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Acute renal failure Reversible Determining prognosis
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Acute renal failure Reversible Determining prognosis- kidneys respond to diuretic with good output; this indicates that kidneys are functioning well Acute Pyelonephritis Diagnosing by clinical symptoms alone can be difficult; can be similar to cystitis Diagnosis established by: -Urine culture -Urinalysis (WBC casts indicates pyelonephritis, but may not always be present) -Signs/Symptoms -Complicated pyelonephritis requires blood cultures and urinary tract imaging Renal Calculi (Renal Stones) Goals of Treatment: Manage acute pain Promote passage of stone Reduce size of stone Prevent new stone formation Chronic Renal Failure Chronic Kidney Disease (CKD) is a progressive loss of renal function associated with systemic disease such as hypertension, diabetes mellitus (most significant risk factor), systemic lupus erythematosus or intrinsic kidney disease CKD stage is determined by estimates of GFR and albuminuria Who is a candidate for dialysis? End-stage renal disease (ESRD) is the final stage of CKD with the number one cause being diabetes mellitus combined with hypertension. At this point, the patient is completely dependent on dialysis to survive. CKD is classified into five stages and is based on the patient's GFR rather than symptoms. Patients will need dialysis when the following symptoms are present: --Metabolic acidosis. --Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis. --Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). --Fluid volume overload that is not responsive to diuretics. --Uremic symptoms due to nitrogenous wastes in the blood stream. Stage I CKD There is kidney damage with normal or elevated GFR
Stage II CKD There is kidney damage with mild decrease in GFR 60- Stage III CKD There is a moderate decrease in GFR 30- Stage IV CKD There is a severe decrease in GFR 15- Stage V CKD Kidney failure- End-stage renal disease <15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as dialysis or kidney transplant Complications of Decreased GFR Anemia Hypertension Decreased calcium absorption Hyperlipidemia Heart failure Left ventricular hypertrophy Fluid volume overload Hyperkalemia Hyperparathyroidism Hyperphosphatemia Metabolic acidosis Malnutrition (late complication) GERD Warning signs include: Symptoms over age of 50: -Dysphagia (difficulty swallowing) -Odynophagia (pain on swallowing) -Nausea and vomiting -Weight loss -Melena -Early satiety (feeling full after eating very little food Hiatal Hernia Often asymptomatic
Hallucinations Delusions Formal thought disorder Bizarre behavior Schizophrenia Negative symptoms Flattened affect Alogia Anhedonia Attention deficits Apathy Schizophrenia Cognitive symptoms: Inability to perform daily tasks requiring attention and planning Hypothyroidism Most common thyroid function disorder Affects between 0.1% and 2% of the U.S. population More common in women and elderly Hormone replacement therapy with the hormone levothyroxine is the treatment of choice Thyroid-Stimulating Hormone (TSH) TSH released by anterior pituitary Review hypothalamic-pituitary axis (Picture) Thyroid-releasing hormone (hypothalamus) Hyperthyroidism/ Grave's Disease Two most distinguishing factors of Grave's disease = pretibial myxedema and exophthalmos Treatment directed at controlling excessive TH production, secretion or action and includes antithyroid drug therapy (methimazole or propylthiouracil), radioactive iodine therapy (absorbed only by thyroid tissue, causing death of cells), and surgery Goal of radioactive iodine ablation for the treatment of Grave's disease is to destroy overactive thyroid tissue Two categories of ophthalmopathy associated with Grave's Disease:
Functional Abnormalities: resulting from hyperactivity of the sympathetic division of the autonomic nervous system (lag of the globe on upward gaze or a lag of the upper lid on downward gaze) Infiltrative Changes: involving the orbital contents with enlargement of the ocular muscles. These changes affect more than half of individuals with Grave's Disease. Increased secretion of hyaluronic acid, adipogenesis, inflammation and edema of the orbital contents results in exophthalmos (protrusion of the eyeball), periorbital edema and extraocular muscle weakness leading to strabismus and diplopia (double vision) Hyperparathyroidism Characterized by stimulation of parathyroid gland in response to hypocalcemia Hypercalcemia Hypercalcemia & Hypophosphatemia may be asymptomatic or affected individuals may present with symptoms related to the neuromuscular changes that include paresthesias and muscle cramps Patients with hypercalcemia can have low bone density that is most noted in the distal one-third of the radius Hypoparathyroidism Hypomagnesemia inhibits PTH secretion Hypomagnesemia may be related to chronic alcoholism, malnutrition, malabsorption, increased renal clearance of magnesium caused by the use of aminoglycoside antibiotics or certain chemotherapeutic agents, or prolonged magnesium-deficient parenteral nutritional therapy Hypocalcemia Symptoms: Dry skin Loss of body and scalp hair Hypoplasia of developing teeth Horizontal ridges on nails Cataracts Basal ganglia calcifications Bone deformities Bowing of the long bones Hypercortisolism Glucose intolerance associated with hypercortisolism --Occurs because of cortisol-induced insulin resistance and increased gluconeogenesis and glycogen storage by the liver
--Tachycardia --Palpitations --Diaphoresis --Tremors --Pallor --Arousal anxiety Alzheimer's Disease Decreased short-term memory occurs with mild cognitive decline as a result of a reduced hippocampus size Parkinson's Disease Symptoms associated with bradykinesia = shuffling gait Other classic symptoms: --Resting tremor --Rigidity --Postural disturbance --Dysarthria --Dysphagia Multiple Sclerosis (MS) Risk factors that may be involved in the development of MS include: --Smoking --Vitamin D deficiency --Epstein-Barr Virus Infection Febrile Seizures One possibility for the development of a febrile seizure is that neurons are excited by decreased CO2 levels caused by hyperventilation during a febrile state Cluster Headache Unilateral trigeminal distribution of severe pain with ipsilateral autonomic manifestations, including tearing on the affected side, ptosis of the ipsilateral eye and congestion of the nasal mucosa Occurs in one side of the head primarily in men between 20 to 50 years of age Pain may alternate sides with each headache episode Severe, stabbing and throbbing Pain often referred to the midface and teeth Migraine Headache Episodic neurologic disorder whose marker is headache lasting 4 to 72 hours
Diagnosed when any two of the following occur: --Unilateral head pain --Throbbing pain --Pain worsens with activity --Moderate or severe pain intensity And at least one of the following: --Nausea and/or vomiting --Photophobia and phonophobia Migraine with aura with visual, sensory or motor symptoms Migraine without aura (most common) Chronic migraine Tension Headache (Tension Type Headache/TTH) Most prevalent type of recurrent headache Not vascular or migrainous Average age of onset is during the second decade of life Usually mild to moderate bilateral headache with sensation of a tight band or pressure around head Bell's Palsy Associated with Cranial Nerve VII paralysis and results in facial asymmetry and inability to close eye, smile or frown on the affected side Bacterial Meningitis Associated with compression of Cranial nerve V and results in severe and sharp stabbing pain that can worsen with chewing Trigeminal neuralgia Characterized by clinical manifestations of systemic infection including Characterized by clinical manifestations of systemic infection including --Fever --Tachycardia --Chills And clinical manifestations of meningeal irritation including