Uremia (uremic syndrome) is a serious complication of chronic kidney disease or acute kidney

injury (ARF) that occurs when urea and other waste products build up in the body because the
kidney ( which filters in the blood) are unable to eliminate it. These substance can be poisonous
(toxic) in the body if left untreated.

Management: definitely dialysis, to relieve the symptoms of uremic syndrome and to reduce
the amount of those waste product until normal function of the kidney restored

Symptoms: nausea and vomiting loss of appetite with loss changes and mental status such as
confusion, psychosis and seizure

Normal urea value: 7-8mg/dl

Ileostomy- is a stoma ( surgical opening ) constructed by bringing the end or loop of intestine
(ileum) out onto the surface of the skin, usually located at lower R side of the abdomen

This surgery is done when the colon or rectum is not working properly.

This is use to move waste out of the body.

This surgery is done for may different disease and problems.

Some condition that can lead to ileostomy in – ulcerative colitis, crohn’s disease, familial
polyposis, and cancer. sometimes an ileostomy is only needed for a short time, but some people
it’s life- long

When part of the bowel become diseased, a long- term (permanent) ileostomy must be made.
The diseased part of the bowel and anus are removed or permanently rested. In this case the
ileostomy is not ever expected to be closed.

Pounching: a pounching system is needed to collect ileostomy output or the stool drainage that
comes out of the stoma.

Before the procedure: 2nd week before

- Always tell the doctor what drugs, are you taking even drug, supplements or herbs you’ve
bought without prescription.
- 2weeks before surgery you need to asked to stop taking drugs that make it harder for your
blood to clot. This includes aspirin, ibuprofen and others.
- If you smoke, try to stop. A day before surgery
- Npo and your provider may ask to use enema and laxatives to clear out the intestine
DURING PROCEDURE:
To create an ileostomy the surgeon make as small surgical out in the wall of the
abdomen. Part of the intestine that is farthest from your stomach as brought up and use to
make an opening. This is called the stoma.
After procedure: you may be able to sip small amount of water to ease the thirst. By the
next day, you may be probably allowed to drink clear liquid you will slowly add thicker
fluid and then soft food to your diet as your bowels begin to work again.
Caring for stoma: the best way to protect your skin is by using a bag or pouch with
correct size opening, so waste won’t leak
Taking good care of the skin around the stoma (normal stoma after surgery; large swollen
red or pink are normal)
EPIDIDYMITIS- is an infection or less frequently, inflammation or the epididymis
which is a tube located at the back of the testicles that stores and carries sperm. Made by
testicles prior to ejaculation.
CAUSE:
The cause of epididymitis depending age and behavior. In children it is the most
commonly associated with UTI. In young and sexually active men, it is commonly linked
to STI. And in older men it is often caused by enlargement of prostate gland.
SYMPTOMS:
It is associated with pain, tenderness and swelling in scrotum that gradually get worse
are the mosr common symptoms of epididymitis. Other symptoms may include fever and
chills frequent pain in urination and discharge from penis.
How does it diagnosed?
Using physical examination and medical history. A culture of discharge from a penis is
done to check for a abacterial infection such as STI. And urinalysis and urine culture are
done to check for UTI you may also have a blood test to check for an elevated WBC and
a ultrasound and nuclear medicine test to make sure you do not have torsion of the
testicles which is an emergency condition that cause loss of blood flow to the testicles
and requires urgent surgical treatment.
COMPLICATIONS
There are usually no long term sexual or reproductive problems. But the infections can
return in the future it is possible for complications to occur but it is rare, but can include
infertility and death of testicular tissue.
TREATMMENT
For epididymitis involves treating the underlying infection of easing the symptoms.
Common treatment include:
Antibiotic, pain medications w/c can be available over the counter (ibuprofen) anti
inflammatory med. Like ketorolac bed red applying old packs to scrotum can also help to
ease the pain and inflammation .
Enteritis- Is inflammation of the small intestine commonly caused by food or drink
contaminated with pathogenic microbes but may have other causes such as NSAIDs
,cocaine, radiation therapy as well as autoimmune conditions like crohn’s disease and
celac disease.
 There are various type Enteritis ;

Viral or bacterial infection radiation induced medication induced, alcohol or drug (cocaine)
induced. Entiritis to inflammatory condition food poisoning is the most common of bacterial
entirititis you can get it after ingesting food or water that is contaminated with bacteria . the
bacteria can enter food supply through improper food handling , poor hygiene and during poultry
and meat processing .
Common bacteria : salmonella ,e-coli , staphylococcus, aureus ,campylobacter jejuni ,shigella ,
bacillus species
You can also get entititis when you come into close contact with other people and animal that are
infected .
Radiation enteritis : can occur after radiation therapy . this occurs when the normal healthy
intestinal cells are damage by radiation and become inflamed . but this condition usually goes
away several weeks after you finish the treatment .

