Hyperphosphatemia, hypomagnesemia, hypermagnesemia, and hypertension were discussed. Hyperphosphatemia can be caused by transcellular shift, increased intake, or decreased renal excretion and treated with dietary restrictions, phosphate binders, and dialysis. Hypomagnesemia can be caused by impaired absorption, increased renal excretion, or transcellular shift and treated with oral supplementation or IV therapy. Hypermagnesemia can be iatrogenic or due to renal failure and treated with calcium, saline, and dialysis if severe. Hypertension was defined and stages and emergencies discussed.
This document provides an overview of acute renal failure in children. It defines acute renal failure, discusses causes (pre-renal, intrinsic renal, post-renal), pathogenesis, laboratory findings, biomarkers, management including fluid resuscitation, diuretics, electrolyte abnormalities, nutrition, and indications for dialysis. Management is aimed at treating the underlying cause and maintaining fluid, electrolyte and acid-base balance until renal function recovers.
Acute renal failure is a clinical syndrome where sudden deterioration of renal function results in the kidneys' inability to maintain fluid and electrolyte homeostasis. It has various etiologies like pre-renal, intrinsic renal, and post-renal factors. Management involves treating the underlying cause, fluid resuscitation, controlling electrolyte abnormalities, and starting dialysis for refractory volume overload, hyperkalemia, acidosis, or neurological symptoms. The healthcare team works to stabilize the patient and prevent long-term kidney damage.
This document provides guidelines for the management of hypokalemia according to NICE guidelines. It defines hypokalemia as a serum potassium level below 3.5 mmol/L. The major causes are decreased intake, increased losses through the kidneys or GI tract, and shifts in distribution. Treatment involves identifying and correcting the underlying cause, monitoring for magnesium deficiency, and replacing potassium orally or intravenously depending on the severity. Close monitoring of serum potassium levels, ECG, renal function, and for side effects is important when replacing potassium.
1. Acute kidney injury (AKI) is the sudden deterioration of renal function that can range from mild to severe. It is a global problem associated with high morbidity and mortality.
2. AKI is classified based on location of injury (pre-renal, intrinsic, post-renal), urine output, and severity of decline in renal function. Common causes include sepsis, nephrotoxins, and decreased renal perfusion.
3. Management involves treating the underlying cause, maintaining fluid/electrolyte balance, and potentially renal replacement therapy for complications like fluid overload or severe electrolyte imbalances. Outcomes depend on factors like age, cause, and need for dialysis.
The document discusses kidney function and urine formation processes. It then summarizes the key functions of the kidneys, which include regulating electrolyte and fluid balance and removing waste from the blood. It describes the three main processes involved in urine formation - filtration, reabsorption, and secretion. The document then focuses on hypertension, describing classifications of blood pressure and types of hypertension. It outlines mechanisms for blood pressure control and discusses non-pharmacological and pharmacological approaches to hypertension management.
Chronic kidney disease (CKD) is defined as decreased kidney function over a period of three months or more. It can cause complications such as anemia, metabolic acidosis, hyperkalemia, and cardiovascular disease as kidney function declines. Treatment involves managing the underlying cause, restricting dietary intake of sodium, potassium, and phosphorus, treating complications pharmacologically, and potentially performing long-term dialysis or kidney transplantation for end-stage renal disease. Nursing care focuses on fluid management, dietary modifications, treatment of complications, and health education.
The kidneys are located retroperitoneally and filter waste from the blood to form urine. Kidney failure occurs when the kidneys cannot adequately remove waste or regulate fluids and electrolytes. Acute kidney injury is a sudden decrease in function while chronic kidney disease is long-term damage. Causes include decreased blood flow, direct damage, and obstruction. Treatment focuses on treating reversible causes and managing complications like anemia and bone disease. Dialysis or transplantation may be needed for late-stage disease.
This document provides information about hepato-renal syndrome (HRS), which is a syndrome that develops in patients with liver cirrhosis and portal hypertension, characterized by impaired renal function. It discusses the pathophysiology, including splanchnic arterial vasodilation, renal arterial vasoconstriction, and cardiac dysfunction. It describes the four types of HRS based on time course and precipitating factors. It provides details on diagnostic criteria and management, including general management, renal vasodilators, systemic vasoconstrictors such as terlipressin, and contraindications for vasoconstrictor therapy.
This document provides an overview of acute renal failure in children. It defines acute renal failure, discusses causes (pre-renal, intrinsic renal, post-renal), pathogenesis, laboratory findings, biomarkers, management including fluid resuscitation, diuretics, electrolyte abnormalities, nutrition, and indications for dialysis. Management is aimed at treating the underlying cause and maintaining fluid, electrolyte and acid-base balance until renal function recovers.
Acute renal failure is a clinical syndrome where sudden deterioration of renal function results in the kidneys' inability to maintain fluid and electrolyte homeostasis. It has various etiologies like pre-renal, intrinsic renal, and post-renal factors. Management involves treating the underlying cause, fluid resuscitation, controlling electrolyte abnormalities, and starting dialysis for refractory volume overload, hyperkalemia, acidosis, or neurological symptoms. The healthcare team works to stabilize the patient and prevent long-term kidney damage.
This document provides guidelines for the management of hypokalemia according to NICE guidelines. It defines hypokalemia as a serum potassium level below 3.5 mmol/L. The major causes are decreased intake, increased losses through the kidneys or GI tract, and shifts in distribution. Treatment involves identifying and correcting the underlying cause, monitoring for magnesium deficiency, and replacing potassium orally or intravenously depending on the severity. Close monitoring of serum potassium levels, ECG, renal function, and for side effects is important when replacing potassium.
1. Acute kidney injury (AKI) is the sudden deterioration of renal function that can range from mild to severe. It is a global problem associated with high morbidity and mortality.
2. AKI is classified based on location of injury (pre-renal, intrinsic, post-renal), urine output, and severity of decline in renal function. Common causes include sepsis, nephrotoxins, and decreased renal perfusion.
3. Management involves treating the underlying cause, maintaining fluid/electrolyte balance, and potentially renal replacement therapy for complications like fluid overload or severe electrolyte imbalances. Outcomes depend on factors like age, cause, and need for dialysis.
The document discusses kidney function and urine formation processes. It then summarizes the key functions of the kidneys, which include regulating electrolyte and fluid balance and removing waste from the blood. It describes the three main processes involved in urine formation - filtration, reabsorption, and secretion. The document then focuses on hypertension, describing classifications of blood pressure and types of hypertension. It outlines mechanisms for blood pressure control and discusses non-pharmacological and pharmacological approaches to hypertension management.
Chronic kidney disease (CKD) is defined as decreased kidney function over a period of three months or more. It can cause complications such as anemia, metabolic acidosis, hyperkalemia, and cardiovascular disease as kidney function declines. Treatment involves managing the underlying cause, restricting dietary intake of sodium, potassium, and phosphorus, treating complications pharmacologically, and potentially performing long-term dialysis or kidney transplantation for end-stage renal disease. Nursing care focuses on fluid management, dietary modifications, treatment of complications, and health education.
The kidneys are located retroperitoneally and filter waste from the blood to form urine. Kidney failure occurs when the kidneys cannot adequately remove waste or regulate fluids and electrolytes. Acute kidney injury is a sudden decrease in function while chronic kidney disease is long-term damage. Causes include decreased blood flow, direct damage, and obstruction. Treatment focuses on treating reversible causes and managing complications like anemia and bone disease. Dialysis or transplantation may be needed for late-stage disease.
