Renal Finals

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Renal Finals
2015-05-05 18:10:01
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  1. Indications for dialysis
    AEIOU: Acidosis, Electrolyte abnormalities, Intoxication (lithium, salicism, methanol), Overload, Uraemia
  2. Lifestyle modifications in chronic renal failure
    Reduce fluid intake, potassium restriction, phosphate restriction
  3. What catheter for peritoneal dialysis?
    Tenckhoff catheter
  4. What types of peritoneal dialysis exist?
    Continuous ambulatory peritoneal dialysis, automated peritoneal dialysis
  5. How does haemofiltration differ from haemodialysis?
    Haemofiltration involves filtering blood through a high pressure column, as opposed to haemodialysis which is a countercurrent system.
  6. complications of dialysis
    Common non-severe: headache, itching, cramps. Disequilibrium syndrome (cerebral oedema), hypotension, hyperkalaemia, fluid balance.
  7. What two special tests can be performed on AV fistulae?
    Arm elevation test (for outflow obstruction) - fistula should collapse. Augmentation test (for anastomotic stenosis) - pulsation when vein occluded
  8. How long does it take for an AV fistula to mature?
    4-6 weeks
  9. what are the complications of an AV fistula?
    1. thrombosis 2. venous stenosis, 3. aneurysm, 4. infections 5. steal syndrome
  10. special instructions for AV fistulae patients
    Do not let anyone take blood from or cannulate a fistula arm
  11. What are alternative methods of performing haemodialysis?
    1. CVC (tunnelled or non tunnelled) 2. PD 3. Vascath (haemofiltration)
  12. What are the advantages of an AV fistula?
    low re-circulation rate, lower infection rate than in situ CVA, efficient dialysis, lower thrombosis rate
  13. What are the contraindications to peritoneal dialysis?
    Peritoneal adhesions, stoma, hernia
  14. What are the complications of peritoneal dialysis?
    peritonitis, site infection, constipation, pleural effusions
  15. What are the advantages of peritoneal dialysis?
    Can be done at home, easier to go on holiday abroad
  16. What are the commonest causes of ESRF?
    diabetes, ADPCKD, hypertension, glomerulonephritis
  17. What are contraindicatinos for renal transplant?
    Cardiopulmonary insufficiency, hepatic disease, cancer, active infection
  18. What scar is associated with renal transplant?
    Rutherford Morrison scar
  19. Which vessels are the transplant kidney attached into?
    External iliac vein, external iliac arter
  20. postoperative immunosuppression after renal transplant
    steroids, azathioprine, ciclosporin (or tacrolimus)
  21. Complications of renal transplantation
    Rejection (hyperacute, acute, chronic), immunosuppression (infection, EBV mediated lymphoproliferation), other (UTIs, kidney thrombosis)
  22. Prognosis
    Lasts 10-15 years, affected by donor type and age. Live 10-15 years longer than if on dialysis
  23. Hepatomegaly causes
    Vascular (BuddChiari, RVF), Infectious (glandular fever, hepatitis, abscesses, malaria), neoplasm (mets, hcc, haem), autoimmune (sarcoid, amyloid), metabolic (ALD, haemochromatosis, NAFLD), Iatro (TB drugs), Congenital (Riedel's lobe)
  24. Splenomegaly
    infiltration (leukaemia, lymphoma, myeloproliferation), increased function (extravascular haemolysis, extramedullary haematopoiesis, infection), Vascular congestion (cirrhosis, splenic vein obstruction, hepatic vein obstruction)
  25. Causes of hepatosplenomegaly
    infection (hepatitis, malaria), infiltration(myeloproliferative disorders), portal hypertension, infiltration (amyloidosis, sarcoidosis)
  26. What is a loop colostomy?
    two holes made in central large bowel and brough to the surface to protect a distal anastamosis.
  27. what is a barrel colostomy?
    when both ends of a resected segment are brought to the surface to form a stoma.
  28. what is the indication for an iliostomy?
    whole colon has been removed e.g. UC, FAP, Hirschsprung's disease
  29. What is the indication for a urostomy?
    Cystectomy for bladder cancer.
  30. Early complications of a stoma
    Early: high output stoma causing dehydration and hypokalaemia, retraction, bowel obstruction, ischaemia of stoma.
  31. Late complications of a stoma
    parastomal hernia, prolapse, fistulae, psychological, skin dermatitis, fistulae.
  32. Stoma care
    stoma nurse, empty when 2/3 full, daily irrigation, change every 2-4 days, diet, wear in shower
  33. How should diet be changed for stoma users?
    lots of fluids. Small amounts of fibre for first 2 months. Avoid: nuts, coconut, sweetcorn, celery, broccoli, beans, fizzy drinks (blockage, flatulence).
  34. what is the location fo the inguinal ligament?
    ASIS to pubic tubercle
  35. What are the contents of the inguinal canal in males?
    spermatic cord (vas deferens, testicular artery, testicular nerves, pampiniform plexus, lymph vessels), ilioinguinal nerve
  36. What are the contents of the inguinal canal in females?
    round ligament of uterus, ilioinguinal nerve.
  37. what are the borders of the inguinal canal?
    MALT: Muscle (internal oblique, roof), Aponeurosis (external oblique, anterior), ligament (inguinal ligament, floor), tendon (transversalis fascia, posterior)
  38. what is the location of the mid-inguinal point?
    halfway between ASIS to pubic symphysis = femoral artery
  39. midpoint of the inguinal ligament
    midpoint between ASIS to pubic tubercle = deep inguinal ring
  40. Where is the deep inguinal ring?
    midpoint of inguinal ligament
  41. Where is the superficial inguinal ring?
    just superior and medial to pubic tubercle
  42. Which is commoner, direct or indirect hernias?
    indirect (60%), direct (40%)
  43. where is a femoral hernia located?
    below and lateral to pubic tubercle
  44. where is a direct inguinal hernia located?
    above and emdial to pubic tubecle
  45. where is an indirect inguinal hernia located?
    anywhere between deep inguinal ring and scrotum