Exams and test : a stool culture may be done to determine the type of infection blood test .
Treatment : treatment for all forms of symptoms like rehydrating with electrolyte solution if the
body does not have enough fluids . anti diarrheal drugs may not be recommended because it can
slow the germ from leaving the digestive tract . but mild cases usually do not need treatment .
Possible complication : is dehydration due to severe fluid loss because of severe diarrhea with
or vomiting
SYMPTOMS can start anywhere from a few hours to few days after infection diarrhea trauma
and nausea and vomiting loss of appetite abdominal cramps and pain fever.
Dehydration is a serious medication condition requiring urgent attention because if left untreated
it can lead to shock. And it can lead to failure of kidneys, heart and liver and even death.
PREVENTION
Always wash hands after using toilet before eating and preparing foods
Boil water from unknown sources.
Cook foods thoroughly especially meat and pork.
HIATAL HERNIA- describes as condition where a part of stomach is normally located at the
abdominal cavity pushes or protrudes through the aesophageal hiatus ( an opening in the
diaphragm through which the esophagus and vagus nerve pass) to rest within the chest cavity
CAUSE:

The exact cause of many hiatal hernia isn’t known. But a person maybe born with a large hiatal
opening, increase pressure abdomen such as coughing, obesity and pregnancy may play a role.

2 type of hernia.

SLIDING HIATAL HERNIA stomach and the section of esophagus that join the stomach slide
up into the chest through the hiatus.

PARAESOPHAGEAL HERNIA- stomach and esophagus stay in their normal location but part
of the stomach squeezes through the hiatus landing it next to esophagus.
RISK OF HIATAL HERNIA- this condition commonly occur more often to women because of
pregnancy to those who are obese because of the pressure in the abdomen and to these who aged
50 up because their muscle weaken.

SYMPTOMS- many people with hiatal hernia have no symptoms but others may have
heartburn related to gastroaesophageal reflux disease and gerd.

DIAGNOSIS- hiatal hernia can be diagnosed with a specialized xray(using barium swallow) that
allows a doctor to see the esophagus or endoscopy may also be done

TREATMENT- most people do not experience any symptoms and their hiatal hernia so there no
treatment is necessary however the paraesophageal hernia can sometimes cause the stomach to
be strangled ( the blood flow was obstructed) so surgery is sometimes recommended.

SYMPTOMS HAVING STRANGLED

N/v or unable to have bowel movement or pus gas

Acid reflux causes most hiatal hernia symptoms changing your diet and reduce symptoms. It
may help to eat smaller meals several times a day instead of three large meal. You should also
avoid snack within a few hours of going to bed.

NURSING INTERVENTION

To reduce intra abdomenal pressure have the pt. sleep in reverse trendelenburg position

Administer prescribed antacid and other med. To ease the symptoms of the gerd.

Encourage the pt. to delay lying down after eating

HERNIA- occur when the contents of a body cavity bulge out of the area where they are
normally contained . hernias are most common in the abdomen but they can also appear in the
upper thigh belly button and grain areas .

Types of hernias :

Inguinal hernia – are the most common in inguinal hernia the bladder or the intestine protrudes
through the abdominal wall or the inguinal canal in the grain. Its most common in men .

Inguinal canal : is found in grain in men it’s the area where the spermatic cord passes from the
abdomen to scrotum . this cord holds up thee testicle . in women the inguinal canal contains a
ligament that helps hold the uterus .
This type of hernia is more common in the men that women . this is because a man’s testicle
descend through the inguinal canal shortly after birth and the canal is supposed to close properly
and leaves a weakened area prone to hernias .

Hiatal hernia : occurs when part of the stomach protrude up through the diaphragm into chest
cavity . this type of hernia is most common in people over 50 years old . if a child has this
condition its typically caused by congenital birth defect .

Large or heavy meals, avoid lying down or bend over after a meal and keeping your body wt. in
ahelathy range you can.

Also improve symptoms by avoiding foods that can cause acid reflux or heart burn.(spicyfood
and tomato based foods)

If your hernia is growing larger or causing pain, your doctor may decide of best to operate. Your
doctor may repair the hernia by sewing the hole in the abdominal wall closed during surgery.

COMPLICATION:

If hernia are left untreated it may grow and become more painful. The intestine can become
obstructed with the bowel and cause severe pain, nausea and constipation. If trapped section of
the intestine doesn’t get enough blood flow, strangulation can occur which can cause the
intestinal tissue to become infected or die.

COLITIS refers to inflammation of the inner lining of the colon or the large intestine which
cause humerous factors like infection, inflammatory bowel disease (crohn’s and ulcerative
collitis), allergic reactions and microscopic collitis

It can be associated with diarrhea, abdominal pain, bloating and blood in the stools

DIAGNOSIS

Depending upon the history and physical examination further testing may be necessary to find
the cause of colitis and may include CBC, urine, stool sample, colonoscopy, barium enema

CAUSES OF COLITIS

VIRUSES AND BACTERIA most are food borne illnesses or food poisoning. Common
bacterial causes of food borne infection include E.coli salmonella and campylobacter. These
infections may cause bloody diarrhea and result in significant dehydration.

