Week 4 Acute on Chronic Conditions

Question 1

Acute on chronic disease

Answer 1

a situation where a patient has an underlying chronic condition (e.g., COPD) and experiences an exacerbation (flare up) of that condition

Question 2

Exacerbation of COPD - pathophysiology

Answer 2

When a patient has underlying COPD and due to various reasons (e.g., viral illness), they will experience an exacerbation of their symptoms which requires acute management and often hospitalisation
Increased airway resistance → worsening airway inflammation → critical EFL (expiratory flow limitation) and DH (dynamic hyperinflation) with an increased loading and functional weakness of the inspiratory muscles

Question 3

Acute on CKD - pathophysiology

Answer 3

Characterised by kidney damage (including urea and creatinine) or GFR <60ml / min for >3 months (lethargy, itchiness, SOB)

Early stages - polyuria, especially at nighttime
Stage 1 - eGFR 90> - mild kidney damage, kidneys work as normal
Stage 2 - 60-89 - mild damage but kidneys still work well
Stage 3 - 50% of nephron function is destroyed, hypertension, elevated urea and creatinine levels, anaemia (affects all body systems)

PRE-RENAL AKI - decrease in blood flow to the kidneys therefore cannot function properly, causing decreased urine output, increased serum creatinine levels (due to dehydration, low blood pressure, or heart failure, 65 MAP)

INTRARENAL AKI - damage to the kidney tissue itself, often due to ischemia or toxins. Kidneys cannot effectively filter waste products and fluids from the blood (results in decreased urine output, increased serum creatinine levels, oedema and electrolyte imbalances)

POST-RENAL AKI - blockage of urine flow out of the kidneys (due to kidney stones, tumours, or prostate enlargement). Urine backs up into the kidneys, which can cause swelling and damage to the kidney tissue (decreased urine output, increased serum creatinine levels, urinary retention and flank pain)

Question 4

acute on chronic pulmonary oedema

Answer 4

left sided heart failure
- blood moves from the lungs to the body via the left side of the heart
- heart does not contract effectively causing a build up of fluid on the lungs