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This includes good lighting and health and the associated reduction in productivity of ventilation purchase fosamax no prescription women's health birth control pill, effective temperature order fosamax with american express women's health tone zone strength training, washing and toilet people and the quality of life 35mg fosamax fast delivery pregnancy resources, the strain on medical facilities order fosamax 35mg on-line menstrual irregularities in perimenopause, and cleanliness at place of work. These costs are not only inevitable but much welfare services, creeche, place for having rest, higher than for installing pollution control technology. There should be an occupational health team consisting • Provisions of good housing. The team should: Factories Act, 1948 undertake repeated surveys and periodical medical check-up, investigate any occupational injury or disease, It came into force on April 1, 1949. Any injury and disease, acute or chronic, found by the occupational health team or reported otherwise should Scope and Definitions (Chapter I) be treated promptly and adequately. Other being carried on with the aid of power or is ordi- specific measures may also be needed. A large number of workers are employed in establishments not coming under the purview of the Every factory shall be kept clean and free from effluvia Factories Act. They are deprived of health, safety and arising from any drain, privy, or other nuisance. They are deprived and refuse must be removed daily from benches, stairs, of even the basic amenities like drinking water and toilet floors, etc. Health cover for such workers is patchy and disinfectant (when necessary), once a week. Painting inadequate except in a small number of progressive and varnishing to be done once in 5 years (once in 3 industrial concerns and in the nationalized undertakings years in case of washable water point). History Effective arrangements shall be made for disposal of reveals that the industrial revolution in the West paid wastes and effluents arising from manufacturing process. The responsibility for health, safety and welfare of the workers should rest with the employers and the Adequate circulation of air is required at temperature Government. If work is in high and Advisory Service, advises the government, the temperature, hot parts should be insulated or cooled industries and the others concerned, about matters related by other means. Only the extracts of these measures shall be taken to prevent their inhalation and Acts are given below to illustrate the health, safety and accumulation. If exhaust appliance is necessary for this welfare facilities provided so far by legislation. The Rules purpose, it shall be applied as near as possible to the 93 in this connection are framed by the State Governments. If humidity of air is artificially increased measures which promote health and provide medical in a factory, the water used for the purpose shall be care. Some provisions are as follows: taken from a public supply or other source of drinking water, or shall be effectively purified before it is so used. Persons handling them be situated within six meters of a washing place, should be trained and readily available any time. If latrine or urinal more than 500 workers are employed, an ambulance • If more than 250 workers are employed, cool water room should be provided with medical and nursing staff to be provided in hot weather. The Latrine Accom m odation (Rule 41) accommodation should be adequate, lighted and venti- 1 latrine for 25 females; for males, 1 for 25 up to 100 lated. Section 94 40-B provides for appointment of a Safety Officer in It provides: “No adult worker shall be required or allowed factories employing 1000 workers or more. Efforts in this direction began It provides a holiday for or one full day each week. The scheme was first started in February, 1952 in the industrial towns of Not more than 5 hours work at a stretch followed by Delhi and Kanpur and now it covers most of the industrial rest for at least half an hour. No child to work for more than four and the following: a half hours a day and not at night from 10 pm to 6 • Nonpower using factories employing 20 or more am (Section 71). At present the Certain accidents to be notified by the manager of the employees drawing wages up to Rs. An employee who is covered specified in the third schedule of the Act, the manager at the beginning of a contribution period shall continue shall send notice therefore to the prescribed authorities. An industrial worker is • Minister for Labor-Chairman exposed to ‘employment injury’ which includes • Secretary, ministry of labor-Vice Chairman accidents and diseases related to his occupation. During • 5 representatives of Central Government 95 illness or employment injury, a worker faces fear of • One representative each from the States and one economic, physical or even social ruin. Social insurance representatives of Union Territories • 5 representatives of employees and 5 of employers, • Maternity-benefits 2 of medical profession and 3 Members of • Disablement benefit Parliament. The medical benefit also includes • Director General of Health Services; ambulance services, domiciliary treatment