This document provides information about hepato-renal syndrome (HRS), which is a syndrome that develops in patients with liver cirrhosis and portal hypertension, characterized by impaired renal function. It discusses the pathophysiology, including splanchnic arterial vasodilation, renal arterial vasoconstriction, and cardiac dysfunction. It describes the four types of HRS based on time course and precipitating factors. It provides details on diagnostic criteria and management, including general management, renal vasodilators, systemic vasoconstrictors such as terlipressin, and contraindications for vasoconstrictor therapy.
Acute renal failure develops when renal function is diminished such that fluid homeostasis can no longer be maintained. It can be oliguric or nonoliguric. Causes include prerenal issues like decreased perfusion, direct renal problems, and postrenal obstruction. Treatment involves fluid management, electrolyte control like treating hyperkalemia, and correcting acidosis while avoiding tetany from rapid changes. Dialysis may be needed for persistent issues.
Pharmacology of drugs acting on Renal System.pdfAFFIFA HUSSAIN
Diuretics also known as water pills increases the excretion of water and electrolytes (Na+) in
urine.
Natriuresis – large amount of sodium excreted in urine due to the action of kidneys.
Promoted by – ventricular and atrial natriuretic as well as calcitonin.
Inhibited by chemicals such as aldosterone. The drugs which increases sodium excretion are
known as natriuretic.
Diuresis – increased or excessive production of urine. The drugs which enhances the excretion
of water without loss of electrolyte is called as aquaretic.
The document provides an overview of acute renal failure (ARF), including its anatomy, physiology, definitions, epidemiology, causes, pathogenesis, clinical features, investigations, complications, management, prognosis and prevention. It discusses ARF in various contexts such as pre-renal, renal and post-renal causes. Key points covered include classification of ARF, common causes like sepsis and nephrotoxins, treatment approaches involving fluid management and dialysis indications. Newborn-specific ARF is also briefly addressed.
The Medical Assessment and Management of OliguriaLuis Daniel Lugo
The document discusses the medical assessment and management of oliguria. It defines oliguria as urine output less than 400 mL per day in adults. Oliguria can result from prerenal, intrinsic renal, or postrenal causes. The assessment of oliguria involves urine analysis and blood tests to evaluate electrolytes, BUN, creatinine, and acid-base balance. Medical management focuses on treating the underlying cause, managing fluid balance and hyperkalemia, and considering dialysis for complications like volume overload or refractory acidosis. Identifying and treating reversible causes is important for prognosis, which depends on etiology and comorbidities.
This document discusses hyponatremia, defined as a serum sodium level below 135 mmol/L. It is common in hospitalized patients. Acute severe hyponatremia can cause morbidity and mortality, while overly rapid correction of chronic hyponatremia can also cause neurological issues. The document then covers etiologies and pathophysiologies of hypotonic hyponatremias including hypovolemic, euvolemic, and hypervolemic types. It discusses evaluation and treatment of hyponatremia, emphasizing the need for slow correction to avoid osmotic demyelination syndrome. Treatment depends on the severity and chronicity of hyponatremia and includes fluid restriction
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
Acute renal failure (ARF) is a clinical syndrome characterized by a sudden deterioration in renal function resulting in the inability to maintain fluid and electrolyte homeostasis. A modified pediatric RIFLE criteria (pRIFLE) has been developed to characterize acute kidney injury in children. ARF can be prerenal, intrinsic renal, or postrenal in etiology. Treatment involves fluid resuscitation, management of electrolyte abnormalities, and potentially dialysis. Prognosis depends on the underlying cause, with renal-limited conditions having a low mortality and multiorgan failure a high mortality.
The summary of the document is:
1. The Renin-Angiotensin-Aldosterone System (RAAS) is activated in response to hypotension, decreased sodium concentration, and decreased blood volume to increase blood pressure through vasoconstriction and sodium retention.
2. Nephrotic syndrome requires proteinuria over 3g per day, hypobulinemia, and edema. The most common causes are membranous glomerulonephritis, minimal-change GN, and focal segmental glomerulosclerosis.
3. Nephritic syndrome presents with hematuria, proteinuria, hypertension, edema, and oliguria. It is often seen in IgA nep
Dr. Arun Karmakar presented on hyponatremia. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder. It is clinically important because acute severe hyponatremia can cause morbidity and mortality, and outcomes are worse in hyponatremic patients with underlying diseases. Hyponatremia can be hypovolemic, euvolemic, or hypervolemic depending on water and sodium levels. Treatment depends on the severity and cause of hyponatremia, with aggressive correction for symptomatic cases and slower correction for chronic cases to avoid osmotic demyelination syndrome.
1. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder seen in clinical practice.
2. The document discusses the etiologies and pathophysiologies of hyponatremia including hypovolemic, euvolemic, and hypervolemic causes.
3. Treatment of hyponatremia depends on the severity and chronicity of the low sodium levels and involves restricting water intake, sodium supplementation, or in severe cases, hypertonic saline therapy. The goal is to correct sodium levels slowly to avoid osmotic demyelination syndrome.
Renal failure occurs when the kidneys cannot remove waste or regulate fluids and electrolytes. There are two main types: acute renal failure, which develops rapidly over hours to days; and chronic renal failure, which is progressive and irreversible. Acute renal failure causes a sudden loss of kidney function and can result from prerenal issues, direct kidney damage, or urinary tract obstruction. Chronic renal failure is treated through diet, medication, and often dialysis to remove waste when kidney function declines. Nursing focuses on managing complications, nutrition, fluid balance, and educating patients.
fluids in children maintenance therapy and normalrichardkikondo5
Total body water is high in fetuses and declines after birth. Two-thirds is intracellular fluid, one-third is extracellular fluid. Hormones like ADH, angiotensin II, aldosterone, and atrial natriuretic factor regulate body fluids and electrolytes. Sodium is the main extracellular ion and levels can become too high (hypernatremia) or too low (hyponatremia). Potassium, calcium, and magnesium also have normal levels and can become abnormal. Acid-base balance is tightly regulated and metabolic acidosis results from low bicarbonate levels. Treatment depends on the underlying cause and severity.
This includes a comprehensive study of Renal Failure - both AKI & CKD (ESRD). It is very helpful for those who are managing the clients with renal failure.
Hyperkalemia&hypokalemia by dr vijithaVijitha A S
This document discusses hypokalemia and hyperkalemia. It begins by covering physiology of potassium including distribution between intracellular and extracellular spaces and homeostasis mechanisms. It then defines and describes causes and treatment of hyperkalemia including shifting potassium intracellularly or removing it. For hypokalemia it discusses increased losses, decreased intake and intracellular shifts as causes and emphasizes replacing losses. Clinical features and management focus on symptom relief and returning potassium to normal range.
This document discusses various electrolyte abnormalities including hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypomagnesemia, hypermagnesemia, hypocalcemia, hypercalcemia, hypophosphatemia, and hyperphosphatemia. For each condition, it defines the abnormality, discusses causes, classification if relevant, and recommendations for treatment. The treatment sections focus on replacing electrolytes orally or intravenously depending on severity and addressing underlying causes of the imbalance.
Hyponatremia, defined as a serum sodium level below 135 mEq/L, is the most common electrolyte disorder. It can be caused by excess water intake relative to sodium, and inappropriate antidiuretic hormone (ADH) secretion is a common cause. Hyponatremia is categorized as hypervolemic, euvolemic, or hypovolemic based on total body water status. Symptoms range from mild gastrointestinal issues to serious neurological effects like seizures or coma if severe. Diagnosis involves assessing sodium, osmolality, and urine studies. Treatment depends on chronicity and severity, with hypertonic saline used for acute cases and fluid restriction or vasopressin receptor antagon
This document discusses fluid and electrolyte imbalance, focusing on sodium and potassium. It begins by outlining where fluid is distributed in the body. It then discusses daily fluid intake and losses. Key points about sodium include that it maintains extracellular fluid balance, nerve impulse transmission, and is regulated by aldosterone and urine output. Causes, symptoms, and treatment of hyponatremia and hypernatremia are summarized. Regarding potassium, it notes its role in muscle function and that the kidney plays a dominant role in regulation. Causes, symptoms, and ECG changes of hypokalemia are outlined.
ionotropes.pptx with medications related to HDDarshanS239776
Inotropes are drugs that affect the force of heart contractions. There are two types: positive inotropes strengthen heartbeats while negative inotropes weaken heartbeats. Positive inotropes can help when the heart is too weak to pump enough blood to the body.
