. Diagnosis is clinical and supported by criteria involving respiratory, neurological and skin findings. Treatment focuses on prevention through early surgical fixation of fractures, as well as supportive care of respiratory, cardiac and neurological complications. Outcomes vary from complete resolution to long-term deficits.
Acs0509 Tumors Of The Pancreas, Biliary Tract, And Liver 2009medbookonline
1) The document discusses tumors of the pancreas, biliary tract, and liver. It focuses on pancreatic ductal adenocarcinoma, which commonly presents with painless jaundice.
2) Diagnostic evaluation involves blood tests, imaging like CT or MRI to identify tumors and stage disease, and ERCP to visualize the biliary tree. Surgical resection is the main treatment if the tumor is resectable.
3) Challenges include determining resectability when tumors are atypical on imaging or small masses are not clearly identified. Additional tests like EUS may be needed in such cases to establish a diagnosis before deciding on surgical management.
The document discusses antibiotic therapy for surgical patients. It covers general principles of antimicrobial therapy including empirical therapy and laboratory tests to determine antibiotic susceptibility. It also discusses factors that influence antibiotic treatment such as route of administration, host factors like pregnancy, and advanced age. Finally, it provides guidelines for selecting antibiotics for common surgical infections like intra-abdominal infections.
Prof. a. el sebaeii.fluid management in patients with akiwessam1071
Acute renal failure (ARF) is common in intensive care units (ICUs) and is associated with high mortality. Early fluid management is important to prevent and treat ARF. While aggressive hydration and maintaining adequate blood pressure can help prevent ARF, both overhydration and underhydration should be avoided as they can worsen renal function. No intravenous fluid is ideal, and fluid choice and management should be tailored to the individual patient based on their fluid status and needs. Early initiation of renal replacement therapy should be considered for patients with complications from ARF such as fluid overload or electrolyte abnormalities.
Contrast induced nephropathy (CIN) is agenerally reversible form of acute kidney injury (AKI) that occurs soon after the administration of radiocontrast media.
The adrenal cortex produces three major classes of steroids:
glucocorticoids,
(2) mineralocorticoids, and
(3) adrenal androgens.
Consequently, normal adrenal function is important for
-modulating intermediary metabolism and immune responses through glucocorticoids;
blood pressure, vascular volume, and electrolytes through mineralocorticoids;
secondary sexual characteristics (in females) through androgens.
The adrenal axis plays an important role in the stress response by rapidly increasing cortisol levels.
Adrenal disorders include hyperfunction (Cushing's syndrome) and hypofunction (adrenal insufficiency) as well as a variety of genetic abnormalities of steroidogenesis.
In this multinational, randomized, controlled trial in patients with chronic kidney disease who were undergoing angiography, researchers found no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over oral placebo for the prevention of death, need for dialysis, or persistent kidney impairment at 90 days or for the prevention of contrast-associated acute kidney injury or other secondary end points.
LVEDP-guided hydration reduces the risk of CI-AKI and major adverse events at 6 months compared to standard hydration. In a randomized controlled trial of 350 patients with chronic kidney disease undergoing cardiac catheterization, the incidence of CI-AKI was lower in those receiving LVEDP-guided intravenous fluids (8%) compared to standard hydration (23%). LVEDP-guided hydration also reduced the composite of death, myocardial infarction, or need for renal replacement therapy at 6 months. No safety issues were reported with LVEDP measurement or fluid administration in this trial.
Perioperative Optimisation of Coagulation and HaemostasisAndrew Ferguson
This document provides a partial curriculum map and clinical scenarios for training in anaesthetics. It outlines objectives, scenarios, and key information related to haemostasis and management of bleeding and coagulopathy. The scenarios involve a patient with sepsis and shock undergoing emergency surgery, a patient on warfarin requiring surgery after injuries, and a trauma patient with bleeding and shock. Treatment options discussed include managing coagulopathy, reversing anticoagulants like warfarin, massive transfusion protocols, and use of blood products and coagulation factors.
This document discusses the relationship between kidney disease and cardiovascular disease. It notes that chronic kidney disease (CKD) is an independent risk factor for mortality in patients with coronary artery disease. Even mild elevations in creatinine are associated with increased risk of cardiovascular events. Acute kidney injury, including contrast-induced nephropathy (CIN), is the third leading cause of in-hospital acute renal failure. CIN risk increases with factors like diabetes, older age, decreased kidney function, and higher contrast volume. CIN is linked to worse clinical outcomes like longer hospital stays, increased mortality, and progression to chronic kidney disease. Prevention strategies aim to reduce CIN risk through measures like hydration and medications like sodium bicar
This document provides an overview of apheresis, including:
- The components of blood and methods of separating them through centrifugation or filtration.
