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ACMSEducate UKMLA Lecture Series President and Created By Yasimin Nankya ACMS SecretaryConditions Acute Kidney Injury Urinary Tract 01 (AKI) 02 Infection (UTI) 03 Appendicitis 04 HypertensionStructure of Lecture Topic Recap A Recap of Important Aspects of the disease Questions & Answers & B Reasoning Practise Questions 01a Acute Kidney Injury (AKI)Acute Kidney Injury Recap Reduction in Renal function due to sudden damage to the kidneys Causes ● Prerenal ● Intrinsic ● PostrenalAcute Kidney Injury Recap Prerenal Cause Occurring in the circulatory system before the kidney is reached E.g ● Hypovolaemia Secondary to Diarrhoea/Vomittng ● Renal Artery StenosisAcute Kidney Injury Recap Intrinsic Cause Relates to intrinsic Damage to the Glomeruli renal tubules or interstitium of the kidneys themselves could be due to toxins (Drugs,contrast etc) or immune mediated glomuleronephritis E.g ● Glomerulonephritis ● Acute Tubular Necrosis Acute Interstitial Nephritis ● Rhabdomyolysis ● Tumor Lysis SyndromeAcute Kidney Injury Recap Postrenal Cause Relates to problems after the kidneys => Obstruction to the urine coming from the kidneys resulting in things backing up and affecting normal renal function ● Kidney Stones in Ureter or Bladder ● Benign Prostatic Hyperplasia (Enlarged Prostate) ● External Compression of Ureter Acute Kidney Injury Recap Signs & Symptoms Risk Factors ● Chronic Kidney Disease ● Early AKI => May be ● Other Organ Failure/Chronic Disease asymptomatic e.g HF Liver Disease DM ● Reduced Urine Output ● History of AKI ● Pulmonary and Peripheral ● Use of drugs with nephrotoxic potential => Oedema 1. NSAIDs ● Arrhythmias 2. Aminoglycosides ● Features of Uraemia => 3. ACE I Pericarditis or Encephalopathy 4. ARBs 5. Diuretics ● Iodinated Contrast Agents ● Aged 65 years or over ● Oliguria => Decreased Urine OutputAcute Kidney Injury Recap Investigations ● U&Es ● Urinalysis ● No identifiable cause for deterioration or at risk of Urinary Tract Obstruction => Renal Ultrasound within 24 Hours NICE GuidelinesAcute Kidney Injury Recap Staging Staged according to Serum Creatinine changes and/or the production of urineAcute Kidney Injury Recap Management Mainly Supportive 01b Acute Kidney Injury (AKI) - Practise QuestionsProtein: Presence of protein in urine may indicate kidney damage or other health conditions. Blood: Presence of blood in urine may indicate various conditions such as urinary tract infections, kidney stones, or kidney disease. Leukocytes: Presence of leukocytes may indicate urinary tract infection or inflammation. 02a Urinary Tract Infection (UTI)UTI Recap An infection of your bladder, kidneys or ureters (the tubes connected to them) Symptoms ● Dysuria ● Urinary Frequency ● Urinary Urgency ● Cloudy/Offensive smelling urine ● Lower Abdominal Pain ● Fever (Low Grade) ● Malaise ● Confusion => Older PatientsUTI Recap Investigations History & Urine dipstick (Positive for Nitrites or Leukocytes and RBCs) Culture Sample Sent to identify bacteria or yeast causing UTI Urine Cultures must be sent under the following conditions=> ● Non visible/Visible Haematuria ● Over 65 ● Pregnant ● Male UTI Recap Management Men/Non Pregnant Women Trimethoprim or Nitrofurantoin for 3 Days => Women Trimethoprim or Nitrofurantoin for 7 Days => Men Pregnant Women Symptomatic or Asymptomatic Urine Culture sent First Line Nitrofurantoin Second Line Amoxicillin or Cephalexin Catheterised Patients Do not treat asymptomatic bacteriuria in Men/Non Pregnant Women Note If patient is symptomatic treat with antibiotics for 7 days Trimethoprim should be avoided during pregnancy as its teratogenic* 02b Urinary Tract Infection (UTI) - Practise QuestionsPatient is asymptomatic !! 03a Appendicitis Appendicitis Recap Inflammation of the Appendix Symptoms ● Sudden pain that begins on the right side of the lower abdomen. ● Sudden pain that begins around the navel and often shifts to the lower right abdomen. ● Pain that worsens with coughing, walking or making other jarring movements. ● Nausea and vomiting. ● Loss of appetite. ● Low-grade fever that may rise as the illness worsens. ● Constipation or diarrhea. ● Abdominal bloating & Gas Appendicitis Recap Classical Signs ● Rovsing's sign (palpation in the LIF causes pain in the RIF) is now thought to be of limited value ● Psoas sign: pain on extending hip if retrocaecal appendix ● Generalised Peritonitis ● Rebound and Percussion Tenderness, Guarding and Rigidity ● Boggy Sensation upon digital rectal examination ● or right sided tenderness with a pelvic appendix Appendicitis Recap Diagnosis ● Raised Inflammatory markers + compatible history + Examination findings ● Neutrophil predominant Leukocytosis is seen 80-90% ● Urine Analysis used to exclude: Pregnancy, Renal Colic ad UTI Appendicitis Recap Management ● Appendicectomy => Can be performed via either an open or laparoscopic approach ● Laparoscopic Appendicectomy is now the treatment of choice ● Prophylactic IV Antibiotics reduces wound infection rates ● Perforated Appendix =. Requires copious abdominal lavage 03b Appendicitis - Practise Questions 04a Hypertension Hypertension Recap High Blood Pressure Symptoms (commonly asymptomatic) ● blurred vision. ● nosebleeds. ● shortness of breath. ● chest pain. ● dizziness. ● headaches. Hypertension Recap Staging Hypertension Recap DiagnosisHypertension RecapHypertension Recap Statin Treatment Atorvastatin Simvastatin Hypertension Recap Management Hypertension Recap Management Pharmacological ● ACE I’s (-Prils) => ● CCBs (-Pines)=> Ramipril Amlodipine Enalapril Nifedipine ALSO Verapamil & Diltiazem but used more in ● ARBs (Artans)=> cardiology Losartan ● Thiazide Like Diuretics => Candesartan Indapamide Metolazone Chlorthalidone Hypertension Recap Management Lifestyle ● Low Salt and balanced Diet ideally 3g/per day ● Reduced Caffeine Intake ● Smoking Cessation ● Less Alcohol ● Exercise ● Weight Loss 04b Hypertension - Practise QuestionsThank you for listening !!