- Giardia lamblia is a unicellular parasite that causes giardiasis in humans. It was first observed by Van Leeuwenhoek in 1681 and named after Alfred Giard.
- It exists in two forms - a cyst form which is infective, and a trophozoite form which attaches to the small intestine mucosa. The cyst is ingested and the trophozoite emerges to attach and feed.
- Symptoms of giardiasis include diarrhea, flatulence, and greasy stool. The infection is common in children and spreads through contaminated food, water, or direct fecal-oral transmission.
Acute renal failure develops when renal function is diminished such that fluid homeostasis can no longer be maintained. It can be oliguric or nonoliguric. Causes include prerenal issues like decreased perfusion, direct renal problems, and postrenal obstruction. Treatment involves fluid management, electrolyte control like treating hyperkalemia, and correcting acidosis while avoiding tetany from rapid changes. Dialysis may be needed for persistent issues.
Pharmacology of drugs acting on Renal System.pdfAFFIFA HUSSAIN
Diuretics also known as water pills increases the excretion of water and electrolytes (Na+) in
urine.
Natriuresis – large amount of sodium excreted in urine due to the action of kidneys.
Promoted by – ventricular and atrial natriuretic as well as calcitonin.
Inhibited by chemicals such as aldosterone. The drugs which increases sodium excretion are
known as natriuretic.
Diuresis – increased or excessive production of urine. The drugs which enhances the excretion
of water without loss of electrolyte is called as aquaretic.
The document provides an overview of acute renal failure (ARF), including its anatomy, physiology, definitions, epidemiology, causes, pathogenesis, clinical features, investigations, complications, management, prognosis and prevention. It discusses ARF in various contexts such as pre-renal, renal and post-renal causes. Key points covered include classification of ARF, common causes like sepsis and nephrotoxins, treatment approaches involving fluid management and dialysis indications. Newborn-specific ARF is also briefly addressed.
The Medical Assessment and Management of OliguriaLuis Daniel Lugo
The document discusses the medical assessment and management of oliguria. It defines oliguria as urine output less than 400 mL per day in adults. Oliguria can result from prerenal, intrinsic renal, or postrenal causes. The assessment of oliguria involves urine analysis and blood tests to evaluate electrolytes, BUN, creatinine, and acid-base balance. Medical management focuses on treating the underlying cause, managing fluid balance and hyperkalemia, and considering dialysis for complications like volume overload or refractory acidosis. Identifying and treating reversible causes is important for prognosis, which depends on etiology and comorbidities.
This document discusses hyponatremia, defined as a serum sodium level below 135 mmol/L. It is common in hospitalized patients. Acute severe hyponatremia can cause morbidity and mortality, while overly rapid correction of chronic hyponatremia can also cause neurological issues. The document then covers etiologies and pathophysiologies of hypotonic hyponatremias including hypovolemic, euvolemic, and hypervolemic types. It discusses evaluation and treatment of hyponatremia, emphasizing the need for slow correction to avoid osmotic demyelination syndrome. Treatment depends on the severity and chronicity of hyponatremia and includes fluid restriction
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
Acute renal failure (ARF) is a clinical syndrome characterized by a sudden deterioration in renal function resulting in the inability to maintain fluid and electrolyte homeostasis. A modified pediatric RIFLE criteria (pRIFLE) has been developed to characterize acute kidney injury in children. ARF can be prerenal, intrinsic renal, or postrenal in etiology. Treatment involves fluid resuscitation, management of electrolyte abnormalities, and potentially dialysis. Prognosis depends on the underlying cause, with renal-limited conditions having a low mortality and multiorgan failure a high mortality.
The summary of the document is:
1. The Renin-Angiotensin-Aldosterone System (RAAS) is activated in response to hypotension, decreased sodium concentration, and decreased blood volume to increase blood pressure through vasoconstriction and sodium retention.
2. Nephrotic syndrome requires proteinuria over 3g per day, hypobulinemia, and edema. The most common causes are membranous glomerulonephritis, minimal-change GN, and focal segmental glomerulosclerosis.
3. Nephritic syndrome presents with hematuria, proteinuria, hypertension, edema, and oliguria. It is often seen in IgA nep
Dr. Arun Karmakar presented on hyponatremia. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder. It is clinically important because acute severe hyponatremia can cause morbidity and mortality, and outcomes are worse in hyponatremic patients with underlying diseases. Hyponatremia can be hypovolemic, euvolemic, or hypervolemic depending on water and sodium levels. Treatment depends on the severity and cause of hyponatremia, with aggressive correction for symptomatic cases and slower correction for chronic cases to avoid osmotic demyelination syndrome.
1. Hyponatremia is defined as a serum sodium below 135 mmol/L and is the most common electrolyte disorder seen in clinical practice.
2. The document discusses the etiologies and pathophysiologies of hyponatremia including hypovolemic, euvolemic, and hypervolemic causes.
3. Treatment of hyponatremia depends on the severity and chronicity of the low sodium levels and involves restricting water intake, sodium supplementation, or in severe cases, hypertonic saline therapy. The goal is to correct sodium levels slowly to avoid osmotic demyelination syndrome.
Renal failure occurs when the kidneys cannot remove waste or regulate fluids and electrolytes. There are two main types: acute renal failure, which develops rapidly over hours to days; and chronic renal failure, which is progressive and irreversible. Acute renal failure causes a sudden loss of kidney function and can result from prerenal issues, direct kidney damage, or urinary tract obstruction. Chronic renal failure is treated through diet, medication, and often dialysis to remove waste when kidney function declines. Nursing focuses on managing complications, nutrition, fluid balance, and educating patients.
fluids in children maintenance therapy and normalrichardkikondo5
Total body water is high in fetuses and declines after birth. Two-thirds is intracellular fluid, one-third is extracellular fluid. Hormones like ADH, angiotensin II, aldosterone, and atrial natriuretic factor regulate body fluids and electrolytes. Sodium is the main extracellular ion and levels can become too high (hypernatremia) or too low (hyponatremia). Potassium, calcium, and magnesium also have normal levels and can become abnormal. Acid-base balance is tightly regulated and metabolic acidosis results from low bicarbonate levels. Treatment depends on the underlying cause and severity.
This includes a comprehensive study of Renal Failure - both AKI & CKD (ESRD). It is very helpful for those who are managing the clients with renal failure.
Hyperkalemia&hypokalemia by dr vijithaVijitha A S
This document discusses hypokalemia and hyperkalemia. It begins by covering physiology of potassium including distribution between intracellular and extracellular spaces and homeostasis mechanisms. It then defines and describes causes and treatment of hyperkalemia including shifting potassium intracellularly or removing it. For hypokalemia it discusses increased losses, decreased intake and intracellular shifts as causes and emphasizes replacing losses. Clinical features and management focus on symptom relief and returning potassium to normal range.