- Definitions of plasmapheresis, cytapheresis, and indications for apheresis procedures.
- Considerations for dosing of plasmapheresis/exchange and anticoagulation with citrate.
- Potential complications of apheresis like hypocalcemia and how to treat it, as well as disease states that may benefit from procedures like Guillain-Barré syndrome and myasthenia gravis.
This document summarizes the results of treating 3 pediatric patients with homozygous familial hypercholesterolemia using cascade filtration plasmapheresis. Over the course of 35-50 treatment sessions, LDL-C levels significantly decreased by an average of 70.8% acutely and 57.9% for total cholesterol. Xanthomas resolved in the 2nd and 3rd patients. Technical difficulties such as puncture issues or low blood flow occurred in some sessions but were minor. Cascade filtration plasmapheresis was found to be an effective treatment for lowering lipid levels and resolving symptoms in these pediatric patients with homozygous familial hypercholesterolemia.
Haemodialysis related ascites prof. mohamed sobhFarragBahbah
This document discusses nephrogenic ascites, a condition where patients with end-stage renal disease develop refractory ascites. It defines nephrogenic ascites and notes the condition is diagnosed by excluding other causes of ascites through tests and imaging. The document outlines the clinical presentation, poor prognosis, and various treatment options for nephrogenic ascites that have been attempted, including fluid restriction, peritoneal dialysis, peritoneovenous shunt placement, and renal transplantation, with transplantation found to be the most effective treatment.
Contrast-induced nephropathy (CIN) is a type of acute kidney injury caused by iodinated contrast media used in medical imaging procedures. The document defines CIN and discusses its risk factors, pathophysiology, prevention, and management. It summarizes that CIN risk increases with reduced kidney function, diabetes, and other comorbidities. Prevention focuses on identifying at-risk patients, using lower contrast volumes and iso-osmolar agents when possible, and intravenous fluid administration before and after the procedure. Sodium bicarbonate and N-acetylcysteine may provide additional protective effects. For higher risk patients, alternative imaging should be considered to avoid CIN.
Contrast-induced nephropathy (CIN) is an acute kidney injury caused by radiocontrast media used in medical imaging. It is usually reversible and defined as an increase in serum creatinine of at least 0.3 mg/dL or 50% within 48 hours of contrast administration. Risk factors include pre-existing chronic kidney disease, diabetes, and higher contrast doses. Prevention focuses on hydration with isotonic saline before and after exposure, using low- or iso-osmolar contrast agents, and avoiding nephrotoxic drugs. Management involves treating the acute kidney injury while prevention remains the best approach to reducing risks of CIN.
The document discusses endocrine hypertension and provides an overview of the endocrine system and what high blood pressure and prehypertension are. It defines hypertension and discusses classifications of blood pressure. It notes that hypertension has no cure but can be prevented and managed. It provides prevalence statistics and discusses types of hypertension including primary, secondary, essential, and idiopathic hypertension. It describes some specific causes of secondary hypertension like pheochromocytoma, aldosterone, Cushing's syndrome, and renal issues. It outlines the renin-angiotensin system and discusses management of hypertension through lifestyle changes and drug treatments.
Hyperviscosity syndrome (HVS) is a condition caused by an increase in the viscosity of blood, making it thicker and less able to flow easily. This can lead to organ dysfunction. HVS occurs when there is an abnormal increase in certain blood components like red blood cells, white blood cells, platelets or proteins. Common causes include polycythemia, leukemia, myeloma and other blood disorders. Patients may experience symptoms like bleeding, visual changes, neurological issues, respiratory problems and renal impairment. Diagnosis involves blood tests, imaging and assessing the underlying condition causing the increased viscosity. Treatment focuses on treating the underlying cause, stabilizing the patient, and procedures like plasmapheresis, hydration and phlebot
Cushing syndrome occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce too much cortisol.
Too much cortisol can cause some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes.
Treatments for Cushing syndrome can return your body's cortisol levels to normal and improve your symptoms. The earlier treatment begins, the better your chances for recovery.