PARASITES INFECTION such as giardia w/c enter the body when infected water is
swallowed the source may be from rivers, lakes, and swimming pools.
PSEUDOMEMBRANOUS COLITIS is caused by bacteria clostridium difficile and often seen
in patients who have been taking antibiotics for an infection.this bacteria produces a toxin that
cause diarrhea. This is an infection and often there is a fever present.

INFLAMMATORY BOWEL DISEASE (IBD) ulcerative colitis which is an autoimmune

illness in w/c the body immune system attack the colon and causes of inflammation. It may begin
at the rectum an eventually spreads to colon and associated with abdominal pain and bloody
bowel movement.

Crohn’s disease inflammation that may involved any part of the digestive tract from the mouth
esophagus and stomach through the small and large intestine all the way to the rectum and anus .
it is likely d/t an abnormal response of the immune system .

Microscopic colitis : there are two disease make up this group of common inflammation
collagenous colitis and lymphocytic colitis . in this disease the inflammation is caused when the
colon wall becomes engorged with either collagen or lymphocytes .

Treatment. for colitis depends upon the cause and often is focused on symptom relief
supportive care and maintaining adequate hydration and pain control . antibiotics may prescribe
to treat infection cause of colitis . some bacteria infection that cause colitis resolved without any
antibiotic treatment .

Gastric / duodenal ulcers – are different from gastric ulcer but they are two kinds of peptic
ulcer . in duodenal ulcer ulceration occurs at the duodenum which is the upper part of small
intestine . while in gastric ulcer ulceration occurs inside the stomach lining .

Cause : gastric and duodenal ulcer is primarily caused by helicobacter pylori or h.pylori which is
a bacterium that damages the mucus that protects the stomach and small intestine allowing the
stomach acid to burn through . usage of NSAID are also a factor because it damage and irritate
the lining .

Symptoms : both types of ulcer causes pain particularly gastric pain climbing up to the
esophagus . however with gastric ulcer pain cannot be relieved by eating foods . in duodenal
ulcer it can be relieved by eating and there a presences of blood in the stool called hematermesis
. in duodenal ulcer pain occurs 3-4 hrs after eating and gastric ulcer pain occurs 1-2 hrs after
eating .

Diagnosis : in diagnosing both ulcers the doctor may order complete blood count to check for
complete WBC. Your doctor may also advice to undergo endoscopy where a camera is inserted
into the mouth and will advance to either the duodenum or stomach has the celebration .

Treatment : rely on antibiotics to lessen the number of it . pylori bacteria . examples of these are
amoxicillin , clarithromycin and tetracycline . in cases of hyper secretion of acid antacids are
given to neutralized the oadity of the stomach . in gastric ulcers patients are advised to avoid
foods which causes hyperacidity and irritation . in duodenal ulcers theres no advised special diet
. however there are finding that alcohol can aggravate duodenal ulcer .

Nephrectomy – is a term used for the surgical removal of a kidney commonly done to treat
kidney disease cancer as well as . other kidney disease and injuries . it is also done for donation
of healthy kidney .

Two types of nephrectomy partial and radical nephrectomy .

Partial nephrectomy only the disease of injured tissue of the kidney is removed and it leaves
healthy tissue in this place . it is also called as the kidney sparing .

Radical nephrectomy (complete )the urologic surgeon removes the entire kidney and often
some additional structures such as the ureter .

Indacaton ; most often nephrectomy is done to treat kidney cancer or to removed benign
(noncancerous) tumor and to deal with a diseased or seriously damaged kidney . and in some
cases donor nephrectomy was performed to get the healthy kidney and to donate it to other
person who needs a functioning kidney .

Preparation : prior to surgery blood samples will be taken from the patient to type and
crossmatch in case transfusion is required during surgery . a catheter will also be inserted into the
patients bladder . the surgical procedure will also be discussed to the patient along with the
possible risk .

How is nephrectomy surgery done?

Laparoscopic surgery- some people who require nephrectomy are suitable for laparoscopic
surgery that involves the use of a laparoscope (wand like camera) that passed through a series of
a small incisions in the abdominal wall.that is used to view the abdominal cavity and remove the
kidney through the small incision and it done with a general anesthesia.

Laparoscopy achieves the same things as traditional surgical techniques and can be used for
both radical and partial surgery.

ADVANTAGE:

Laparoscopic surgery has a shorter recovery time, shorter hospital stay, has smaller incisions and
fever post op complications.

OPEN NEPHRECTOMY- is rarely adviced but it is also done under general anesthesia. The
surgeon makes a cut (incision) in the abdomen or in the side of the abdomen, a rib may need to
removed to perform the procedure. The ureter along w/ the blood vessels are cut away from the
kidney and the kidney is removed the incision is then closed w/ stitches.
POST OP CARE immediately after surgery, your health care team will carefully watch blood
pressure, electrolytes and fluid balance because these body functions are controlled in part by the
kidneys. Pain reliever are also given after surgery and during recovery period to minimize
discomfort. Breathing exercise was advised to prevent pneumonia. You’ll be encouraged to
return to light activities as soon as you feel up to it. Heavy lifting should be avoided for 6weeks
after surgery.