This document discusses various electrolyte abnormalities including hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypomagnesemia, hypermagnesemia, hypocalcemia, hypercalcemia, hypophosphatemia, and hyperphosphatemia. For each condition, it defines the abnormality, discusses causes, classification if relevant, and recommendations for treatment. The treatment sections focus on replacing electrolytes orally or intravenously depending on severity and addressing underlying causes of the imbalance.
Hyponatremia, defined as a serum sodium level below 135 mEq/L, is the most common electrolyte disorder. It can be caused by excess water intake relative to sodium, and inappropriate antidiuretic hormone (ADH) secretion is a common cause. Hyponatremia is categorized as hypervolemic, euvolemic, or hypovolemic based on total body water status. Symptoms range from mild gastrointestinal issues to serious neurological effects like seizures or coma if severe. Diagnosis involves assessing sodium, osmolality, and urine studies. Treatment depends on chronicity and severity, with hypertonic saline used for acute cases and fluid restriction or vasopressin receptor antagon
This document discusses fluid and electrolyte imbalance, focusing on sodium and potassium. It begins by outlining where fluid is distributed in the body. It then discusses daily fluid intake and losses. Key points about sodium include that it maintains extracellular fluid balance, nerve impulse transmission, and is regulated by aldosterone and urine output. Causes, symptoms, and treatment of hyponatremia and hypernatremia are summarized. Regarding potassium, it notes its role in muscle function and that the kidney plays a dominant role in regulation. Causes, symptoms, and ECG changes of hypokalemia are outlined.
ionotropes.pptx with medications related to HDDarshanS239776
Inotropes are drugs that affect the force of heart contractions. There are two types: positive inotropes strengthen heartbeats while negative inotropes weaken heartbeats. Positive inotropes can help when the heart is too weak to pump enough blood to the body.
- Giardia lamblia is a unicellular parasite that causes giardiasis in humans. It was first observed by Van Leeuwenhoek in 1681 and named after Alfred Giard.
- It exists in two forms - a cyst form which is infective, and a trophozoite form which attaches to the small intestine mucosa. The cyst is ingested and the trophozoite emerges to attach and feed.
- Symptoms of giardiasis include diarrhea, flatulence, and greasy stool. The infection is common in children and spreads through contaminated food, water, or direct fecal-oral transmission.
This document provides instructions for nasogastric tube insertion. It defines nasogastric tube insertion as introducing a tube into the stomach for therapeutic or diagnostic purposes. It describes the indications, equipment needed, preparation of the patient and unit, step-by-step procedure, recording/reporting, and methods to check tube placement including auscultation, aspirating gastric contents, and testing pH of aspirated fluid. The goal is to properly place the tube in the stomach to provide artificial feeding, administer oral medications or perform other procedures while ensuring patient safety and comfort.
This document discusses dialysis treatment for patients who are HIV, HCV, or HBsAg positive. It notes that these patients may develop kidney disease and require dialysis. Treatment for these patients is similar to other patients, though additional precautions are taken due to infection risk. These include isolating positive patients, thorough cleaning, avoiding dialyzer reuse, and proper handling and disposal of any contaminated fluids or waste. Staff also strictly follow universal precautions like protective equipment and cleaning between patients. Exposure incidents may also warrant post-exposure prophylaxis. The document reviews medications and vitamins given during dialysis to support patient health and replace lost nutrients.
1. Chronic kidney disease patients are susceptible to infections due to immunosuppression and should receive appropriate vaccinations when diagnosed.
2. Vaccine response is often sub-optimal in hemodialysis patients, and some live vaccines cannot be given to transplant patients.
3. Planning vaccination is important, with hepatitis B vaccine recommended for hemodialysis patients except those HBsAg positive, using double the normal dose.
This document outlines the steps for terminating a dialysis treatment session through either saline or air rinse. It describes disconnecting the patient from the dialysis machine by using saline or a saline-air mixture to displace the remaining blood in the extracorporeal circuit and return it to the patient. It notes that air rinse increases the risk of air embolism so must be carefully supervised. The document also provides instructions for caring for vascular access sites after treatment and in emergency situations.
This document provides information on cannulation for hemodialysis. It discusses the cannulation approach which involves using two needles, one for withdrawing blood from the patient into the dialysis circuit (arterial needle) and one for returning purified blood to the patient (venous needle). It describes three cannulation techniques: rope ladder, buttonhole, and area puncture. The buttonhole technique involves cannulating in the exact same spot each time. Physical assessment of the access is recommended before each cannulation. Factors to consider for a patient's first dialysis session include limiting blood and fluid removal. The document outlines the cannulation procedure and equipment needed.
The document describes the key components and functions of a dialysis machine. It discusses the three main compartments, features like the blood pump and dialysate delivery system, safety monitors including pressure monitors, and options like bicarbonate and variable sodium. It provides details on how each component works, such as how the blood pump circulates blood and how safety monitors detect issues like high pressure or air bubbles. The document also covers system disinfection and how to respond to common alarm situations during dialysis treatment.
CAPD catheters are flexible plastic tubes inserted into the abdomen to allow dialysis fluid to enter the abdominal cavity and remove toxins from the bloodstream. They have a titanium adapter to securely connect transfer sets or tubing. Transfer sets are used to connect the catheter to bags of dialysis solution and are replaced every 6-9 months. An automated peritoneal dialysis cycler machine fills the abdominal cavity with fresh dialysis solution, allows it to dwell, then drains the used solution automatically overnight while the patient sleeps.
Diffusion and osmosis are processes that allow for the exchange of solutes and fluid across the dialysis membrane during hemodialysis treatment. Diffusion is the movement of solutes down their concentration gradient from high to low concentration until equilibrium is reached. Osmosis is the movement of water from high to low concentration areas. Factors like temperature, surface area, and concentration gradients affect diffusion rates. Transmembrane pressure is the difference in pressure across the membrane and can cause alarms if too high or low. Venous pressure and ultrafiltration rates are also monitored during treatment.
The document discusses renal failure, including acute renal failure (ARF) and chronic renal failure (CRF). It defines renal failure as when the kidneys cannot remove metabolic waste or perform regulatory functions. ARF is a reversible clinical syndrome with sudden loss of kidney function over hours to days. CRF is kidney damage for 3+ months with decreased GFR. CRF management focuses on slowing progression, limiting complications like anemia and bone disease, and preparing for renal replacement therapies like dialysis and transplantation.
AKI and CKD are both conditions affecting kidney function. AKI refers to acute kidney injury and can be caused by factors like sepsis that lead to a rapid decline in kidney function over a period of days. CKD refers to chronic kidney disease, which develops over a period of months or years due to conditions like diabetes or hypertension. The prevalence of CKD stages 3-5 is around 5-7% globally. Mortality from AKI depends on the underlying cause, ranging from low to over 70% when associated with multi-organ failure from sepsis. Management of CKD focuses on slowing progression of disease and treating complications through diet, medication and preparing for renal replacement therapies like dialysis if needed.
This document discusses vital signs including temperature, pulse, respiration, and blood pressure. It provides details on:
- How and where to measure each vital sign
- Normal ranges
- Factors that can influence measurements
- How to document readings
- When to notify the nurse of abnormal findings
The key messages are that vital signs must be measured accurately according to standard procedures, documented properly, and any abnormalities reported immediately to the nurse. Regular monitoring of vital signs is important for assessing patient health and detecting changes that may require medical intervention.
This presentation reviews the WHO guidelines for proper hand hygiene. It discusses that hand hygiene includes cleaning hands with soap and water or alcohol-based hand rub to remove germs. The "who, what, where, when, why and how" of hand hygiene are explained, including that everyone should practice hand hygiene, especially in healthcare settings. The key moments when hand hygiene should be performed are outlined as well as the proper technique.
1) Fractures are breaks in bone continuity that can be complete or partial. Types include simple, compound, complicated, and greenstick fractures.