Dialysis principal, modalities, its role as renal replacement therapy (R.R.T.).
Indications for dialysis, other R.R.T. options how to choose, and their limitations.
HD technique, terminology; e.g. dry weight, U.F., Dialysis prescription, Dialysis adequacy.
HD monitoring, complications, management.
HD session case management.
Laboratory investigations are an important aid for oral and maxillofacial surgeons. This document discusses various hematological, biochemical, and microbiological tests that are relevant for presurgical evaluation and management. Key hematological tests covered include complete blood count, coagulation tests, and electrolyte levels. Biochemical tests discussed include tests assessing kidney and liver function. Together, laboratory evaluations can help diagnose diseases and allow for optimized presurgical planning and postoperative care of patients.
Urgent Hemodialysis Sessions Impacts and Outcome Omar Kamal
This study evaluated 30 patients who received urgent hemodialysis sessions at a single center over 14 days. The patients presented with indications including pulmonary edema, hyperkalemia, and uremic encephalopathy. Preliminary diagnoses included acute kidney injury (AKI), AKI on chronic kidney disease (CKD), end-stage renal disease (ESRD), and ESRD on hemodialysis. Final diagnoses for some patients changed. The majority received multiple hemodialysis sessions, with outcomes being improvement in 5 patients and ongoing dialysis in 23 patients. The study recommends pre-dialysis care for CKD patients and early hemodialysis initiation for AKI to avoid life-threatening complications.
The document discusses statin therapy and its potential side effects. It notes that while statins are effective for lowering LDL cholesterol and reducing cardiovascular risk, they have been associated with small increased risks of new-onset diabetes, muscle symptoms, and mild liver enzyme elevations in some patients. However, it finds no clear evidence of increased risks of cognitive impairment, renal or hepatic dysfunction, or hemorrhagic stroke with statin use. Overall, the benefits of statins in reducing cardiovascular events far outweigh these potential risks.
Fat embolism syndrome is a complication that can occur after long bone fractures, with onset of symptoms between 12-72 hours. It involves the blockage of small blood vessels in the lungs and other organs by fat globules, and can lead to respiratory distress, hypoxemia, neurological symptoms and petechial rash. Diagnosis is clinical and supported by criteria involving respiratory, neurological and skin findings. Treatment focuses on prevention through early surgical fixation of fractures, as well as supportive care of respiratory, cardiac and neurological complications. Outcomes vary from complete resolution to long-term deficits.
Acs0509 Tumors Of The Pancreas, Biliary Tract, And Liver 2009medbookonline
1) The document discusses tumors of the pancreas, biliary tract, and liver. It focuses on pancreatic ductal adenocarcinoma, which commonly presents with painless jaundice.
2) Diagnostic evaluation involves blood tests, imaging like CT or MRI to identify tumors and stage disease, and ERCP to visualize the biliary tree. Surgical resection is the main treatment if the tumor is resectable.
3) Challenges include determining resectability when tumors are atypical on imaging or small masses are not clearly identified. Additional tests like EUS may be needed in such cases to establish a diagnosis before deciding on surgical management.
The document discusses antibiotic therapy for surgical patients. It covers general principles of antimicrobial therapy including empirical therapy and laboratory tests to determine antibiotic susceptibility. It also discusses factors that influence antibiotic treatment such as route of administration, host factors like pregnancy, and advanced age. Finally, it provides guidelines for selecting antibiotics for common surgical infections like intra-abdominal infections.
This document provides an overview of acid-base disorders and their pathophysiology. It discusses three key points:
1. Acid-base balance is determined by the strong ion difference (SID), total weak acid concentration, and partial pressure of carbon dioxide. Disorders occur when these variables are altered.
2. Metabolic acid-base disorders involve changes in SID, such as loss of chloride leading to alkalosis or generation of organic acids causing acidosis. Respiratory disorders alter carbon dioxide levels.
3. The kidneys and gastrointestinal tract regulate acid-base balance by reabsorbing and secreting strong ions like chloride. Loss of chloride through vomiting can cause alkalosis by increasing SID
Acs0524 Procedures For Benign And Malignant Pancreatic Disease 2006medbookonline
1) The document describes surgical procedures for treating both benign and malignant pancreatic diseases, including the pylorus-preserving pancreaticoduodenectomy (Whipple procedure).