COMPLICATIONS

All surgery has its certain risks and complications and nephroctomy has a possible complication
of infection to the surgery, site,bleeding that requires blood transfusion, post op pneumonia, rare
allergic reactions to anesthesia.

ACUTE GLOMERULONEPHRITIS- is an active inflammation in the glomeruli which is the

basit filtration of the kidney. It can be a response to an infection such ad strepthroat or an
abscessed tooth or may be due to problems with the immune system overreacting to the infection
and this can go away without treatment.

Heavy use of NSAID may also be factor

SYMPTOMS

It is associated with puffiness in the face, urinating less often, presence of blood in the urine and
high BP.

DIAGNOSIS

Test to assess kidney function and make a diagnosis of acute glomerulonephritis includes
urinalysis that might show RBC and red cell cast in the urine which is an indicator of possible
damage to the glomeruli also WBC might also show that was an indicator of infection and
inflammation and increase protein that indicates damage to the nephron.

Blood test was also done to provide information about the kidney damage and impairement of
the glomeruli by measuring waste product such as creatinine and BOD.

TREATMENT

Some cases of AGN, specially those that follow strepinfections, might improve on their own. But
if there’s underlying cause such as HIGHBLOOD, an infection or autoimmune dse function will
be directed to underlying cause.

ACUTE RENAL FAILURE/ CHRONIC RENAL FAILURE -ARF is a rapid loss of kidney
ability to remove waste and help balance fluid and electrolytes in the body usually caused by an
event that leads kidney malfunction, s/c as dehydration, blood loss from major surgery and even
diuretic therapy. However, CRF which is an condition characterized by a gradual loss of kidney
function overtime and is usually caused by long term disease, such as high blood pressure

IT IS CAUSE INTO ARF

PRERENAL FAILURE- results from – that interrupts the renal blood supply such as
hypovolemia, shock, hemorrhage and burns

INTRARENAL FAILURE - Which causes on actual parenchymal damage to glomeruli such

as over used of NSAID nephrotoxic agents and infections

POSTRENAL FAILURE - Which results of an obstruction to distal part of the kidney like
calculi blood clots, tumor

SYMPTOMS

In ARF it is usually accompanied by fatigue, breath odor, generalized swelling and fluid
retention, high bp, n//v, changes in mental status like confusion specially in adults and reduce
urine output , however, in CRF it is accompanied by appetite loss, itching, dryskin, fatigue and
anemia

DIAGNOSIS

As a first step toward diagnosis of kidney disease like ARF and CRF your doctor may ask your
own personal and family history. She might also ask you if you’ve been diagnosed with
hypertension, if you’ve been taking drug that may affect your kidney and if your experienced in
your urinary habit. You need also undergo certain test like blood test to look for the level of
waste product, urine test to reveal abnormalities that point to CRF and to identify the cause of the
disease.

ABDOMINAL XRAY , CT SCAN OR ABD, MRI can detect if there is a blockage in urinary
tract.

TREATMENT

ARF depend on the cause and the goal is to restore normal kidney functions, preventing fluid and
waste building up in the body while recovering of your kidney is important.

Restricting the sodium intake to prevent water retention and high in carbs and low in protein,
potassium to reduce the build up of toxins. Antibiotics may prescribed or to treat any infections
that occur at the same time. But in CRF it is often, no cure. Treatment usually consists measure
to help control signs and symptoms , reduce complications and slow progression of the disease.
It may induce treating HPN by highblood pressure medications commonly ACE inhibitors are
given or angiotensin II blocker, meds lower cholesterol levels, meds to treat anemia, meds to
relieve swelling, and meds to protect the bones ( calcium and vit.D)
DIFFUSION - Is a process that occurs when a substance such as water, molecules and ions
which are usually needed for various cellular process enter and leave the cells.

The molecules moves from an area of high concentration to lower concentration until both
molecules have the same amount of substance and it is distributed evenly.

FILTRATION - Water molecules and extremely small solutes are forced to move from area of
higher hydrostatic pressure and lower hydrostatic pressure which is created by pumping action of
the heart and gravity against capillary wall.

HYDROSTATIC PRESSURE- Pushes fluid out of vessels into tissue space higher to lower
concentration.

OSMOTIC PRESSURE- Pulls fluid into the vessels.

THIRD SPACING- Occurs when too much fluid moves from the intravascular space into the
interstitial space or the “third space” which is nonfunctional area between cells. It is the unusual
accumulation of fluid in a transcellular space.

For example, in severe burns fluid may pool on the burn side (fluid lying outside of the
interstitial tissue, exposed to evaporation) and causes the depletion of fluids.