2) Causes include direct force from impacts or falls, indirect force from twisting motions, and diseases weakening bones.
3) Signs are pain, swelling, deformity, inability to move the injured area, and sometimes hearing a snapping sound.
4) First aid aims to prevent further injury, reduce pain, and prepare for medical transport. Injured areas are immobilized using splints or other supports.
This document discusses effective communication and its importance. It defines effective communication as a two-way process of sending the right message to the right person. It outlines the 7Cs of effective communication: completeness, conciseness, consideration, clarity, concreteness, courtesy and correctness. Barriers to effective communication include lack of skills, sensitivity and knowledge as well as distractions. The document also discusses listening as a key part of communication and provides techniques for active listening such as paraphrasing, summarizing and questioning.
Dialysate is the fluid used during dialysis that draws waste and excess fluid from the blood. It has a similar composition to plasma with electrolytes like sodium, chloride, calcium, potassium, and either acetate or bicarbonate. Dialysate prevents essential electrolytes from being removed from the blood and controls water removal during dialysis. The two main types are acetate and bicarbonate dialysate, with bicarbonate being preferred as acetate can cause side effects like hypotension. Dialysate delivery systems carefully blend concentrates and water, monitor dialysate parameters, control flow rates, and disinfect equipment to safely perform dialysis.
This document provides instructions for making occupied, unoccupied, and surgical beds. It discusses the importance of wrinkle-free sheets, hygiene measures when changing sheets, and proper positioning and support of the patient. The steps for making an occupied bed with a patient in it are outlined, including covering the patient, changing soiled linens on one side of the bed before the other, and tucking in the draw sheet at the end. Hospital corners and fan folding techniques are also described.
Aerosol drug administration involves delivering medication via small particles that are inhaled through the lungs. It allows for rapid absorption and localization of drugs to treat conditions like asthma and COPD. Nebulization converts liquid medications into a mist using a nebulizer machine. Metered dose inhalers (MDIs) precisely deliver medication via an aerosol spray with each push of the canister. Proper administration of both requires specific techniques to ensure the patient inhales the full dose.
This document discusses suturing techniques and materials. It begins by outlining the objectives of learning suturing instruments and closure techniques. Various instruments used for suturing like forceps and scissors are described. Different types of needles, suture materials both absorbable and non-absorbable, and whether they are monofilament or braided are explained. Basic suturing techniques like simple interrupted sutures, running sutures, and mattress sutures are outlined. Factors to consider when choosing a suturing technique based on wound type and location are highlighted. Principles of knot tying are reviewed.
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
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Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Pristyn Care Reviews
Precision becomes a byword, most especially in such procedures as hip and knee arthroplasty. The success of these surgeries is not just dependent on the skill and experience of the surgeons but is extremely dependent on preoperative planning. Recognizing this important need, Pristyn Care commits itself to the integration of advanced imaging technologies like CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) into the surgical planning process.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...Kumar Satyam
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Recent Trends
Strategic Collaborations and Partnerships
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Browse over XX market data Figures and spread through XX Pages and an in-depth TOC on " India Medical Devices Market.” - https://www.techsciresearch.com/report/india-medical-devices-market/8161.html
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Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
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Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
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Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
Ensure the highest quality care for your patients with Cardiac Registry Support's cancer registry services. We support accreditation efforts and quality improvement initiatives, allowing you to benchmark performance and demonstrate adherence to best practices. Confidence starts with data. Partner with Cardiac Registry Support. For more details visit https://cardiacregistrysupport.com/cancer-registry-services/
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Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
10. • Investigations-
1.urine phosphorus excretion(renal excretion >100mg
by 24 hour urine collection or a fractional excretion of
phosphate >5% during hypophosphatemia indicates
renal loss)
2.vitamin d estimation
3.intact PTH
11. • Treatment
1.Acute moderate(1.0-2.5 mg/dl)-
no specific treatment if asymptomatic, treat underlying
cause
2.Acute severe(<1.0 mg/dl)-
iv phosphate therapy(potassium phosphate, sodium
phosphate)
13. Hypermagnesemia
• Serum magnesium >2.2 mEq/L
• Causes-
1.Iatrogenic(large doses of magnesium containing
antacids or laxatives, during treatment of pre-eclampsia
with i.v magnesium, therapeutic doses of antacids in
renal insufficiency)
2.ESRD
16. • Clinical features
-Signs and symptoms when magnesium level >4mEq/l
1.Neuromuscular abnormalities-
-hyporeflexia(1st sign)
-lethargy and weakness
-progression to paralysis, diaphragmatic involvement,
leading to respiratory failure
20. Hypomagnesemia
• Serum magnesium less than 1.46 mg/dL)
• Hypomagnesemia can be attributed to chronic
disease, alcohol use disorder, gastrointestinal losses,
renal losses, and other conditions. Signs and
symptoms of hypomagnesemia include anything
from mild tremors and generalized weakness to
cardiac ischemia and death
21. • Causes
1.Hypomagnesemia can be secondary to
decreased intake, as seen in:
-Startvation
-Alcohol use disorder
-Critically ill patients who are receiving total
parenteral nutrition
22. 2.It also can be secondary to the following medications:
-Loop and thiazide diuretics
-Proton pump inhibitors
-Aminoglycoside antibiotics
-Amphotericin B
-Digitalis
-Chemotherapeutic drugs, such as cisplatin,
cyclosporine
23. 3.Hypomagnesemia can be induced by gastrointestinal
and/or renal losses,
-Acute diarrhea
-Chronic diarrhea
-Hungry bone syndrome
24. -Acute pancreatitis
-Gastric bypass surgery
-Inherited tubular disorders (Gitelman
syndrome, Bartter syndrome)
-Familial hypomagnesemia with hypercalciuria
and nephrocalcinosis
26. 2. Cardiovascular Manifestations
-Electrocardiogram changes, including widening of the
QRS complex, peaked T waves, prolongation of the PR
interval
-Atrial and ventricular premature systoles
-Atrial fibrillation
-Ventricular arrhythmias
-Cardiac ischemia
27. 3.Other Electrolyte and Hormone Abnormalities
-Hypocalcemia
-Hypoparathyroidism
-Hypokalemia
29. • Treatment
-If a patient is hemodynamically unstable in an acute
hospital setting, 1 to 2 grams of magnesium sulfate can
be given in about 15 minutes.
-For symptomatic, severe hypomagnesemia in a stable
patient, 1 to 2 grams of magnesium sulfate can be
given over one hour.
30. -Non-emergent repletion of the adult patient is
generally 4 to 8 grams of magnesium sulfate given
slowly over 12 to 24 hours. In pediatric patients, the
dose is 25 to 50 mg/kg (with a maximum of 2 grams).
-For an asymptomatic patient who is not hospitalized
and can tolerate medications by mouth, sustained-
release oral replacement should be tried first
31. HYPERTENSION
• Hypertension is defined as the presence of blood
pressure elevation to a level that places patients at
increased risk for target organ damage in several
vascular beds including the retina, brain, kidneys and
large conduit arteries.
• Stage 1 hypertension(SBP 130-139 or DBP 80-
89mmhg)
• Stage 2(SBP >140 or DBP>90)
32. • Hypertensive urgencies-DBP >120mmhg,warrant bp
reduction within several hours. Associated with
hypertension with optic disc edema, progressive
end-organ complications rather than damage.
• Hypertensive emergencies include accelerated
hypertension, SBP >180mmhg, DBP>120mmhg
presenting with headaches, blurred vision or focal
neurological symptoms and malignant
hypertension(requires presence of pappiloedema)
33. *Hypertensive emergencies requires immediate bp
reduction by 20-25% over first hour to prevent or
minimize end organ damage
• Resistant hypertension-B.p >130/80 mmhg in
hypertensive patient on >3 antihypertensives agents
one of which is diuretic or controlled b.p on >4
antihypertensives.