2) The Whipple procedure involves mobilizing the duodenum and head of the pancreas, dividing key structures like the gastroduodenal artery, and transecting the neck of the pancreas while preserving the superior mesenteric vein and portal vein.
3) Preoperative evaluation with imaging modalities like CT, MRI, and EUS is important to accurately determine the extent of disease and resectability.
This document discusses endocrine problems that may occur in the perioperative period. It focuses on diabetes mellitus. Key points:
- Diabetic patients have a 50% chance of surgery in their lifetime and perioperative management is complicated by metabolic abnormalities and potential complications.
- Preoperative evaluation includes assessing glycemic control through history, physical exam, HbA1c levels, and creatinine levels.
- Elective surgery patients should aim for blood glucose under 125 mg/dl fasting and 180 mg/dl postprandial through metabolic monitoring and medication adjustments before and during surgery. Emergency surgery requires intensive insulin treatment.
This document discusses motility disorders, focusing on constipation and fecal incontinence. It provides details on evaluating and diagnosing constipation, including taking a thorough history and conducting a physical exam. For mild constipation, lifestyle and dietary changes may help, along with laxatives. More severe cases require tests to determine if slow transit or problems relaxing muscles are causes. Treatments depend on test results and may include biofeedback, surgery, or supportive management.
Hyperfunction of the adrenal cortex can cause excess production of mineralocorticoids, glucocorticoids, or androgens. Primary hyperaldosteronism is characterized by autonomous overproduction of aldosterone by the adrenal glands, often leading to hypertension and hypokalemic alkalosis. It can be caused by aldosterone-producing adenomas or bilateral adrenal hyperplasia. Tests like the saline suppression test and adrenal vein sampling are used in the diagnosis. Cushing's syndrome results from prolonged exposure to high levels of cortisol and can be caused by pituitary or adrenal tumors or ectopic ACTH secretion. Signs include central obesity, moon face, and fragile skin
This document summarizes guidelines for the evaluation and management of adrenal incidentalomas. It defines adrenal incidentaloma and discusses prevalence. It notes that most cases are non-functioning adenomas, but some may secrete cortisol (subclinical Cushing's), catecholamines (pheochromocytoma), or aldosterone. Evaluation involves hormonal and imaging tests to identify functioning tumors or cancer risk based on size and features. Management may involve surgery for younger patients or those with hormone excess, while older patients or those with non-functioning tumors may be monitored.
AKI is defined as an increase in serum creatinine concentration within 48 hours or 1.5 times the baseline within 7 days. It can be prerenal, intrinsic, or postrenal. Prerenal AKI is reversible if renal perfusion is optimized through fluid resuscitation and vasopressors. Intrinsic AKI is commonly caused by sepsis, ischemia, nephrotoxins and has a worse prognosis. Treatment focuses on treating the underlying cause, managing complications like fluid overload, and starting renal replacement therapy for severe cases.
The document discusses adrenal gland anatomy and function, as well as conditions related to adrenal hormone imbalances such as Cushing's syndrome and adrenal insufficiency. It covers the causes, signs and symptoms, investigations, and management approaches for each condition. Cushing's syndrome can be caused by excessive cortisol secretion from the adrenal glands or pituitary gland. Adrenal insufficiency, such as Addison's disease, results from inadequate cortisol production and can be primary or secondary. Tests are used to distinguish between conditions and guide treatment, which may involve surgery, medications or hormone replacement therapy.
- A 55-year-old male presented with 3 weeks of weakness, fatigue, and weight loss. Physical exam found him to be thin and lean with oral pigmentation.
- Labs found leukopenia, a positive PPD test, low cortisol, increased ACTH, and a normal chest x-ray.
- The final diagnosis was tuberculosis adrenalitis, which had caused primary adrenal insufficiency.
Hypertension is a major risk factor for cardiovascular disease that accelerates atherosclerosis and increases the workload of the heart. This puts hypertensive patients at risk for conditions like heart attack, stroke, renal failure, and heart failure. The document discusses evaluation and management of hypertension, including classification of blood pressure levels and investigation of secondary causes. Key tests involve assessing for end organ damage to the eyes, heart, kidneys, and ruling out secondary causes through tests like renal ultrasound and 24-hour urine collections. Treatment involves lifestyle modifications and medications, with surgery sometimes needed for treatable secondary causes.