URINE - Is the body’s liquid waste mainly made of water, salt and chemicals like urea and uric
acid which is excreted by the kidneys where filtration occur together with the waste of the blood
that flows to the ureters of the urinary bladder down to the urethra during urination.

NORMAL ODOR

If everything is normal and healthy. The odor should be pale yellow to amber and if it has no
color at all, that may be because you’ve been drinking a lot of water or taking a drug called
diuretic, which helps your body to get rid of fluid. Very dark or brown colored urine must be a
sign that you’ve dehydrated and needs to get more fluid right away but it can also be a sign of
liver due like hepatitis or liver cirrhosis that causes excess bilirubin. And no matter what color it
is you should check with your doctor. If it is looks toamy or frothy it maybe a sign that you have
protein in your urine which is a sign of an issue in the kidney.

HOW OFTEN?

Most people urinate between 6-8x a day. But if you’re drinking plenty, it is normal to go as many
as 10x a day. You may also –more often if you’re taking certain medication like diuretics.

UROLITHIASIS/ NEPHROLITHIASIS - In urolithiasis, it is a term used to describe calculi

or stone that form the urinary tract and involves the formation of calcification in the urinary
system, usually in the kidney or ureters but may also affect the bladder or urethra. In
nephrolithiasis, it is a term used for the formation of calculi and stone within the kidneys both
condition has a hardened mineral deposits that form and originate as microscopic particles and
develop into stone over time.

The most common type of stone contains calcium in combination either oxalate or phosphate.

CAUSE

The kidney stones form when the urine contains more crystal forming substances calcium,
oxalate, phosphate , uric acid. Medicines can also a factor in developing calcium stones
furosemide(loop diuretics)

SYMPTOMS

The first symptoms of a kidney stone is extreme pain. The pain often begin suddenly when a
stone moves in the urinary tract causing irritation or blockage.

APPENDICITIS - Is an inflammation of the appendix which is finger shape pouch that projects
from the colon on the lower R side of the abdomen. Although anyone can develop appendicitis.
Most often it occue when people between the age of 10 and 30.

CAUSE

In many cases the main cause for appendicitis is ‘UNKNOWN’. But doctors believe that the
ibtruction of the appendix has caused it. Obstruction is often due to an accumulation of fecal
matter, foreign body, or even tumor. When there’s an obstruction inside the appendix, the
bacteria can multiple inside the organ that eventually lead to formation of pus .

The blockage can lead to increase pressure, problems with the blood flow, and inflammation and
if left untreated it can eventually burst and spread the infection in the abdomen that causes a
condition called peritonitis.

SYMPTOMS

Appendicitis is primary associated with stomach pain, but this pain can also be felt on sides or
back that eventually worsens if you move, walk or cough. The pain are start at the vague
stomach ache hear the navel and process to the lower R side of the abdomen. You can also
experience painful urination, vomiting that precedes abdominal pain, constipation or diarrhea
with gas.

If you any of the mentioned symptoms, seek med. Attention immediately, because timely
diagnosis and treatment is very important. Do not eat, drinks, or use any pain remedies, antacids,
laxative and enemas because it can also cause an inflamed of the appendix to rupture.

DIAGNOSIS
Your doctor will begin by performing physical examination. They’ll look for tenderness in the
lower R side of the abdomen and if perforation occurs, the stomach has become hard and swollen
which needs emergency operation. Your doctor also order a blood test that will show if you have
increased WBC which may indicate an infection. Also, urinalysis may also ordered to make sure
that the cause of pain is not a UTI or a kidney stone. Ct scan and abdominal x-ray may also done
to confirm appendicitis.

TREATMENT

In the most cases, surgery is the most option. If you have an abscess that hasn’t ruptures, your
doctor may administer antibiotics. He will be drain the abscess using a tube placed through the
skin, after you’ve received treatment for infection , you’ll undergo surgery to remove the
appendix. But if you have ruptured abscess or appendix, surgery is necessary right away. Surgery
to remove the appendix is known as appendectomy. Your doctor can perform this procedure as
open surgery or through laparoscopy, which is less invasive and making the recovery time
shorter or even laparoscopic.

Appendectomy may also be an option in which the surgeon inserts a special surgical tools and
video camera into the abdomen to remove the appendix.

If your appendix has ruptured and infection has spread beyond the appendix or you have an
abscess, you may need an open appendectomy which allows surgeon to clean the abdominal
cavity as open surgery or through laparoscopy , which is less invasive it making the recovery
time shorter or even laparoscopic

Appendectomy may also be an option is which the surgeon insert a special surgical tools and a
video camera into the abdomen to remove the appendix

If your appendix has ruptured and infection has spread beyond the appendix or you have an
abscess, you may need an open appendectomy which allows your surgeon to clean the abdominal
cavity.