34. RENAL PHYSIOLOGY
• MAJOR FUNCTIONS OF THE KIDNEY
Regulation of body fluid volume
Regulation of osmotic balance
Regulation of electrolyte composition
Regulation of acid-base balance
Regulation of blood pressure
Erythropoiesis
Excretion of waste products and
Foreign substances
36. • QUANTITIES OF SOLUTE FILTERED AND EXCRETED
Plasma conc. Of solutes & Percent reabsorbed
Na 140 ,99+
Cl 105 ,99+
HCO3 25 99+
K 4 86+
Glucose 5 100%
Urea 5 60%
37. • The main role of the kidneys is to filter the circulating
blood in order to remove from the body waste
products acquired through direct ingestion or
resulting from catabolism of the organism. The
removal of these products is meant to avoid their
accumulation to toxic levels
38. • A second critical role of the kidneys is to regulate and
try to maintain within normal levels the extracellular
fluid, circulating blood volume and, as a
consequence, the blood pressure. This is achieved by
regulating the volume of electrolytes and fluid which
is excreted in urine and also through the production
and release of enzymes by the rennin angiotensin
system, leading to the production of vasoactive
compounds.
39. • The kidney also has an endocrine role which
contributes to several rather important physiological
activities. It contributes to the regulation of red
blood cell through production or erythropoietin.
40. • Regulates diuresis through increased renal blood
flow as a result of production of urodilatin and,
calcium absorption through conversion of 25-
hydroxycholecalciferol to 1,25-
dihydroxycholecalciferol, the active form of Vitamin
D3. The kidneys also secrete renin, an enzyme
involved in the production of angiotensin II, leading
to synthesis and release of aldosterone
41. • The final role attributed to the kidney is in
gluconeogenesis. Tubular cells of the kidney are
capable of using amino acids from circulation to
make glucose and export it to circulation as the liver
does. The main difference appears to be that liver
operates more in a circadian rhythm according to
food intake, while kidneys produce a continuous
supply of glucose
42. RENAL BLOOD SUPPLY
• The kidney is irrigated through the renal
artery which branches of the abdominal aorta.
The renal artery enters through the hilus of
the kidney into the renal sinus and divides into
several segmental arteries which in turn give
rise to the interlobar and arcuate arteries
43. • These travel through the renal column towards the
cortex of the kidney and upon reaching the base of
the pyramids they follow the base projecting
interlobular arteries towards the cortex and these, in
turn divide into the afferent arterioles that brings
blood to each glomerulus forming the glomerular
capillaries within each renal corpuscle.
44. • Exiting the renal corpuscle the glomerular capillaries
coalesce into the efferent arteriole which, intimately
associated with each nephron, form a plexus named
peritubular capillaries in close apposition with the
proximal and distal convoluted tubules of each
nephron. The peritubular capillaries then travel into
the medulla where it becomes the vasa recta which
are in close contact with the loop of Henle of the
juxtamedullary nephrons.
45. • Finally, the vasa recta join and become the
interlobular vein leaving the cortex into the arcuate
vein.
• Several arcuate veins form the interlobar vein which
travels through the renal column towards the renal
vein.
• This in turn leaves the kidney through the renal sinus
and joins general circulation through a connexion to
the inferior vena cava
46. URINE ANALYSIS
• Urine analysis involves assessment of urine
characteristics to aid in disease diagnosis and
consists of physical observation, chemical, and
microscopic analysis.
47. • Physical observation involves assessing color and
clarity. The normal color of urine is straw colored in
the presence of dehydration urine is a darker color.
Red urine may indicate hematuria or porphyria or
represent the dietary intake of food like beets.
Cloudy urine may be seen in the presence of pyuria
due to urinary tract infection.
48. • Specific gravity is an indicator of renal concentrating
ability may be measured using refractometry or
chemically by use of urine dipstick. The physiologic
range for specific gravity is 1.003 to 1.030 and is
increased with concentrated urine and decreased
with dilute urine.
49. • Urine dipstick provides qualitative analysis of
different analytes in urine using chemical analysis.
• Dipstick uses dry chemistry methods to detect for
the presence of protein, glucose, blood, ketones,
bilirubin, urobilinogen, nitrite, and leukocyte
esterase. These may be performed as a point-of-care
test near a patient. The color changes following
interaction of the urine with the chemical reagents
impregnated on the paper of the dipstick are
compared to the color chart guide to interpret the
results.
50. • In normal urine RBC per high-power field is between
0 to 3 and white blood cells (WBC) between 0 to 5.
Ketones are present in fasting, severe vomiting, or
diabetic ketoacidosis. Urine dipstick only detects
acetoacetate and acetone, not the ketone beta-
hydroxybutyrate..
51. • Bilirubin is detected in the presence of conjugated
hyperbilirubinemia, urobilinogen may normally be
present but is absent in conjugated
hyperbilirubinemia and increased in the presence of
prehepatic jaundice and hemolysis. Nitrite and
leucocyte esterase are indicators of urinary tract
infection. Some bacteria, for example,
Enterobacteriaceae, convert nitrates to nitrites
52. • The microscopic analysis involves wet-prep analysis
of urine to assess in the presence of cells, casts, and
crystals as well as micro-organisms. Red blood casts
usually denote glomerulonephritis while white blood
cell casts are consistent with pyelonephritis.
Presence of white blood cells and WBC casts
indicates infection; red blood cells indicate renal
injury; RBC casts indicate tubular damage or
glomerulonephritis. Hyaline casts consist of protein
and may occur in glomerular disease.
53. • Crystals may also be identified in urine and are
indicative of the following conditions:
-Triple phosphate in pseudogout.
-Uric acid crystals associated with gout.
-Oxalate crystals in ethylene glycol poisoning or primary
and secondary hyperoxaluria.
-Cystine in cystinuria.
54. • The best specimen for urine analysis is a freshly
voided midstream urine. Midstream urine is utilized
as it is less likely to be contaminated by commensal
bacteria and epithelial cells.
55. • Albuminuria and Proteinuria
• Albuminuria is used as a marker for detection of
incipient nephropathy in diabetics; it is an
independent marker for the cardiovascular
disease since it connected increased endothelial
permeability and is also a marker of chronic renal
impairment. Urine albumin may be measured in
24-hour urine collections or early
morning/random specimens as an
albumin/creatinine ratio.
56. • Presence of albuminuria on two occasions with the
exclusion of a urinary infection indicates glomerular
dysfunction. The presence of albuminuria for 3 or
more months is indicative of chronic kidney disease.
57. • Frank proteinuria is defined as greater than 300 mg
per day of protein. Normal urine protein up to 150
mg per day (30% albumin; 30% globulins; 40% Tamm
Horsfall protein). Increased amounts of protein in
urine may be due to:
-Glomerular proteinuria: Caused by defects in perm
selectivity of the glomerular filtration barrier to plasma
proteins (for example, glomerulonephritis or nephrotic
syndrome)
-Tubular proteinuria: Caused by incomplete tubular
reabsorption of proteins (for example, interstitial
nephritis)
58. • Overflow proteinuria: Caused by increased plasma
concentration of proteins (for example, multiple
myeloma-Bence Jones protein,
myoglobinuria),Urinary tract inflammation or tumor
• Urine protein may be measured using either a 24-
hour urine collection or random urine protein:
creatinine ratio (early morning sample preferred and
more representative of the 24-hour sample).
