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Health and Society Year 3 > Metabolic > Flashcards

Metabolic Flashcards

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1
Q

Prevention of AKI

A

Maintain perfusion
Correct hypovolaemia, cardiac output and blood pressire
Glycaemic control
Avoid nephrotoxic drugs

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2
Q

How often does a patient require hamodialysis

A

3 days a week

4 hours each session

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3
Q

Advantages and disadvantages of haemodialysis

A

Adv: treatment free days
Disadv: timely and costly travel, restrict fod and drinks

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4
Q

Explain how peritoneal dialysis works

A

Continuous Ambulatory Peritoneal Dialysis (CAPD): Portable but 2h a day dialysing (30-40 mins 4x a day)
Automated Peritoneal Dialysis (APD): Overnight

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5
Q

Advantages and disadvantages of peritoneal dialysis

A

Adv: easily at home, portable, fewer food restrictions
Disadv: risk of peritonitis, low protein/malnutrition

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6
Q

General advantages and disadvantages of dialusis

A

Adv: Life saving, relief from oneliness, can still exercise, swim and go on holiday
Disadv: depression, dependence on hospital, time consuming, impact social life, sie effects

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7
Q

Effects of incontinence

A

Stigma, distress, embarrassment, inconvenience, self-esteem , quality of life
Increases morbidity, depression and institutionalisation

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8
Q

Where are transplant patients registered

A

UK national transplant database

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9
Q

Who determines allocation

A

Medical professionals, DoH, advisory groups

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10
Q

Which transplants are urgent

A

Heart and liver

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11
Q

What is the allocation based of?

A

Tissue match (ABO/HLA) and number of points (length of time on list and age)

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12
Q

Types of donation

A 
Cadaveric (brain death or cardiac death)
Live donor (related or unrelated)

Brain death common then living then cardiac least common

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13
Q

What is the role of an independent assessor

A

Independent of transplant team
Sees donor and recipient
Ensures no coercion or compensation
Ensures donor is informed, has capacity, explores relationship

Licensed by the human tissue authority

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14
Q

Factors that affect the choice to transplant

A

Availability of organ
Waiting lists
Other recipients
Compliance with anti-rejection medication
Likelihood of organ abuse and effective transplantation

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15
Q

Adverse effects of organ donation

A

Organ rejection
Non-compliance with medication
Patients continue to drink/take drugs

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16
Q

What is the role of the Human Tissue Act

A

Regulates the removal, storage and use of human tissue

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17
Q

Define DNA theft

A

It is unlawful to have human tissue with the intention of DNA being analysed without consent from the donor

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18
Q

Offences under the human tissue act 2004

A

Removing, storing and using human tissue for purposes without consent or for another purpose than specified
Trafficking in human tissue
DNA theft
No license

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19
Q

Who cannot become an organ donor

A

Active cancer, HIV, Hep C

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20
Q

What system does the UK currently have

A

Opt out from spring 2020

The family will be approached before the donation and their decisions respected

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21
Q

Groups excluded from UKs opt out system

A

Under 18
Lack mental capacity to understand new arrangement
Visitors to england
Living in england less than 12 months

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22
Q

Organ donation in children under 18 years

A

The family will be asked to make a decision and provide consent
If a child wants to donate, parents must consent

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23
Q

What can individuals do if they want to donate but their family are against it

A

Nominate two representatives to be asked for you

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24
Q

How can an individual indicate their willingness to donate

A

Making wishes known to family and friends

Carrying a donor card and registering on the register

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25
Q

Difference between soft and hard opt out

A

Soft: e.g. spain, if relative hasn’t opted out then relatives can refuse
Hard: e.g. australia relatives views aren’t taken into account

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26
Q

Arguments for opt out system

A

Saves more lives at no cost to the individual (ethically correct thing to do)
UK law: corpse is not considered properly but relatives wishes will be taken into account (soft)
Positive stigma to donation
Still a choice to opt out
People might want to opt in but have never had the opportunity to

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27
Q

Arguments against the opt out system

A

People who believe in the afterlife may feel as though they are forfeiting access
Many religions do support donation
Upsetting to next of kin
Stigma to opting out - people might not want to but feel ashamed to
Shifts from autruistic giving organs to taking them
True consent (autonomy?)