CHVOSTEK SIGN

Is a clinical sign of a spasm of the facial muscles elicited by tapping the facial nerve in the region
of parotid gland. Seen in hypocalcemia. It refers to an abdominal reaction to the stimulation of
the facial nerve. When the facial nerve tapped in front of the tragus, the facial muscle on the
same side of the face will contract momentarily ( typically a twitch of the nose or lips) because
of hypocalcemia ( example: from hypoparathyroidism, pseusohypoparathyroidism ) with
resultant of hyperexcitability of nerves. It is mostly a sign of tetany. Through classically
described in hypocalcemia, This sign may also seen in hyperventilation, which can lead to a
drastic reduction of the concentration in serum of calcium ions while at normal levels, for the
binding of a significant proportion of ionized calcium with albumin and globulins.
TROUSSEAU’S SIGN

Is the medical sign observed in patients with low calcium which is an indicator also of latent
tetany in which carpal spasm occurs when the upper arm is compressed, as by a tourniquet or a
bp cuff. This sign may be positive before other manifestations of hypocalcemia such as
hyperreflexia and tetany, such as it is generally believed to be more sensitive than the chvostek
sign for hypocalcemia.

To elicit the sign, a BP cuff is placed around the arm and inflated to a pressure greater than the
systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery and
in the absence of blood flow, the patient is hypocalcemia and subsequent neuromuscular,
irritability will include spasm of the muscles of the arms and forearm.

NEPHROTIC SYNDROME- Is a kidney disorder that causes the body to excrete too much
protein in the urine and includes low blood protein levels in blood, high cholesterol level, and
swelling.

CAUSES

Nephrotic syndrome is caused by different disorders that damage the kidney, that leads to release
of too much protein in urine.

The most common cause in children is minimal changes disease (which is damage in glomeruli).
In adults the most common cause is membranous glomerulonephritis ( a disorders that leads to
changes and inflammation of the structures of glomeruli that filters waste and fluid). It can also
be a caused by secondary disease like cancer, diabetes, systemic lupus erythematous, hepatits B.

DIAGNOSIS

Along with obtaining a complete medication history, a series of biochemical test are required
such as albumin blood test, BUN, creatinine blood test, urinalysis in order to arrive at an accurate
diagnosis that verifies the presence of infection

SYMPTOMS

Swelling (edema) is the most common symptoms, it may occur in face, feet and ankles and
belly area . It is also accompanied by skin rash or sores , foamy appearance of urine (protein)
weight gain (fluid retention ) seizure.

TREATMENT

The goal of treatment are to relieve symptoms, prevent complication, and to delay kidney
damage, and it includes keeping the blood pressure low to delay kidney damage, so ACE
inhibitor may given or angiotensin receptor blocker. Treating high cholesterol to reduce the risk
of heart and blood vessels problems. Low salt diet may help with swelling in hand and legs.
ERCP ( ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAM)

Is a diagnostic procedure designed to examine disease of the liver, bile ducts and pancreas using
a scope that is put through the mouth and gently moved down the throat. Until if goes to
esophagus, stomach and duodenum until it reaches the point where the ducts from the pancreas
and gallbladder drain into duodenum together with the guide of x-ray.

Frequently, therapeutic measures can be performed at the same time of ERCP to remove stones
in the bile ducts or to relieves obstructions of the bile ducts.

WHY IT IS PERFORMED?

The procedure is used mostly to treat a problem of pancreas or bile ducts that can cause
abdominal pain (most often in R upper or middle stomach area)

GRCF may also be used to open the entry of the ducts into the bowel (sphicterectomy)

Stretch out narrow segments ( bile ducts strictures)

Remove or crush gallstones

Diagnose conditions such as biliary cirrhosis

Take tissue samples to diagnose a tumor of the pancreas, bile ducts, or gallbladder

AFTER PROCEDURE

Someone will need to drive you home from the hospital. The air that is used to inflate the
stomach and bowel during an ERCF can cause some bloating or gas for about 24 hours. After
the procedure, you may have a sore throat for the first day.

URETEROLITOTHOMY

Refers to the open or laparoscopic surgical removal of a stone from the ureter that is tool large to
pass, cause pain or bleeding, blocks the flow of urine, or places pressure on the kidney.

General Anesthesia will be used.

An incision will be made in your side or abdomen and depend exactly where the stone is ( by
taking image of urinary system). A --- may be placed in the ureter to help the ureter to keep
open.

CREATININE CLEARANCE TEST

May be used to help detect and diagnosed kidney dysfunction that may be used in follow up to
abnormal results on a blood creatinine test and glomerular filtration rate. ( the rate of blood flow
through the kidney )

CREATININE

Is a waste product of creatine, which is a chemical that the body uses to supply the muscles with
energy. Creatinine is for medication as a result of the natural breakdown of the muscle tissue and
can then enter the blood.

Under normal condition, your kidneys filters creatinine from the blood.

Creatinine leaves the body through the urine

Anyone can be at risk for a kidney disease at some point in time. However, some people are
more at risk that other for developing kidney disease. You are at higher risk for developing
kidney disease if you are over 60 y/o or if you have diabetes, high BP, a history (family) of
kidney D.O, so you need to have creatinine clearance test.

