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Health and Society Year 3 > Metabolic > Flashcards

Metabolic Flashcards

1
Q

Prevention of AKI

A

Maintain perfusion
Correct hypovolaemia, cardiac output and blood pressire
Glycaemic control
Avoid nephrotoxic drugs

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2
Q

How often does a patient require hamodialysis

A

3 days a week

4 hours each session

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3
Q

Advantages and disadvantages of haemodialysis

A

Adv: treatment free days
Disadv: timely and costly travel, restrict fod and drinks

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4
Q

Explain how peritoneal dialysis works

A

Continuous Ambulatory Peritoneal Dialysis (CAPD): Portable but 2h a day dialysing (30-40 mins 4x a day)
Automated Peritoneal Dialysis (APD): Overnight

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5
Q

Advantages and disadvantages of peritoneal dialysis

A

Adv: easily at home, portable, fewer food restrictions
Disadv: risk of peritonitis, low protein/malnutrition

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6
Q

General advantages and disadvantages of dialusis

A

Adv: Life saving, relief from oneliness, can still exercise, swim and go on holiday
Disadv: depression, dependence on hospital, time consuming, impact social life, sie effects

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7
Q

Effects of incontinence

A

Stigma, distress, embarrassment, inconvenience, self-esteem , quality of life
Increases morbidity, depression and institutionalisation

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8
Q

Where are transplant patients registered

A

UK national transplant database

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9
Q

Who determines allocation

A

Medical professionals, DoH, advisory groups

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10
Q

Which transplants are urgent

A

Heart and liver

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11
Q

What is the allocation based of?

A

Tissue match (ABO/HLA) and number of points (length of time on list and age)

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12
Q

Types of donation

A 
Cadaveric (brain death or cardiac death)
Live donor (related or unrelated)

Brain death common then living then cardiac least common

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13
Q

What is the role of an independent assessor

A

Independent of transplant team
Sees donor and recipient
Ensures no coercion or compensation
Ensures donor is informed, has capacity, explores relationship

Licensed by the human tissue authority

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14
Q

Factors that affect the choice to transplant

A

Availability of organ
Waiting lists
Other recipients
Compliance with anti-rejection medication
Likelihood of organ abuse and effective transplantation

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15
Q

Adverse effects of organ donation

A

Organ rejection
Non-compliance with medication
Patients continue to drink/take drugs

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16
Q

What is the role of the Human Tissue Act

A

Regulates the removal, storage and use of human tissue

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17
Q

Define DNA theft

A

It is unlawful to have human tissue with the intention of DNA being analysed without consent from the donor

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18
Q

Offences under the human tissue act 2004

A

Removing, storing and using human tissue for purposes without consent or for another purpose than specified
Trafficking in human tissue
DNA theft
No license

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19
Q

Who cannot become an organ donor

A

Active cancer, HIV, Hep C

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20
Q

What system does the UK currently have

A

Opt out from spring 2020

The family will be approached before the donation and their decisions respected

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21
Q

Groups excluded from UKs opt out system

A

Under 18
Lack mental capacity to understand new arrangement
Visitors to england
Living in england less than 12 months

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22
Q

Organ donation in children under 18 years

A

The family will be asked to make a decision and provide consent
If a child wants to donate, parents must consent

