• Archive for April, 2013

    Reflux and Hiatal Hernia

    by  • 30/04/2013 • Gastroenterology • 0 Comments

     A hiatal hernia is a herniation of the proximal stomach into the chest caused by a congenital defect in the diaphragm (rarely acquired abnormality).  It predisposes to gastro-oesophageal reflux of gastric acid contents and inflammation of the distal third of the oesophagus (=reflux oesophagitis) or gastric metaplasia (=Barrett’s epithelium).  Incidence: v...

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    Nutritional Deficiencies

    by  • 29/04/2013 • Gastroenterology • 0 Comments

     Xerophthalmia = lack of Vit A o Major cause of blindness in the Tropics o Conjunctivae become dry and develop oval/triangular spots (=Bitot’s spots). Cornea becomes cloudy and soft. o Tx: Vit A 200,000 units stat po, repeat in 24h, then again 7/7 later. Seek special advice if pregnant (Vit A embryopathy must...

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    Renal- At a Glance

    by  • 28/04/2013 • Renal • 0 Comments

     Drugs excreted by kidney which can accumulate in renal failure: digoxin, lithium, morphine and metabolites, penicillins, gentamicin, vancomycin, erythromycin, acyclovir  Drugs which require higher doses in renal failure: frusemide  Drugs that can exacerbate metabolic effects in pre-existing renal failure: spironolactone (=hyperkalaemia), corticosteroids (=uraemia), NaCl (=water retention)  Drugs which can produce...

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    Drugs and Kidneys

    by  • 28/04/2013 • Renal • 0 Comments

     Final common route of elimination for many drugs/metabolites is the kidney, through: glomerular filtration, active tubular secretion or passive tubular reabsorption.  Water soluble drugs are excreted in the unchanged active form (gentamycin)  Lipid soluble drugs like morphine, first undergo hepatic conjugation with a highly polarised endogenous substance (e.g. glucoronic acid) to...

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    Renal Transplant

    by  • 28/04/2013 • Renal • 0 Comments

     2000 renal transplants / yr in UK  Specific criteria must be met to be suitable for renal transplant: o Age <70yo o Must be HIV negative o Free of bacterial infection/malignancy o Have no severe cardiac disease o Must not have a renal disease that will recur  Transplantation is limited by...

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    Chronic Renal Failure (CRF)

    by  • 28/04/2013 • Renal • 0 Comments

     CRF = abnormally low GFR for >3/12  Causes: glomerulonephritis (30%), interstitial nephritis and reflux nephropathy (20%), polycystic kidneys (10%), DM (10%), renovascular disease/HTN (10%)obstructive uropathy and unknown causes (20%).  Incidence of CRF suitable for renal replacement therapy 65-100/million/year   Functions of kidneys and effects of failure:  Failure to regulate salt...

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    Acute Renal Failure (ARF)

    by  • 28/04/2013 • Renal • 0 Comments

     Characterised by rapid decline in GFR over daysweeks with accumulation of nitrogenous waste  Often noticed by rapidly rising serum creatinine and urea, accompanied by reduced urine output  p/c: fluid overload, nausea, malaise, encephalopathy   Causes:  Pre-renal: o Reduced/inadequate perfusion and inability of post-glomerular arteriole to constrict o If these two...

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    Genetic/Hereditary Renal Disease

    by  • 28/04/2013 • Renal • 0 Comments

    Autosomal dominant polycystic kidney disease (APKD)  Variety of inherited conditions affecting kidney – but adult polycystic kidney disease (APKD) is most common  Accounts for 8-10% of patients with end stage renal failure  Autosomal dominant inheritance: chromosome 16 (PKD1 gene in 95% of cases), or C14 PKD2 in 5%.  Typically presents...

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    Renal Involvement in Systemic Disease

    by  • 28/04/2013 • Renal • 0 Comments

    Diabetes Mellitus:  DM causes renal disease (30% have nephropathy after 20 years).  It accounts for 10% of renal replacement therapy  Initial diabetic renal disease manifests as microalbuminuriaproteinurianephrotic syndrome  Loss of excretory function = increasing creatinine and urea  If nephropathy – suspect retinopathy and neuropathy  Mx: aggressive ACEi therapy...

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    Glomerulonephritis

    by  • 28/04/2013 • Renal • 0 Comments

     Types of presentation: o Acute/chronic renal failure o Nephrotic syndrome (=oedema, proteinuria, hypoalbuminaemia) o Haematuria o Proteinuria and HTN  Cardinal signs of GN are: proteinuria, haematuria, urinary cysts.  GN affects both kidneys symmetrically  GN may affect kidneys only = primary GN or be systemic = Wegeners granulomatosis/SLE/other secondary glomerulonephritides. ...

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