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28
Q

Define altruism

A

Basis of donations in the UK, any other system would make it a market system

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29
Q

Arguments for and against a market system for donation

A

For: supply increased if remove donors, financial rewards lower healthcare costs, donation is cost-effective, each property has rights over their own body
Against: erodes sense of community, redistributes blood from poor to rich

30
Q

Blood demand and supply

A

Demand drastically outweighs supply

Demand for surgery and medicine
Supply: 2 million donors a year, highest supply is A+/O+, lowest supply is O-ve (universal donor)

31
Q

Risks of blood transfusion

A

Wrong blood type

infections

32
Q

Contraindications for donation

A

Tattoo/piercing
Received blood since 1994
MSM in 12 months
Blood infections

33
Q

Alternative to transplant

A

Dialysis - very expensive

34
Q

What are PSA levels affected by

A

Levels affected by enlarged prostate, prostatitis, urine infection, exercise, ejaculation, anal sex, biopsy, medication e.g. finasteride

35
Q

Who can get a PSA screening test

A

Men over 50 after talking to the GP (or over 45 with FHx)

36
Q

Advantages of PSA

A

Helps to detect prostate cancer before symptoms
Early treatment
Save lives
Screening follows utilitarian logic - gives patient an informed choice

37
Q

Disadvantages of PSA

A

Normal range can still indicate cancer
High range - commonly normal
Biopsy can cause pain, infection
Treatment can have side effects: incontinence, ED

Overdiagnosis: people who are diagnosed with cancer that will never cause sx during lifetime
Overtreatment: people treated unnecessarily for tumours that would unlikely be harmful

38
Q

Diagnosis of diabetes for asymptomatic and symptomatic individuals

A

Symptomatic: fasting glucose 7, random or OGTT glucose 11.1
Asymptomatic: same on 2 occastions

39
Q

HBA1c diagnostic

A

48 mmol/mol (6.5%)

40
Q

When can HbA1c not be used

A

Haemoglobinopathies: Increased red cell turnover

41
Q

Roles of the diabetes care team

A

Specialist nurse: care, support and advice, education programmes
Podiatrist: screen for foot problems which impact QOL, recommend footwear, debride wounds and refer to orthoticcs
Dietician: help pts make informed and practical decisions about their diet
Doctors

42
Q

What doctors are involved in diabetes care

A 
Endocrinologist: complex cases
Nephrologist: renal complications
Ophthalmologist: diabetic retinopathy
Cardiologist: CV complications
Neurologist: neuropathy/strokes
43
Q

Diabetes targets

A

BP: 140/80 (130/80 if end organ damage)
HbA1c less than 7%
Cholesterol less than 5%

44
Q

First line drug for diabetes htn

A

ACEi

45
Q

Complications of diabetes

A

Microvascular: retinopathy, nephropathy, neuropathy
Macrovascular: peripheral vascular, cardio and cerebrovascular disease

Other: impaired would healing and infection

46
Q

When does nephropathy occur in diabetics

A

15-25 years after diagnosis

47
Q

Initial diagnosis of diabetes

A 
Enter to diabetes register
Full examination
CV risk factors
Medication review
Educate!
Refer to dietician
Refer to screening programmes

Develop personalised management plan

48
Q

Psychological and social impact of diabetes

A

Increased depression
Hide diagnosis
Unsure how to cope - fear of complications
Anxious about hypos

Monitor glucose
Affect insurance and driving

49
Q

Psychosocial impact of endocrinological disease e.g. thyroid, pituitary, adrenal

A

Psychiatric disorders
Impact mood, weight and fatigue
Impact of regular medication and appointments
Change in appearance e.g. eyes