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23
Q

What can individuals do if they want to donate but their family are against it

A

Nominate two representatives to be asked for you

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24
Q

How can an individual indicate their willingness to donate

A

Making wishes known to family and friends

Carrying a donor card and registering on the register

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25
Difference between soft and hard opt out
Soft: e.g. spain, if relative hasn't opted out then relatives can refuse Hard: e.g. australia relatives views aren't taken into account
26
Arguments for opt out system
Saves more lives at no cost to the individual (ethically correct thing to do) UK law: corpse is not considered properly but relatives wishes will be taken into account (soft) Positive stigma to donation Still a choice to opt out People might want to opt in but have never had the opportunity to
27
Arguments against the opt out system
People who believe in the afterlife may feel as though they are forfeiting access Many religions do support donation Upsetting to next of kin Stigma to opting out - people might not want to but feel ashamed to Shifts from autruistic giving organs to taking them True consent (autonomy?)
28
Define altruism
Basis of donations in the UK, any other system would make it a market system
29
Arguments for and against a market system for donation
For: supply increased if remove donors, financial rewards lower healthcare costs, donation is cost-effective, each property has rights over their own body Against: erodes sense of community, redistributes blood from poor to rich
30
Blood demand and supply
Demand drastically outweighs supply Demand for surgery and medicine Supply: 2 million donors a year, highest supply is A+/O+, lowest supply is O-ve (universal donor)
31
Risks of blood transfusion
Wrong blood type | infections
32
Contraindications for donation
Tattoo/piercing Received blood since 1994 MSM in 12 months Blood infections
33
Alternative to transplant
Dialysis - very expensive
34
What are PSA levels affected by
Levels affected by enlarged prostate, prostatitis, urine infection, exercise, ejaculation, anal sex, biopsy, medication e.g. finasteride
35
Who can get a PSA screening test
Men over 50 after talking to the GP (or over 45 with FHx)
36
Advantages of PSA
Helps to detect prostate cancer before symptoms Early treatment Save lives Screening follows utilitarian logic - gives patient an informed choice
37
Disadvantages of PSA
Normal range can still indicate cancer High range - commonly normal Biopsy can cause pain, infection Treatment can have side effects: incontinence, ED Overdiagnosis: people who are diagnosed with cancer that will never cause sx during lifetime Overtreatment: people treated unnecessarily for tumours that would unlikely be harmful
38
Diagnosis of diabetes for asymptomatic and symptomatic individuals
Symptomatic: fasting glucose 7, random or OGTT glucose 11.1 Asymptomatic: same on 2 occastions
39
HBA1c diagnostic
48 mmol/mol (6.5%)
40
When can HbA1c not be used
Haemoglobinopathies: Increased red cell turnover
41
Roles of the diabetes care team
Specialist nurse: care, support and advice, education programmes Podiatrist: screen for foot problems which impact QOL, recommend footwear, debride wounds and refer to orthoticcs Dietician: help pts make informed and practical decisions about their diet Doctors
42
What doctors are involved in diabetes care
``` Endocrinologist: complex cases Nephrologist: renal complications Ophthalmologist: diabetic retinopathy Cardiologist: CV complications Neurologist: neuropathy/strokes ```
43
Diabetes targets
BP: 140/80 (130/80 if end organ damage) HbA1c less than 7% Cholesterol less than 5%
44
First line drug for diabetes htn
ACEi
45
Complications of diabetes
Microvascular: retinopathy, nephropathy, neuropathy Macrovascular: peripheral vascular, cardio and cerebrovascular disease Other: impaired would healing and infection
46
When does nephropathy occur in diabetics
15-25 years after diagnosis
47
Initial diagnosis of diabetes
``` Enter to diabetes register Full examination CV risk factors Medication review Educate! Refer to dietician Refer to screening programmes ``` Develop personalised management plan
48
Psychological and social impact of diabetes
Increased depression Hide diagnosis Unsure how to cope - fear of complications Anxious about hypos Monitor glucose Affect insurance and driving
49
Psychosocial impact of endocrinological disease e.g. thyroid, pituitary, adrenal
Psychiatric disorders Impact mood, weight and fatigue Impact of regular medication and appointments Change in appearance e.g. eyes
50
Causes of weight gain
Calorie intake is higher than calorie expenditure ``` Genetics Hormonal Medical conditions Behaviour: unhealthy eating habits Environment: fatty foods Social: unhealthy foods are cheaper, limited transport Modernisation: convenience food Urbanisation: more transport, less exercise ```
51
BMI
Healthy: 18.5-24.9 Overweight 25-30 Obese 30+ (5 mild, mod, severe)
52
Waist circumference
Men over 94 is high | Women over 80 is high
53
Medical conditions that increase if you're overweight
``` Arthritis Cancer Carpal Tunnel Gout Surgical complications T2DM Renal disease Gallbladder and liver disease Sleep apnoea Urinary stress incontinence CVD Chronic venous insufficiency DVT/PE Stroke HTN ```
54
Assessment for obesity
``` Underlying causes Eating behaviours Comorbidities Risk asssessment (lipid, bp, HbA1c) FHx ```
55
When is referral needed
Complex disease state (e.g. learning disability) Underlying cause Surgery considered
56
Management for obesity
1. advice, lifestyle intervention, 600cal deficit for weight loss Medication: Orlistat (BMI above 30) Bariatric surgery: BMI above 40, fit for surgery and committed to LT follow up
57
4 ways to tackle obesity
Increase exercise: cheaper gyms, more cycle paths and parks Education: balanced diet Legislation: advertising and tax Schools: encourage activity and healthy dinners
58
Define impaired glucose tolerance
Blood glucose raised beyond normal levels but not enough for diabetes Blood glucose between 7.9 and 11.1 after 2h OGGT There is a long period of impaired tolerance that precedes diabetes, screening can identify these people and risk factors can be addressed There is still a high risk of developing diabetes
59
Define prediabetes
Impaired glucose levels which are above normal but not high enough for diabetes Impaired glucose tolerance or fasting glucose
60
Best method of reducing CVD risk in diabetes
Exercise and lifestyle modification is better than metformin at reducing risk
61
Goals of the diabetes prevention programme
Primary goal: to delay the development of T2DM in patients with impaired glucose tolerance Secondary goal: Reduce CV disease events and risk factors
62
Define alloimmunisation | What increases the risk of it
Blood transfusion may immunise the recipient against the donor through antigens Increased risk with repeated transfusions
63
Explain the ABO and RH blood system
ABO: IgM anti-A and anti-B antibodies RH: IgG RhD antibodies
64
How often can you give blood
Men every 12 weeks | Women every 16 weeks
65
What happens during pretransfusion compatibility testing
ABO and RH groups determined Atypical antibodies are screened Tested against 2 O donors and red cell antigens Selection of donor blood and crossmatching
66
Process of blood ordering
Elective: blood ready Emergency: Two units O- (emergency) 10-15min: blood with same ABO and RH 45min: crossmatch
67
Complications of blood transfusion
Alloimmunisation (subsequent transfusions) Haemolytic transfusion reaction (pain, rigor, sob, hypotension, hb in urine, DIC) Non-haemolytic transfusion reaction (febrile reactions) Urticaria (plasma protein incompatibility) Infection
68
Avoidance of unnecessary transfusion
Strict criteria for blood products Stop drugs that might cause bleeding in surgery Treating anaemia prior to surgery Anti-fibrinolytics CHECK that the correct product is being transferred
69
transfusion associated deaths
Death via serious hazard of transfusion (SHOT)
70
Explain the structure of blood transfusion services
NHS Blood and Transplant | Health authority within the NHS that deals with blood, platelets, stem cells, tissues and organs

Health and Society Year 3 (5 decks)

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