This document discusses adrenal insufficiency (AI), including its pathophysiology, classification, epidemiology, etiology, diagnosis, clinical presentation, and treatment. AI arises from disruption of the hypothalamus-pituitary-adrenal axis regulation of steroidogenesis. It can be primary, resulting from dysfunction of the adrenal glands, or secondary, due to dysfunction of the hypothalamus or pituitary gland. Diagnosis involves assessing cortisol levels and response to stimulation tests to determine if cortisol secretion is inadequate and if the cause is a lack of ACTH. Treatment differs between acute adrenal crisis and chronic AI.
Secondary hypertension by dr Raj kishor DrRaj Singh
1. Secondary hypertension accounts for 5-20% of hypertension cases and has an identifiable underlying cause. Common causes include renal parenchymal disease, renovascular hypertension, primary aldosteronism, Cushing's syndrome, pheochromocytoma, and coarctation of the aorta.
2. Renal disease is the most common cause of secondary hypertension. Renovascular hypertension, usually caused by atherosclerosis or fibromuscular dysplasia, can lead to renal artery stenosis and impaired renal function.
3. Other hormonal causes include primary aldosteronism, characterized by excessive aldosterone secretion leading to hypokalemia, and Cushing's syndrome, where excess cort
Cushing's syndrome is caused by excessive cortisol levels and can be due to exogenous glucocorticoid use or endogenous overproduction. It is characterized by central obesity, moon face, buffalo hump, skin changes, hypertension and diabetes. The diagnosis involves tests to check for cortisol suppression and circadian rhythm disturbances. Further tests are then used to determine the underlying cause as pituitary, adrenal or ectopic tumor. Treatment depends on the specific cause but may include surgery, medication or radiation. Pheochromocytomas are rare catecholamine-secreting tumors that cause hypertension and panic attacks. Diagnosis involves urine or plasma tests for metabolites and imaging to locate the tumor. Preparation with alpha-blockers is usually
Seminar presentation by group C 5th year medical student under supervision Dato Imi, endocrine specialist in HRPZ II.
Reference as mentioned at the end of the slide presentation
This document discusses endocrine causes of hypertension, including primary aldosteronism, pheochromocytoma, Cushing's syndrome, thyroid disorders, and others. It provides details on the pathophysiology, diagnostic approach, and management of primary aldosteronism in particular. Primary aldosteronism is one of the most common causes of secondary hypertension and can lead to hypokalemia, sodium retention, and cardiac damage if left untreated. Diagnosis involves measuring aldosterone and renin levels with calculation of the aldosterone-renin ratio, followed by confirmatory testing and imaging of the adrenal glands. Treatment options include adrenalectomy for localized disease or mineralocorticoid receptor
This document discusses various endocrine causes of hypertension. Adrenal causes include pheochromocytoma, primary aldosteronism, congenital adrenal hyperplasia, apparent mineralocorticoid excess, and Cushing's syndrome. Thyroid disorders like hyperthyroidism and hypothyroidism can also cause hypertension. Other endocrine conditions that may increase blood pressure include primary hyperparathyroidism and acromegaly. The treatment for endocrine hypertension involves treating the underlying endocrine disorder through medications, surgery, or other therapies.
Cushing syndrome and Addison disease-Dr.Hamisi MkindiMkindi Mkindi
#Cushing syndrome #Addison Disease #Adrenal Insufficiency #Adrenal Excess #Hyperaldosteronism #Nelson Syndrome #Dr.Hamisi Mkindi #Samuel Kalluvya
Adrenal insufficiency can be caused by diseases of the adrenal gland (primary),
Interference with corticotropin (ACTH) secretion by the pituitary gland (secondary)
Interference with
corticotropin-releasing hormone (CRH) secretion by the hypothalamus (tertiary)
Etiology:
Primary = adrenocortical disease = Addison’s disease
1.Autoimmune: isolated or in assoc w/ APS
2.Infection: TB, CMV, histoplasmosis, paracoccidioidomycosis,syphillis
3.Vascular: hemorrhage (usually in setting of sepsis Eg:Warerhouse-Friderichson), adrenal vein thrombosis, HIT, trauma
4.Metastatic disease: (90% of adrenals must be destroyed to cause insufficiency)
5.Deposition diseases: hemochromatosis, amyloidosis, sarcoidosis
6.Drugs: azole antifungals, etomidate (even after single dose), rifampin, anticonvulsants
Nelson syndrome
Secondary = pituitary failure of ACTH secretion
But aldosterone intact b/c RAA axis
Any cause of primary or secondary hypopituitarism
-Hypophysitis
Glucocorticoid therapy (can occur after ≤2 wk of “suppressive doses”; dose effect variable; even <10 mg of prednisone daily chronically can be suppressive
Megestrol (a progestin with some glucocorticoid activity)
Early a.m. serum cortisol: <3 µg/dL virtually diagnostic; ≥18 µg/dL generally consistent with intact adrenal function
Standard (250 µg) cosyntropin stimulation test (testing ability of ACTH → ↑ cortisol)
Normal = 60-min (or 30-min) post-ACTH cortisol ≥18 µg/dL
Abnormal in primary b/c adrenal gland diseased and unable to give adequate output
Abnormal in chronic secondary b/c adrenals atrophied and unable to respond (very rarely, may be normal in acute pituitary injury b/c adrenals still able to respond→ use early a.m. cortisol instead)
All glucocorticoids (incl creams, inh. & drops) affect test. Must know exposure to interpret.