50
Q

Causes of weight gain

A

Calorie intake is higher than calorie expenditure

Genetics
Hormonal
Medical conditions 
Behaviour: unhealthy eating habits
Environment: fatty foods
Social: unhealthy foods are cheaper, limited transport
Modernisation: convenience food
Urbanisation: more transport, less exercise
51
Q

BMI

A

Healthy: 18.5-24.9

Overweight 25-30
Obese 30+ (5 mild, mod, severe)

52
Q

Waist circumference

A

Men over 94 is high

Women over 80 is high

53
Q

Medical conditions that increase if you’re overweight

A 
Arthritis
Cancer
Carpal Tunnel
Gout 
Surgical complications
T2DM
Renal disease
Gallbladder and liver disease
Sleep apnoea
Urinary stress incontinence
CVD
Chronic venous insufficiency
DVT/PE
Stroke HTN
54
Q

Assessment for obesity

A 
Underlying causes
Eating behaviours
Comorbidities
Risk asssessment (lipid, bp, HbA1c)
FHx
55
Q

When is referral needed

A

Complex disease state (e.g. learning disability)
Underlying cause
Surgery considered

56
Q

Management for obesity

A
  1. advice, lifestyle intervention, 600cal deficit for weight loss
    Medication: Orlistat (BMI above 30)
    Bariatric surgery: BMI above 40, fit for surgery and committed to LT follow up
57
Q

4 ways to tackle obesity

A

Increase exercise: cheaper gyms, more cycle paths and parks
Education: balanced diet
Legislation: advertising and tax
Schools: encourage activity and healthy dinners

58
Q

Define impaired glucose tolerance

A

Blood glucose raised beyond normal levels but not enough for diabetes
Blood glucose between 7.9 and 11.1 after 2h OGGT

There is a long period of impaired tolerance that precedes diabetes, screening can identify these people and risk factors can be addressed
There is still a high risk of developing diabetes

59
Q

Define prediabetes

A

Impaired glucose levels which are above normal but not high enough for diabetes
Impaired glucose tolerance or fasting glucose

60
Q

Best method of reducing CVD risk in diabetes

A

Exercise and lifestyle modification is better than metformin at reducing risk

61
Q

Goals of the diabetes prevention programme

A

Primary goal: to delay the development of T2DM in patients with impaired glucose tolerance
Secondary goal: Reduce CV disease events and risk factors

62
Q

Define alloimmunisation

What increases the risk of it

A

Blood transfusion may immunise the recipient against the donor through antigens
Increased risk with repeated transfusions

63
Q

Explain the ABO and RH blood system

A

ABO: IgM anti-A and anti-B antibodies
RH: IgG RhD antibodies

64
Q

How often can you give blood

A

Men every 12 weeks

Women every 16 weeks

65
Q

What happens during pretransfusion compatibility testing

A

ABO and RH groups determined
Atypical antibodies are screened

Tested against 2 O donors and red cell antigens

Selection of donor blood and crossmatching

66
Q

Process of blood ordering

A

Elective: blood ready
Emergency: Two units O- (emergency)

10-15min: blood with same ABO and RH
45min: crossmatch

67
Q

Complications of blood transfusion

A

Alloimmunisation (subsequent transfusions)
Haemolytic transfusion reaction (pain, rigor, sob, hypotension, hb in urine, DIC)
Non-haemolytic transfusion reaction (febrile reactions)
Urticaria (plasma protein incompatibility)
Infection

68
Q

Avoidance of unnecessary transfusion

A

Strict criteria for blood products
Stop drugs that might cause bleeding in surgery
Treating anaemia prior to surgery
Anti-fibrinolytics

CHECK that the correct product is being transferred

69
Q

transfusion associated deaths

A

Death via serious hazard of transfusion (SHOT)

70
Q

Explain the structure of blood transfusion services

A

NHS Blood and Transplant

Health authority within the NHS that deals with blood, platelets, stem cells, tissues and organs

Health and Society Year 3 (5 decks)

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