HOW IT IS DONE?

This test requires samples of blood and urine. The blood sample is drawn through a needle from
a vein in the arm.

For a 24hr urine test, you must collect “all” of your urine for 24hrs. Empty your bladder
completely first thing in the morning without collecting it and note the time. And collect your
urine every time you urinate over the 24hrs. This includes the following morning when 10mins.
of the time you collected your first urine sample.

NORMAL CREATININE TEST RESULTS

88-128 ML/MIN (WOMEN)

97- 137 ML/MIN (MEN)

BUN is also a indicator of kidney function.

NORMAL BUN = 7- 18 MG/DL

LAPAROSCOPIC SURGERY

Also known as “minimally invasive surgery” describes the performance of surgical procedures
with the assistance of video camera and several thin instrument. It is a modern surgical technique
in which operation be performed far from their location through small incisions ( usually 0.5-1.5
cm) else where in the body.
There are number of advantage to the patient with laparoscopic surgery versus the more
common, open procedure. Pain and hemorrhaging are reduced due to smaller incisions and
recovery times are shorter.

The key element in laparoscopic surgery is the use of laparoscope, a long fiber optic cable
system which allows viewing of affected area by snakig the cable from a more distant, but more
easily accessible location.

PROCEDURE

During laparoscopy, surgeon make a small cut (incision) of around 0.5-1.5 cm, usually near the
belly button. A tube is inserted through the incision and carbon dioxide gas is pumped through
the tube to inflate the abdomen to allow s surgeon to see the organs more clearly and gives them
more room (space) to work. A laparoscope in then inserted through this tube and relays images
to a television monitor in the operating theatre.

CYSTOLITHOTOMY

Is a term used for the surgical removal of bladder stones via lower abdominal incision that is
typically performed for a patient with large or numerous bladder stones or if an endoscopic
approach has not been successful.

PROCEDURE

Open removal of bladder stone is performed under general anesthesia. The first step is
cystoscopy ( which is an visualization of urethraand bladder under general anesthesia. Once the
abdomen has been examined, an incision is made in lower abdomen to access the bladder and the
bladder is open and the stones remove.

Sometimes it is necessary to gently drip fluid in and out in the bladder, for a period of time as
there is often some bleeding from bladder as a result of the operation. The catheter will remain in
place for 1-2 weeks depending on the size of incision in the bladder.

SERUM ELECTROLYTES

Is a substance and are minerals in the blood other fluid that carries an electric charge. In our
bodies, electrolytes includes sodium (Na+), potassium (K+), calcium (Ca2+), Bicarbonate
(HCO3-), Magnesuim (Mg2+), Chloride( CI-), and hydrogen phosphate (HOP42-)

Electrolytes affects how you body function in many waste include :

 the amount of water in your body

 acidity of blood Ph
 muscle function
SERUM is a component of blood which not contains cells. It is the portion of blood that is not
electrolyte or any of the clotting factors.

SERUM ELECTROLYTES are ions in liquid or gel forms and this are the components of our
blood that carries out the “helper” tasks. They’re the components of our bodies that use their
charge (- or +) to lend a helping hand to our proteins/enzymes etc. so they may carry out their
functions properly.

ELECTROLYTES PANEL TEST

Used to identify an electrolytes, fluid or pH imbalance ( acidosis and alkalosis)

The electrolytes panel typically includes test for.

1. SODUIM- is the most found in extracellular fluid, outside of the body’s cell, where it
helps to regulate the amount of water in the body.
2. POTASSUIM- is found mainly inside the body’s cells. Monitoring potassium is
important as small changes in the potassium level can affect the heart’s rhythm and
ability to contract.
3. CHLORIDE- this electrolyte moves in and out of the cells to maintain electrical
neutrality and its level usually mirrors that of sodium.
4. BICARBONATE- the main job is to released and reabsorbed by the kidneys to help
maintain a stable pH level.

HYPERNATREMIA- increase sodium in blood occurs whenever there is excess sodium in

relation to water. Causes : kidney disease, too little water intake, and loss of water due to
diarrhea of vomiting.

HYPONATREMIA- occurs whenever there is relatively increase in the amount of body water
relative to sodium. Causes : disease of liver and kidney, patient with CHF and in burn victims.

HYPERKALEMIA- potassium is normally excreted by the kidney so the decrease the function
of the kidney can result to hyperkalemia.

HYPOKALEMIA- can arise due to kidney disease, excessive losses due to heavy sweating,
vomiting, diarrhea.

HYPERCHLOREMIA- may be seen in diarrhea, certain kidney disease and sometimes in over
activity of the parathyroid glands.

HYPOCHLOREMIA- chloride is normally loss in urine sweat and stomach secretion.

RETROGRADE PYELOGRAPHY
Is a form of x-ray used to get details of the bladder, ureters and kidneys using a special dye
(contrast agent) that is injected to ureter to be more easily to seen on the x-ray. The flow of
contrast (up from the bladder to the kidney) is opposite the usual out bound flow of urine.