Other tests : renin, aldosterone, insulin-induced hypoglycemia (measure serum cortisol response)
Metyrapone (blocks cortisol synthesis and therefore stimulates ACTH, measure plasma 11-deoxycortisol and urinary 17-hydroxycorticosteroid levels)
ACTH: ↑ in 1°, ↓ or low-normal in 2°
Imaging studies to consider pituitary MRI to detect anatomical abnormalities
Adrenal CT: small, noncalcified adrenals in autoimmune, enlarged in metastatic disease, hemorrhage, infection or deposition (although they may be normal-appearing)
Cushing's syndrome may be either corticotropin (ACTH) dependent or independent.
80 percent of endogenous Cushing's syndrome cases are ACTH dependent, and approximately 20 percent are ACTH independent
Primary (adrenal disorders, renin-independent increase in aldosterone)
Adrenal hyperplasia (60–70%), adenoma (Conn’s syndrome, 30–40%), glucocorticoid-remediable aldosteronism (GRA; ACTH-dep. rearranged promoter)
Secondary (extra-adrenal disorders, ↑ aldosterone is renin-dependent)
-Primary reninism:
The document provides an overview of adrenal tumors, including:
- The different types such as Conn's syndrome, Cushing's syndrome, adrenal adenomas, adrenal carcinomas, and pheochromocytomas.
- The anatomy, embryology, physiology and functions of the adrenal glands and hormones.
- The clinical presentations, laboratory diagnoses, imaging features, and management principles for each type of adrenal tumor.
Detailed information is given on the pathogenesis and treatment of various functional and non-functional adrenal masses.
Life threatening side effects of PsychotropicsDr Wasim
This document summarizes several life-threatening side effects of psychotropic medications, focusing on antipsychotics. It discusses QT prolongation which can lead to fatal arrhythmias. It also discusses diabetic ketoacidosis, drug-induced SIADH which can cause hyponatremia, increased risk of pneumonia, and serious hematological and cardiovascular side effects of clozapine including agranulocytosis, thromboembolism, myocarditis, and cardiomyopathy. Monitoring and management of these side effects is important for patient safety.
Hepatorenal Syndrome (HRS) is a functional kidney failure that occurs in patients with cirrhosis and advanced liver disease. It is characterized by severe abnormalities in renal blood flow regulation and renal function. There are two main types - type 1 is a rapidly progressive form and type 2 is a slower progressive form. The pathogenesis involves splanchnic vasodilation leading to renal vasoconstriction. Diagnosis requires meeting criteria related to kidney function tests and ruling out other causes. Treatment aims to reverse renal failure through use of vasoconstrictors like terlipressin or octreotide to relieve renal vasoconstriction until liver transplantation.
1. The adrenal glands sit above the kidneys and have two parts - the inner adrenal medulla and outer adrenal cortex.
2. Primary hyperaldosteronism (Conn's syndrome) is caused by excessive aldosterone and results in hypertension. It can be treated by surgery or medication.
3. Cushing's syndrome is excessive cortisol and can be ACTH-dependent or independent. It is usually diagnosed by hormone tests and treated by surgery, medication, or radiation depending on the cause.
Similar to Acs0538 Disorders Of The Adrenal Glands (20)
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
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Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
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A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
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This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
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This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.