MEDICAL

Question 1

Define AKI

Answer 1

• AKI is classified by the rise in serum creatinine (a measure of glomerular function) and the reduction in urine output (a measure of waste removal/overall kidney function).

Question 2

define pre renal failure and causees

Answer 2

• Any aetiology which causes a reduction in the required MAP for renal function can be classified as a pre renal cause of AKI

pre renal failure we are thinking about aetiologies associated with hypotension (think pump, vessel or volume failure)
* Hypovolemia
* Cardiac failure
* Peripheral vascular disease (consider sepsis/ anaphylaxis/cirrhosis etc

Question 3

define intra renal failure and causes

Answer 3

• intra-renal failure is kidney failure as a result of damage or impaired function of the tubules, nephrons or glomerulus

rhabdo
medications

Question 4

how does rhabdo effect the kidneys

Answer 4

can lead to aki due to wide spread release of myoglobin

Myoglobin can cause AKI through three mechanisms; the promotion of renal vasoconstriction (influencing blood flow), formation in intratubular casts (accumulation of myoglobin in the renal tubules, affecting throughflow), as well as the direct toxic effects that myoglobin has on the tubular cells. Myoglobinuria, the presence of myoglobin in the urine, is diagnostic of rhabdomyolysis and skeletal muscle injury.

Question 5

define post renal failure

Answer 5

impairment or injury to the bladder, prostate and urinary tract - any mechanism which impedes urine outflow. This causing a urinary backlog, leading to an increased pressure in the collecting system, ultimately causing an impedance on glomerular filtration.

Question 6

4 main things that contribute to liver dysfunction

Answer 6

• Toxins ( eg paracetamol OD)
• Ischemia (impaired blood flow resulting in impaired function. Hepatic blood flow is over 1400mls/min)
• Sepsis ( not fully understood, re connection around inflammation and increased reliance for medication and toxin clearance)
• Viruses

Question 7

define portal hypertension

Answer 7

Portal hypertension is a serious complication of liver disease characterized by abnormally high blood pressure in the portal vein, which carries blood from the digestive organs to the liver. It can lead to serious complications like bleeding varices, ascites, and hepatic encephalopathy.

Question 8

what is albumin

Answer 8

a protein that maintains blood volume and prevents fluid buildup

Question 9

define hepatic encephalopathy and its pathogenesis

Answer 9

(HE) may be defined as a disturbance in central nervous system function because of hepatic insufficiency.

nitrogenous substances derived from the gut adversely affect brain function. These compounds gain access to the systemic circulation as a result of decreased hepatic function or portal-systemic shunts. Once in brain tissue, they produce alterations of neurotransmission that affect consciousness and behaviour.

Question 10

mx of haemodynamic failure in ALF

Answer 10

characterised by hyperdynamic circulation with high cardiac output, low MAP and low systemic vascular resistance.

• The initial treatment of hypotension should involve intravenous infusion of normal saline and a volume challenge is recommended
• After adequate fluid replacement and treatment of infection and sepsis, vasopressors may also be required to maintain adequate MAP and CPP
• Noradrenaline, with fewer β-adrenergic side effects, could increase hepatic blood flow in parallel with minimizing tachycardia and is often the preferred vasopressor
• Patients with uncorrectable hypotension after volume repletion and vasopressor administration should be evaluated for adrenal insufficiency, which occurs frequently in this setting. Adrenal insufficiency could be corrected with a stress dose of hydrocortisone 200-300 mg/d in divided doses.

Question 11

main causes of pancreatitis

Answer 11

alcohol or gallstones

Question 12

bicarb buffering system equation

Answer 12

co2 + H20 -> hc03 -> H+ + hco3

Question 13

what is anion gap and how to measure

Answer 13

usually 8-16mm/l
used for eval of meta acid
sum of your cations (+) minus your anions (-)
either means you have an accumulation of acids or impaired excretion / increase in anions

Question 14

base excess

Answer 14

• BE= Amount of acid/alkali needed to get pH back to normal
• If negative=deficit If positive=excess
• Measures total amount of bases have in body
• Normally +2 to -2 (tight range)
• If its saying +5 (excess) = alkalosis, this means that to get it back to normal we need to “minus” 5
• If its saying -5 we are “missing” -5 “base units” = acidosis, so to get back to normal we need to “add” 5 units