59. RENAL BIOCHEMISTRY
• There are a number of clinical laboratory tests
that are useful in investigating and evaluating
kidney function. Clinically, the most practical
tests to assess renal function is to get an
estimate of the glomerular filtration rate (GFR)
and to check for proteinuria (albuminuria).
60. • Glomerular Filtration Rate
-The best overall indicator of the glomerular function is
the glomerular filtration rate (GFR). The normal GFR for
an adult male is 90 to 120 mL per minute. GFR is the
rate in milliliters per minutes at which substances in
plasma are filtered through the glomerulus, in other
words, the clearance of a substance from the blood.
61. The characteristics of an ideal marker of GFR are as
follows:
-It should appear endogenously in the plasma at a
constant rate
-It should be freely filtered at the glomerulus
-It can be neither reabsorbed nor secreted by the renal
tubule
-It should not undergo extrarenal elimination.
62. • Creatinine
-The most commonly used endogenous marker for
assessment of glomerular function is creatinine. The
calculated clearance of creatinine is used to provide an
indicator of GFR. This involves the collection of urine
over a 24-hour period or preferably over an accurately
timed period of 5 to 8 hours since 24-hour collections
are notoriously unreliable.
63. • Creatinine clearance is then calculated using the
equation:
C = (U x V) / P
C = clearance, U = urinary concentration, V = urinary
flow rate (volume/time ie ml/min), and P = plasma
concentration
64. • Creatinine is the by-product of creatine phosphate in
muscle, and it is produced at a constant rate by the
body. For the most part, creatinine is cleared from
the blood entirely by the kidney. Decreased
clearance by kidney results in an increased blood
creatinine. The amount of creatinine produced per
day depends on muscle bulk, and thus, there is a
difference in creatinine ranges between males and
females with lower creatinine values in children and
those with decreased muscle bulk..
65. • Diet also influences creatinine values. Creatinine can
change as much as 30% after ingestion of red meat.
As GFR increases in pregnancy lower creatinine
values are found in pregnancy. Additionally, serum
creatinine is a later indicator of renal impairment-
renal function is decreased by 50% before a rise in
serum creatinine is observed
66. • Serum creatinine is also utilized in GFR estimating
equations such as the Modified Diet in Renal Disease
(MDRD) and the CKD-EPI equation. These eGFR
equations are superior to serum creatinine alone
since they include race, age, and gender variables.
GFR is classified into the following stages based on
the kidney disease.
67. • Improving Global Outcomes (KDIGO) stages of
chronic kidney disease (CKD):
-Stage 1 GFR greater than 90 ml/min/1.73 m
-Stage 2 GFR-between 60 to 89 ml/min/1.73 m
-Stage 3a GFR 45 to 59 ml/min/1.73 m
-Stage 3b GFR 30 to 44 ml/min/1.73 m
-Stage 4 GFR of 15 to 29 ml/min/1.73 m
-Stage 5-GFR less than 15 ml/min/1.73 m (ESRD)
68. • Blood Urea Nitrogen (BUN)
-BUN is a nitrogen-containing compound formed in the
liver as the end product or protein metabolism and
urea cycle. About 85% of urea is eliminated via kidneys;
the rest is excreted via the gastrointestinal (GI) tract.
Serum urea is increased in acute and chronic renal
failure/impairment). Urea may also increase in other
conditions not related to renal diseases such as upper
GI bleeding, dehydration, catabolic states, and high
protein diets. Urea may be decreased in starvation,
low-protein diet, and severe liver disease.
-
69. • The ratio of BUN:Creatinine can be useful to
differentiate prerenal from renal causes when the
BUN is increased. In pre-renal disease the ratio is
close to 20:1, while in intrinsic renal disease it is
closer to 10:1.
• Cystatin C
-Cystatin C is a low-molecular-weight protein which
functions as a protease inhibitor produced by all
nucleated cells in the body. Serum levels of cystatin C
are inversely correlated with the glomerular filtration
rate (GFR). Cystatin C is measured in serum and urine.
The advantages of cystatin C over creatinine are that it
is not affected by age, muscle bulk, or diet.
70. • Tests of Tubular Function
-The renal tubules play an important role in
reabsorption of electrolytes, water, and maintaining
acid-base balance. Electrolytes, sodium, potassium,
chloride, magnesium, phosphate can be measured in
urine as well as glucose. Measurement of urine
osmolality allows for assessment of concentrating
ability of urine tubules. A urinary osmolality greater
than 750 mOsmol/Kg H2O implies a normal
concentrating ability of tubules.
71. RENAL RADIOIMAGING
• PLAIN X-RAY
-Radiographic features
length should not be less than three vertebral body
lengths, and no more than four vertebral body
lengths 10.
• CT
-on unenhanced CT, the renal pyramids can appear
hyperdense
72. • Ultrasound
-Antenatally, fetal kidneys show varying texture
depending on gestational age. It is echogenic in the first
trimester, with decreasing echogenicity as the
pregnancy progresses. Corticomedullary differentiation
can be appreciated after 15 weeks of gestation but
clear demarcation between cortex and medulla can be
seen at 20 weeks. Renal echogenicity decreases
compared to liver
73. -Normal kidney appearance in adult :
• cortex is less echogenic than the liver
• medullary pyramids are slightly less echogenic than the cortex
• cortex thickness equals/is more than 6 mm
• if the pyramids are difficult to differentiate, the parenchymal
thickness can be measured instead and should be 15-20 mm
• central renal sinus, consisting of the calyces, renal pelvis and fat, is
more echogenic than the cortex
• renal pelvis may appear as a central slit of anechoic fluid at the
hilum
• normal ureters are generally not well seen on ultrasound
74. APPLIED ANATOMY OF NECK
• The neck is limited superiorly by the inferior border
of the mandible, anteriorly by midline, inferiorly by
the superior border of the clavicle, and posteriorly by
the anterior margin of the trapezius muscle. Many of
the reported anatomical triangles of the neck have
been depicted and mainly classified within the
broader anterior and posterior cervical triangles .
75. • The neck also contains such triangles as the
suboccipital triangle in the posterior aspect of the
neck, the triangle of the vertebral artery and scalene
triangle in deep layer of the neck, Lesser's, Pirogov's,
Béclard's, and Farabeuf's triangles . These anatomical
triangles contain nerves, vessels, and other
anatomical structures.
76.
77. • Anterior Triangle of the Neck
-The anterior cervical triangle is bounded by the
midline of the neck, the anterior border of the
sternocleidomastoid muscle (SCM), and the inferior
border of the mandible [3]. This triangle is typically
subdivided into three paired and one unpaired triangle.
The three paired triangles are the submandibular
(digastric), carotid, and muscular triangles. The
unpaired triangle is the submental triangle.
78. • Submandibular (digastric) triangle
-The anterior and posterior borders of the submandibular
triangle are the anterior and posterior bellies of the
digastric muscle, respectively, and the base is the inferior
border of the mandible. The floor of this triangle is formed
by the mylohyoid muscle. The attachment of the mylohyoid
muscle onto the mandible is more inferiorly in the anterior
region and more superiorly in the posterior region of the
triangle. For this reason, odontogenic inflammation caused
by lower molar tooth infection, especially the wisdom
teeth, could easily spread below the mylohyoid muscle into
the submandibular space.
79. • This triangle usually contains the marginal
mandibular branch of the facial nerve (MMB), the
facial and lingual arteries and veins, the
submandibular gland and lymph nodes, the nerve to
the mylohyoid, the hypoglossal nerve, and the lower
pole of the parotid gland. The submandibular
incision to access to this triangle, e.g., abscess
drainage and submandibulectomy, should be inferior
to the MMB.
80.
