Kidney And Urological Disorders And Diabetes And Hypothyroidism

Front 1

Glomerular disease – Nephrotic syndrome

Back 1

Severe proteinuria

Front 2

Test urine with dipstick test for Nephrotic syndrome

Back 2

Proteinuria : Creatinine ratio (PCR)

Front 3

Nephrotic syndrome signs

Back 3

–Oedema
–Hypoalbuminaemia
–Hyperlipidaemia

Front 4

Nephrotic syndrome Diagnosis

Back 4

Renal biopsy
Refer

Front 5

Urinary tract infection “bladder infection” or cystitis

Back 5

Can be complicated or uncomplicated
–Uncomplicated is a lower UTI in a non-pregnant woman.
–Everything else is regarded as complicated (including males and children)

Front 6

pyelonephritis

Back 6

Upper UTI

Front 7

Symptoms of Upper UTI

Back 7

Flank pain/ tenderness
Temperature 38°C or higher
Sepsis with Tachycardia Tachypnoea
Confusion Hypotension and vomiting

Front 8

Children UTI treatment

Back 8

Amoxycillin/clavulanic acid 8 hourly for 5 days according to mass

Front 9

Uncomplicated cystitis treatment

Back 9

Ciprofloxacin, oral, 500 mg as single dose.

Front 10

Complicated cystitis treatment

Back 10

Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.

For pregnant women:
Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 7 days.

Front 11

Prostatitis

Back 11

Infection of the prostate gland by Urinary or STI pathogens

Front 12

Prostatitis Signs

Back 12

–Perineal, sacral or suprapubic pain
-Dysuria and frequency
–Obstruction leading to urinary retention
–Sometimes fever
–Acutely tender prostate on rectal exam

Front 13

Prostatitis Treatment

Back 13

Men < 35 yrs
–Cefixime 400mg stat then doxycycline 100mg bd
Men > 35 years
–Ciprofloxacin 500mg 12 hourly for 14 days

Front 14

Prostatitis refer

Back 14

–No response
–Urinary retention
–High fever
–Chronic or relapsing prostatitis

Front 15

DIABETES MELLITUS

Back 15

» Type I, Type 2
» Pancreatic diabetes mellitus
» Gestational diabetes mellitus
Diabetes Mellitus in
Pregnancy

Front 16

Diabetes Type 1
Symptoms:

Back 16

-Constantly hungry thirsty (polydipsia), Polyuria
–Sweet smell on breath (+ve ketones test)
–Tiredness
–Unexplained weight loss (Type 1) and susceptible to UTI and infecton

Front 17

Diabetes Management objectives

Back 17

Prevent acute and chronic complications
–Control blood sugar levels (under 8 mmol/L)
–Improve and maintain quality of life
–Educate and counsel patients and caregivers on self care

Front 18

Diabetes general measures

Back 18

•Regular meal eating with correct food
•Regular exercise
•Stop smoking, Low to no alcohol intake
•wear notification bracelet

Front 19

Types of Insulin

Back 19

•Short acting (Three times daily, 30min before meals)
•Intermediate action (Once or twice daily, usually bedtime, 8 hours before breakfast)
•Biphasic (once or twice daily)

Front 20

Body Mass Index (BMI)

Back 20

Mass (kg) / Height (m)

Front 21

Complications of Diabetes

Back 21

•Diabetic Foot
•Ischaemic heart disease, Peripheral artery disease
•Stroke
•Deteriorating eyesight
•Foot ulcers

Front 22

Decrease hyperlipidaemia

Back 22

Simvastatin 10mg daily (at night)
ALL type 2 diabetic patients must receive
To reduce cardiovascular risk

Front 23

Diabetic Nephropathy

Back 23

Significant proteinuria
–Spot urine protein creatinine ration of > 0.1g/mmol
–OR Albumin-creatinine ratio > 100g/mol
Rx – ACE inhibitors – enalapril 10mg BD

Front 24

Diabetis monitoring visit

Back 24

At every visit:
» blood glucose,
» weight, and
» blood pressure.

Front 25

Diabetis monitoring annual

Back 25

» potassium,
» creatinine,
» urine albumin creatinine ratio,
» lipids (fasting triglycerides and cholesterol), and
» eye examination to look for retinopathy.

Front 26

Target for glucose level

Back 26

fasting (mmol/L) 4–7, 2-hour post-prandial (mmol/L) 5–8
(HbA1c) (%) < 7
BMI (kg/m2) 18.5 – 25

Front 27

Weght circumference target

Back 27

Male < 94 cm

Female < 80 cm

Front 28

Glycated hemoglobin (HbA1c)

Back 28

is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time.

Front 29

1st line Diabetis 2 treatment

Back 29

Metformin, oral, 500 mg daily with meals.
o Titrate dose slowly depending on HbA1c and/or fasting blood
glucose levels to a maximum dose of 850 mg 8 hourly.

Front 30

Metformin contra indications

Back 30

o renal impairment i.e. eGFR < 50 mL/minute,
o uncontrolled congestive cardiac failure,
o severe liver disease, or
o patients with significant respiratory compromise

Front 31

2nd line Diabetis 2 treatment

Back 31

metformin plus a sulphonylurea
Gliclazide, oral, 40 mg daily 30 minutes before breakfast.maximum dose of 160 mg 12 hourly. Or
Glibenclamide, oral, 2.5 mg daily 30 minutes before breakfast. Max 15 mg daily.

Front 32

Diabetic oral agents contra indication

Back 32

should not be used in type 1 diabetes, renal impairment or
clinical liver failure.

Front 33

Inability to control blood glucose with oral drugs

Back 33

Add Intermediate to long acting insulin 10-40 units max before bedtime, but not after 22h00.
Substitute Biphasic insulin 10 units, 30 minutes
before breakfast.5 units, 30 minutes before supper.
50 units max

Front 34

DIABETES MELLITUS TYPE 1 treatment

Back 34

Insulin, short acting, SC, three times daily, 30 minutes before meals:
Insulin, intermediate acting, SC, once or twice daily
Insulin, biphasic, SC, once or twice daily. (Humalog 30/70)

Front 35

HYPOGLYCAEMIA signs

Back 35

» Anxiety » Sweating
» Palpitations » Hunger
» Headaches » Behavioural changes» Tremor
» Confusion » Coma

Front 36

Hypoglycaemia emergency

Back 36

Dextrose 50%, rapid IV injection, 50 mL.

Front 37

Hypothyroidism causes

Back 37

» thyroiditis,
» post surgery, and
» post radio-active iodine.

Front 38

Hypothyroidism sings

Back 38

–Courseness or Loss of Hair, Cold intolerance
–Depression
–Dry skin
–Weight gain
–Fatigue

Front 39

Hypothyroidism diagnosis

Back 39

Check TSH levels (Thyroid stimulating hormone).

If high, check T4 and T3 concentration

Front 40

Hypothyroidism treatment

Back 40

Levothyroxine sodium 100μg daily
–(syn thyroxine – called Eltroxin®)
If there is a risk of ischaemic heart disease, start at 25 mcg daily
and increase by 25 mcg every 4 weeks.

Front 41

Where to inject insulin

Back 41

into the fatty layer beaneth the skin when holding a pinch of fat
not too close to upper later (cause lump or pain or red spot) or too deep (pain and insulin absorbed too fast)

Front 42

Injection site

Back 42

Buttocks (slowest absorption)
Abdomen (fastest absorbing)
Arms
Thighs
Do regular injection site rotation