Renal and Electrolytes
Kristen Davies, Shadaba Ahmed in Core Conditions for Medical and Surgical Finals, 2020
Dialysis describes the use of a semipermeable membrane that acts as a filter with a solution to regulate the fluid and electrolytes in the blood. There are three main forms: Haemodialysis: Uses an AV fistula (between radial artery and cephalic vein) with blood flowing from one side of a semipermeable membrane with dialysis solution flowing in the opposite direction. Requires multiple treatments per week. Complications include hypotension, infection, thrombosis (from AV fistula) and dialysis disequilibrium syndrome (cerebral oedema).Haemofiltration: Blood flows through a machine through a semipermeable membrane but no dialysis solution is used. Positive hydrostatic pressure pushes fluid across. Complications are similar to haemodialysis but haemofiltration causes less hypotension.Peritoneal dialysis: Uses the peritoneum as the semipermeable membrane with access gained via a Tenchkoff catheter through the anterior abdominal wall. Cheaper than haemodialysis/haemofiltration and more flexible for patients. Complications include peritonitis (most commonly due to Staphylococcus epidermidis). Contraindications include peritoneal adhesions, abdominal hernias and colostomy.
Supported Lives
Roger Cooter, John Pickstone in Medicine in the Twentieth Century, 2020
Another key innovation grew from peritoneal dialysis, a means of dialyzing in emergencies that had been tried with varying degrees of success from the 1920s. In this method, dialysis fluid is poured into the patient’s peritoneal cavity through a needle or tube in the abdomen; the membranes lining the cavity allow waste products in the bloodstream to pass through by osmosis, and the fluid is removed and replaced either continuously or intermittently. The weak point in this method was the insertion of a needle or tube bringing a high risk of peritonitis. As with the Scribner shunt, new materials changed the picture and in 1978 a Canadian team devised a permanent indwelling cannula, inserted in the wall of the abdomen below the navel, which allowed fairly safe repeated dialysis — ‘repeated’ here meaning every six hours. This process, known as Continuous Ambulatory Peritoneal Dialysis (CAPD) took off as a serious alternative to hemodialysis from about 1980. Some patients objected to having a tube protruding from their bellies, while others preferred this method because it allowed greater freedom of diet and fluid intake than hemodialysis. The varying extent of uptake of CAPD in different countries was largely, however, a matter of macro-policy. The US, with its generous funding for dialysis, retained a high level of hemodialysis; the UK, which had one of the lowest levels of provision in Western Europe in the 1970s, aimed to increase coverage while keeping costs down, and so used more CAPD than most other European countries.
Nutritional Disorders/Alternative Medicine
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The most common cause of thiamine (B1)deficiency in this and other developed countries is alcoholism. The condition is also seen in the clinical setting with use of peritoneal or hemodialysis. The two primary syndromes of the deficiency affect the cardiovascular system (wet beriberi) and the nervous system (dry beriberi, Wernicke-Korsakoff syndrome). Cardiovascular symptoms involve peripheral vasodilation, myocardial failure, and sodium-water retention leading to edema. Peripheral neuropathy (nerve disorder), Wernicke's encephalopathy (cerebral beriberi), and Korsakoff syndrome with amnesic psychosis are nervous system manifestations.
Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis
Published in Expert Review of Medical Devices, 2023
Hari Dukka, Maarten W. Taal, Roger Bayston
Peritonitis is associated with significant morbidity and mortality. The treatment of peritonitis requires intra-peritoneal (IP) antibiotics such as vancomycin, second-generation cephalosporins, or aminoglycosides. IP antibiotics are needed for at least 2 weeks and if dialysate white cell count remains greater than 100/µL after day 5 of treatment, then catheter removal is indicated [16]. Catheter removal is generally needed for fungal peritonitis, as it has a high mortality risk [16]. Management of peritonitis is usually conducted in an outpatient setting, unless a patient is septic and/or needs catheter removal. About 20% of peritonitis cases require catheter removal, which is more commonly associated with S. aureus and gram-negative organisms. In one study, peritonitis was associated with a 95% increase in all-cause mortality [5,24]. This is more commonly associated with S. aureus, gram-negative organisms, and fungal peritonitis. Catheter removal also requires transfer to HD at least on a temporary basis, which may compromise a patient’s quality of life especially if they are elderly and comorbid. Peritonitis may also lead to decreased volume of fluid removal due to change in transport status of the peritoneal membrane [25]. This may be temporary or a permanent effect and may lead to significant fluid retention in patients, which has a high risk of mortality.
Proteomic study of mesothelial and endothelial cross-talk: key lessons
Published in Expert Review of Proteomics, 2022
Juan Manuel Sacnun, Rebecca Herzog, Klaus Kratochwill
There is a plethora of proteomic studies investigating EC and even some secretome studies in combination with other cell types that could potentially be used to extrapolate effects on MC [121–123]. MC research, however, seems to be the limiting factor for discussing crosstalk between these two cell types. In the past, ECs were thought to be a relatively simple cell layer with barrier and transport function separating the systemic circulation from tissue, though today we understand the endothelium as a more complex system with a vast amount of different functions [20]. The same is true for the peritoneum, an organ long thought to have few functions but providing a surfactant cover for the inner organs of the abdominal cavity. Over the last years, this notion has changed, as it became increasingly clear that it is more complex than a simple serous membrane [3]. MCs are, for example, crucial for kidney replacement therapy with peritoneal dialysis, a therapy where – even though the endothelial cells are never in direct contact with the PD fluid – the submesothelial vasculature gets significantly more damaged than expected by uremia alone [124,125]. This vascular damage, in turn, may be the culprit for the increased prevalence of cardiovascular disease in patients on kidney replacement therapy, eventually resulting in increased mortality. This highlights the clinical relevance of this knowledge gap and the need of adequate research. The mesothelium is in contact with both microvascular and lymphatic vessels [126].
Manifestations, complications, and treatment of neurobrucellosis: a systematic review and meta-analysis
Published in International Journal of Neuroscience, 2022
Amin Tajerian, Masoomeh Sofian, Nader Zarinfar, Amitis Ramezani
Neurobrucellosis has a different clinical picture in pediatric patients. The disease is less chronic in children, and the median of the course of the symptoms is 30 days shorter in this population. Fever, nausea and vomiting, fatigue, and abdominal pain were more prevalent in children. Also, convulsions, ascites, sensorineural hearing loss, and papilledema are more prevalent signs in children. One of the most important clinical pictures in children was ventriculoperitoneal shunt infection (17.1%), especially in patients with a history of hydrocephalus. This infection may lead to a peritoneal infection presented with abdominal pain. Removing VP-shunt was the key factor to treat these patients. Temporary placement of external ventricular drains could help patients with high intracranial pressure to complete the treatment course. After completion of the treatment and recovery, the VP-shunt could be placed again [35–40]. VIII CN involvement was significantly less common in children with only 2 cases observed.
Related Knowledge Centers
- Coelom
- Lymphatic Vessel
- Mesothelium
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- Vertebra
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- Blood Vessel
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