Flashcards in Genitourinary Deck (378)
What happens to JVP in fluid overload?
becomes more visible and increases
What should be done for fluid management?
fluid input and output chart, weight and stool chart, oral fluid if able, IV if unable
What are the two types of IV fluid?
crystalloid and colloid
What is crystalloid fluid?
small molecules pass through cell membrane form intravascular to extravascular, if fluid contains salt, it stays in intravascular space a bit longer than 5% dextrose e.g. isotonic solutions
What is colloid fluid?
large molecules which do not pass through cell membrane, remains in intravascular compartment and expands the intravascular volume through higher oncotic pressure
What patients are at risk of hypovolaemia?
elderly, ileostomy, short bowel syndrome, bowel obstruction
What patients are at risk of hypervolaemia?
CKD, heart failure, liver failure
What is euvolaemia?
no signs or symptoms of hypo or hypervolaemia
How to treat a rise in creatinine?
reduce diuretics or relax fluid restriction
What are the 3 methods of renal replacement therapy?
haemodialysis, peitoneal dialysis, transplant
How does haemodialysis work?
exchange out side the body, it is removed for cleansing, dialysed then returned to the body via and AV fistula
What is an AV fistula?
joining of an artery to a vein to provide permanent and easy access for insertion of needle with good blood flow, 2 needles, one to add and one to remove
How long does it take for an AV fistula to be mature?
pressure from the artery makes the vein bigger, taking 4-8 weeks
How is haemodialysis used in urgent situations?
on right atrium and one other side of chest, using a cuffed haemodialysis catheter
How often is haemodialysis done?
in hospital 4hrs 3x a week or 2-3hrs 4-5x a week at home
What drug is also given during haemodialysis?
heparin as an anticoagulant as foreign bodies would activate the clotting cascade
Side effects of haemodialysis?
hypotension from excessive extracellular fluid removal, cramps, nausea, headache, chest pain, fever, rigors
What are the potential risks in haemodialysis?
blocked dialysis or catheter, infection, fistula aneurym, removal too fast, amyloidosis
What is peritoneal dialysis?
uses the peritoneum as a membrane to exchange fluids and solutes in the blood in the lower abdomen, waste products move down conc gradient into dialysis fluid
What type of catheter is used in peritoneal dialysis?
What is the difference between continuous ambulatory peritoneal dialysis (CAPD) and APD?
capd - done every 3-4 hours for about 30 minutes
apd - done at night
When would peritoneal dialysis be the preferred choice?
young, full time work, want control and responsibility, severe HF
When would haemodialysis be the preferred option?
live alone, frail, elderly, scared of operating machienes, previous abdominal surgery, hernia, lack of space at home
Long term complications of dialysis?
CV disease, sepsis, peritonitis, amyloidosis
Why is amyloidosis caused by dialysis?
accuulation and polymerisation of B2 microglobulin as it is not excreted by the kidney but not dialysis
Benefits of renal transplant?
increased survival over dialysis (80% at 10yr)
can get pregnant
increased QoL, can go abroad
Treatment of stage 5 CKD?
Which is better, living or deceased donor and why?
living as increases survival and graft half life, reduces mortality by CV, infection, malignancy, treatment withdrawal
Surgical complications of renal transplant?
bleeding, infection, blood clot in renal artery, need immuno suppression