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jaz_walker
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Indications for dialysis
AEIOU: Acidosis, Electrolyte abnormalities, Intoxication (lithium, salicism, methanol), Overload, Uraemia
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Lifestyle modifications in chronic renal failure
Reduce fluid intake, potassium restriction, phosphate restriction
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What catheter for peritoneal dialysis?
Tenckhoff catheter
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What types of peritoneal dialysis exist?
Continuous ambulatory peritoneal dialysis, automated peritoneal dialysis
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How does haemofiltration differ from haemodialysis?
Haemofiltration involves filtering blood through a high pressure column, as opposed to haemodialysis which is a countercurrent system.
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complications of dialysis
Common non-severe: headache, itching, cramps. Disequilibrium syndrome (cerebral oedema), hypotension, hyperkalaemia, fluid balance.
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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
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How long does it take for an AV fistula to mature?
4-6 weeks
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what are the complications of an AV fistula?
1. thrombosis 2. venous stenosis, 3. aneurysm, 4. infections 5. steal syndrome
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special instructions for AV fistulae patients
Do not let anyone take blood from or cannulate a fistula arm
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What are alternative methods of performing haemodialysis?
1. CVC (tunnelled or non tunnelled) 2. PD 3. Vascath (haemofiltration)
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What are the advantages of an AV fistula?
low re-circulation rate, lower infection rate than in situ CVA, efficient dialysis, lower thrombosis rate
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What are the contraindications to peritoneal dialysis?
Peritoneal adhesions, stoma, hernia
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What are the complications of peritoneal dialysis?
peritonitis, site infection, constipation, pleural effusions
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What are the advantages of peritoneal dialysis?
Can be done at home, easier to go on holiday abroad
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What are the commonest causes of ESRF?
diabetes, ADPCKD, hypertension, glomerulonephritis
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What are contraindicatinos for renal transplant?
Cardiopulmonary insufficiency, hepatic disease, cancer, active infection
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What scar is associated with renal transplant?
Rutherford Morrison scar
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Which vessels are the transplant kidney attached into?
External iliac vein, external iliac arter
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postoperative immunosuppression after renal transplant
steroids, azathioprine, ciclosporin (or tacrolimus)
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Complications of renal transplantation
Rejection (hyperacute, acute, chronic), immunosuppression (infection, EBV mediated lymphoproliferation), other (UTIs, kidney thrombosis)
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Prognosis
Lasts 10-15 years, affected by donor type and age. Live 10-15 years longer than if on dialysis
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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)
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Splenomegaly
infiltration (leukaemia, lymphoma, myeloproliferation), increased function (extravascular haemolysis, extramedullary haematopoiesis, infection), Vascular congestion (cirrhosis, splenic vein obstruction, hepatic vein obstruction)
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Causes of hepatosplenomegaly
infection (hepatitis, malaria), infiltration(myeloproliferative disorders), portal hypertension, infiltration (amyloidosis, sarcoidosis)
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What is a loop colostomy?
two holes made in central large bowel and brough to the surface to protect a distal anastamosis.
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what is a barrel colostomy?
when both ends of a resected segment are brought to the surface to form a stoma.
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what is the indication for an iliostomy?
whole colon has been removed e.g. UC, FAP, Hirschsprung's disease
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What is the indication for a urostomy?
Cystectomy for bladder cancer.
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Early complications of a stoma
Early: high output stoma causing dehydration and hypokalaemia, retraction, bowel obstruction, ischaemia of stoma.
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Late complications of a stoma
parastomal hernia, prolapse, fistulae, psychological, skin dermatitis, fistulae.
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Stoma care
stoma nurse, empty when 2/3 full, daily irrigation, change every 2-4 days, diet, wear in shower
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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).
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what is the location fo the inguinal ligament?
ASIS to pubic tubercle
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What are the contents of the inguinal canal in males?
spermatic cord (vas deferens, testicular artery, testicular nerves, pampiniform plexus, lymph vessels), ilioinguinal nerve
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What are the contents of the inguinal canal in females?
round ligament of uterus, ilioinguinal nerve.
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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)
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what is the location of the mid-inguinal point?
halfway between ASIS to pubic symphysis = femoral artery
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midpoint of the inguinal ligament
midpoint between ASIS to pubic tubercle = deep inguinal ring
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Where is the deep inguinal ring?
midpoint of inguinal ligament
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Where is the superficial inguinal ring?
just superior and medial to pubic tubercle
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Which is commoner, direct or indirect hernias?
indirect (60%), direct (40%)
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where is a femoral hernia located?
below and lateral to pubic tubercle
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where is a direct inguinal hernia located?
above and emdial to pubic tubecle
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where is an indirect inguinal hernia located?
anywhere between deep inguinal ring and scrotum
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