The procedure requires cystoscopy (endoscopy of urinary bladder via urethra) and placement of
small tube into the lower part of the ureter to inject contrast. It is usually done under
general/regional anesthesia.

INDICATION: you may need RP if your heath care provider thinks something is blocking in
your kidney or ureters. It is also to identify a possible cause of blood in urine, that may be a
tumor, stone, blood clot or narrowing.

SHOCK WAVE- also known as extracorpeal shock wave therapy is a treatment used in physical
therapy, orthopedics, urology, and cardiology. The shock wave are abrupt, high amplitude pulses
of mechanical energy, similar to sound waves, generated by an electromagnetic coil or a spark in
water. Similar technology using focused higher is used to break up kidney and gallstone and is
termed as LITHOTRIPSY.

“EXTRACORPEAL” means that the shockwaves are generated externally to the body and
transmitted from a pad through the skin.

EXTRACORPEAL SHOCK WAVE LITHOTRIPSY (ESWL)

Uses a shock waves to break a kidney stone into small pieces that can more easily travel through
the urinary tract and pass from the body.

WHAT TO EXPECT AFTER? After ESWL, stone fragments usually pass in the urine from
few days and causes mild pain.

INDICATION: it may be used on a person who has kidney stone that is causing pain or
blocking the urine flow stones that are between 4mm to 2cm in diameter are more likely to be
treated with ESWL.

ESWL may work best for kidney stone in the kidney or ureters close to the kidney. The surgeon
may push the stone back into the kidney with small instrument (ureteroscope) and then use
ESWL.

STOMA- an anatomy, a natural stoma is any opening in the body, such as the mouth. But
surgically, it is an opening surface of the abdomen which has been surgically created to divert
the flow of feces or urine. Individuals of all ages can have a stoma, and there’s many reasons for
surgery including cancer, ulcerative colitis, crohn’s disease, diverticular disease or trauma.

TYPES OF STOMA
Generally, a stoma will be pink and moist (like the inside of our cheeks) a stoma will initially be
swollen after the operation but this will reduce after 6-8 wks. There are no nerves in a stoma so
there are no sensations when touching it.

COLOSTOMY- is the term used to described an opening from the colon (large intestine) in
which the surgeon will bring apart the colon from inside patients body, through their abdomen to
the outside and stitch it down to secure it. Normally, this will be on the left side of the abdomen.

The output in here differs from person to person but the stoma commonly functions between 1-
3x a day. The output tends to be more solid and often resembles to a traditional stool.

ILEOSTOMY- is the term used to describe the opening from the small intestine, specially the
ileum. The surgeon will bring a part of a small intestine from inside the patient’s body, through
their abdomen to the outside and stitch it down to secure it. Typically, this will be on the R of the
abdomen.

An ileostomy is more active with the output being looser than the of colostomy and to clean the
bag every 3-6x a day.

UROSTOMY- is the term used to described the opening for a person’s urine, by taking a piece
of a person’s small intestine and attaching the ureter to it forming a passageway for urine to pass
trough. One end of the tube is brought out through the abdomen to create the urostomy.

TEMPORARY OR PERMANENT STOMA- some ostomy patient have a temporary stoma

formed with the intention that it may be later be reversed. This is often the case when the
diseased or damage bowel lower down the digestive system needs time to heal for a period of
time. Other patient have a permanent stoma formed from the outset but improved surgical
techniques mean that operation to form permanent stomas are declining.

ANTI DIARRHEAL- are the name given to certain types of medicine that stop or slow
diarrhea which only relieve the symptoms such as increased frequency and urgency when
passing stools, but they do not eliminate the cause of it ( bacteria or other microorganisms or
other causes) this means that as soon as you stop taking an anti diarrheal, diarrhea will return
unless whatever has caused it. Some diarrheals works by slowing down intestinal contraction,
increasing the time it takes for the content of the bowel to be excreted. This allows move water
to be absorbed from the bowel back into the body, reducing the water content of the stool.

TYPES :

ANTIDIARRHEAL DRUG (LOPERAMIDE) - works by slowing down how fast things

move through the intestines. This allow more fluid to be absorbed so that you have less diarrhea
and more formed stools.
BISMUTH SUBSALICYLATE – works by balancing. The way fluid moves through the
intestines. It also reduces inflammation and keeps certain bacteria and viruses the cause diarrhea
from growing in the stomach and intestine.

CONTRAINDICATIONS

Do not give loperamide to children 2 years old.

Don’t take loperamide if you have fever of you have rash or an allergic reaction after taking it.

SIDE EFFECT

Anti diarrhea:

 Constipation, nausea and vomiting

Bismuth Subsalicylate

 Tinnitus

LOPERAMIDE – brand name – IMODIUM

BISMUTH SUBSSALICYLATE - brand name – KAOPECTATE, PEPTO- BISMOL