81. • Lesser's triangle
-It is bounded by the anterior and posterior bellies of
the digastric muscle and the hypoglossal nerve.The
most important structure in it is the lingual artery. The
floor of Lesser's triangle is the hyoglossus muscle, and
the lingual artery is found beneath it.It is an ideal
location for accessing the lingual artery, especially to
control severe hemorrhage in the oral floor when it is
injured . The lingual foramen is where the sublingual or
submental artery enters the mandible.
82. • Carotid triangle
-The carotid triangle is bordered by the posterior belly
of the digastric muscle, the superior belly of the
omohyoid muscle, and the anterior border of the SCM.
The floor and medial wall of this triangle is formed by
the hyoglossus, thyrohyoid, and inferior and middle
pharyngeal constrictor muscles. In the normal position,
the inferior border of this triangle reaches the level of
the carotid tubercle (anterior tubercle of the transverse
process of the C6).
83. -The carotid triangle includes the common carotid
artery and its bifurcation into the external carotid
artery (ECA) and internal carotid artery (ICA). It usually
contains the superior thyroid, lingual, facial, occipital,
and ascending pharyngeal arteries. The superior
thyroid, lingual, facial, ascending pharyngeal, and
occipital veins accompany with these arteries, and all of
them drain into the internal jugular vein (IJV). The
hypoglossal nerve travels across the ECA and ICA. The
external and internal branches of the superior laryngeal
nerve arising from the vagus nerve can be identified
medial to the ECA below the hyoid bone.
84. • Farabeuf's triangle
-Within the carotid triangle. The boundaries of this
triangle are the IJV, the common facial vein, and the
hypoglossal nerve and direct its base superiorly. This
triangle was constantly located within the carotid
triangle and included at least one of the branches of
the common carotid artery. The carotid bifurcation was
contained within this triangle on two sides.This triangle
is a helpful landmark in extensive dissections of the
neck, especially in locating the IJV, the safety of which
is best conserved by promptly exposing it.
85. • Posterior Triangle of the Neck
-The posterior cervical triangle is bounded by the
posterior border of the SCM anteriorly, the anterior
border of the trapezius muscle posteriorly, and middle
one-third of the clavicle inferiorly. Its floor is covered
with the prevertebral layer of the deep cervical fascia.
86. • The posterior cervical triangle is subdivided into
occipital and supraclavicular (subclavian or
omoclavicular) triangles by the omohyoid muscle. It
contains the accessory lymph nodes, the inferior deep
lymph nodes, the transverse cervical lymph nodes, the
suprascapular artery, the subclavian artery, the
external jugular vein (EJV), the accessory nerve, great
auricular nerve, transverse cervical nerve,
supraclavicular nerve, the inferior belly of the
omohyoid, and branches of the thyrocervical trunk. It
also includes branches to the levator scapulae, serratus
anterior and rhomboid muscles.
87. • Supraclavicular triangle
-The supraclavicular triangle is a clinically important
anatomical area. Diseases of the vessels and lymph nodes
located in it cause various clinical syndromes. This triangle is
the anterior division of the posterior cervical triangle. The
anterior and inferior borders are the same as those of the
posterior cervical triangle, but the superior border is the
inferior belly of the omohyoid. It corresponds to the
supraclavicular fossa, which is immediately above the
clavicle.It is bounded by the superficial and deep fasciae and
the platysma muscle, and the supraclavicular nerves travel
across it.
88. • It mainly contains the subclavian artery and vein, and
the brachial plexus. The trunks of the brachial plexus
and the subclavian artery can be palpated with an
examining finger. The suprascapular vessels and
dorsal scapular artery run transversely across the
triangle. The EJV runs behind the posterior border of
the SCM to end in the subclavian vein.
89. APPLIED ANATOMY OF FEMORAL
TRIANGLE
• The femoral triangle is a hollow area in the anterior
thigh. Many large neurovascular structures pass
through this area, and can be accessed relatively
easily. Thus, it is an area of both anatomical and
clinical importance.
90. • Borders
-Superior border – Formed by the inguinal ligament, a
ligament that runs from the anterior superior iliac spine
to the pubic tubercle.
-Lateral border – Formed by the medial border of the
sartorius muscle.
-Medial border – Formed by the medial border of the
adductor longus muscle. The rest of this muscle forms
part of the floor of the triangle.
91. • Floor and a roof:
-Anteriorly, the roof of the femoral triangle is formed
by the fascia lata.
-Posteriorly, the base of the femoral triangle is formed
by the pectineus, iliopsoas and adductor longus
muscles.
-The inguinal ligament acts as a flexor retinaculum,
supporting the contents of the femoral triangle during
flexion at the hip.
92.
93. • Contents (lateral to medial):
-Femoral nerve – Innervates the anterior compartment
of the thigh, and provides sensory branches for the leg
and foot.
-Femoral artery – Responsible for the majority of the
arterial supply to the lower limb.
-Femoral vein – The great saphenous vein drains into
the femoral vein within the triangle.
-Femoral canal – A structure which contains deep
lymph nodes and vessels.
94. • Clinical Relevance: The Femoral Triangle
1.Access to the Femoral Artery
-The femoral artery is located superficially within the
femoral triangle, and is thus easy to access. This makes
it suitable for a range of clinical procedures such as
coronary angiography
2.Access to the femoral vein
-The femoral vein is located medial to femoral artery,
and is used for femoral catheterisation for dialysis.
97. • The arterial supply to the upper limb is delivered via
five main vessels (proximal to distal):
-Subclavian artery
-Axillary artery
-Brachial artery
-Radial artery
-Ulnar artery
98.
99. • Clinical Relevance: Axillary Artery Aneurysm
-An axillary artery aneurysm is a dilation of the vessel to more
than twice its original size. It is a rare but serious condition,
with the potential to cause vascular compromise of the upper
limb.
-The dilated portion of the axillary artery can compress the
brachial plexus, producing neurological symptoms such as
paraesthesia and muscle weakness.
-The definitive treatment of an axillary artery aneurysm is
surgical. It involves excising the aneurysm and reconstructing
the vessel wall using a vascular graft.
100. • Clinical Relevance: Occlusion or Laceration of
the Brachial Artery
-If the artery is completely occluded (or
severed), the resulting ischaemia can cause
necrosis of forearm muscles. Muscle fibres are
replaced by scar tissue and shorten considerably
– this can cause a characteristic flexion
deformity, called Volkmann’s ischaemic
contracture.
101.
102. DIET IN AKI
• Diet to be planned according ti phase of aki
• In oliguric phase –salt,potassium, fluids and proteins
are restricted and calories supplied mainly from
carbohydrates and fats
• In diuretic phase-fluid 300-500 ml more than urine
output. Sodium and potassium supplementation may
be required
103. • Calories-30kcal/kg body weight
• Proteins-0.5/0.6 g/kg(60% of high biological
value)
• Fluids-oliguric-urine output + 500ml,daily
weight loss of 0.2-0.3 kg in oliguric patient
104. • Sodium-signs of fluid overload, salt free diet,
diuretic phase salt intake liberalised
• Potassium-restriction in oliguric phase
105. DIET IN CKD
• Calories-30 kcal/day, 85% from
carbohydrates,10% from fats and 5% from
proteins
• Proteins-0.5-0.6g/kg/day(can be increased in
patient of dialysis)
• Sodium-if odema-upto 3g/day, if no
hypertension,odema-6 gm/day
106. • Calcium and phosphorus-dietary phosphate
binders calcium carbonate often prescribed
107. Diet in nephrotic syndrome
• Calories-30-40 kcal/kg
• Protein-1.5g/kg/day
• Fluid –if oedema restriction to equal to urine
output
• Salt-2-3 gm/day