facility and • Deputy Director General of Health Services; provisions of drugs, dressings and some appliances. A dispensary with full time medical assisted by 4 Principal Officers: (1) Medical Commis- officer and paramedical staff serves an area having sioner, (2) Financial Adviser and Chief Accounts Officer, 1000 or more ‘employees family units’; but part (3) Insurance Commissioner, (4) Actuary. Indirect system or Panel system: In this system Regional and Local Medical Benefit Councils. It empanelled private medical practitioners called delegates them powers to administer the scheme in the ‘Insurance Medical Practitioner’ provide care to the States. It also appoints Inspectors to inspect factories workers and their dependent family members. The scheme is primarily funded by contribution raised from insured employees and their employers as Extended sickness benefit (cash): For some specified a small but specified percentage of wages payable to long-term diseases like paralytic disorders, tuberculosis, such employees. The covered employees contribute leprosy, coronary artery disease, psychosis, chronic 1. Employers earning less than fifty rupees a day absence from work on medical advice are entitled for as daily wage are exempted from payment of their share the cash benefit for longer period of two years. The state government as per the payable in cash as extended sickness benefit is equal to provision of the act bears one-eight share of about 70 percent of the daily wages. The Benefit to employee: Various benefits under the act that duration of benefit for miscarriage is 6 weeks. The rate the insured employees and their dependants are entitled of payment of the benefit is equal to wage. The payment is made according to labor enactments such as Workmen’s Compensation the plan prescribed. Worker Absenteeism Other benefits: Absenteeism is a major factor affecting work productivity • Free supply of physical aids and appliances such as and is closely related to a worker’s health as well as his crutches, wheelchairs, spectacles and other such personal, domestic and social life. The causes of • Rijiv Ghandhi Shramik Kalyan Yojana: Under this absenteeism are: scheme the insured person who are rendered • Sociocultural causes related to domestic and social unemployed involuntarily due to retrenchment / factors such as joint family system, harvesting season, closure of factory is entitled for unemployment fairs and festivals, quarrels, etc. Rehabilitation benefit: Workers entitled to receive an It should be apparent from the above that the first artificial limb are awarded a rehabilitation allowance, for two causes are not directly related to disease or each day of their admission at the artificial limb center, occupational hazard at all, while the third cause has only for provision or replacement of an artificial limb. It is thus implicit, and several other Acts that have been framed to ensure amply borne out by facts, that only a small proportion worker’s rights, safety, health and welfare. The Government of India will bear the Some New Initiatives employer’s share of provident Fund contribution on 14 wages upto Rs. Delhi: National certify skills of youth population in the country to Book Trust 17, 1984.

Pharmacological interventions should take into consider- This may assist in the development of environmental and ation the increased sensitivity of elderly patients to medi- communication modifications to enhance function cheap fosamax online visa women's health xmas kekse. Age-related physiological changes and pharmacokinetic implications Function Pharmacokinetic effect Clinical implications in relevant drugs Absorption ↓ Rate of absorption Delayed onset purchase fosamax american express breast cancer 2a, incomplete absorption buy generic fosamax on line women's health yuma az, reduced effect ↑ Gastric pH ↓ Gastric emptying ↓ Mesenteric blood flow Distribution ↑ Volume of distribution for lipophilic drugs ↑ Time until steady-state plasma concentration ↓ Muscle mass ↑ Elimination half-life of lipophilic drugs ↓ Duration of effect of single doses ↓ Total body water Slower titration ↑ Total body fat Plasma protein binding ↑ Free fraction of highly protein-bound drugs ↑ Potency and toxicity at lower doses ↓ Albumin Reduced dosage ↓ γ1-acid glycoprotein Hepatic metabolism ↑ Elimination half-life of hepatically metabolized ↑ Time till steady-state plasma concentration drugs ↓ Liver volume ↑ Ratio of parent drug to demethylated derivative Reduced dosage ↓ Hepatic blood flow Slower titration ↓ Oxidative metabolism ↓ N-demethylation → Conjugation Renal clearance ↑ Elimination half-life of active hydrophilic drugs ↑ Time till steady-state plasma concentration ↓ Renal blood flow Reduced dosage Glomerular filtration Slower titration rate Note cheap fosamax 35mg menstrual tracker app. This approach is ad- Mood stabilizers and atypical antipsychotics appear to be dressed more completely in Chapter 36, Psychotherapy. Clari- the specific circumstances and needs of elderly patients fying the symptom may be important to effective treatment. Atypical antipsychotic medications may reduce ir- ritability and aggression in elderly patients with dementia. The atypical antipsychotic medications have been role functioning in families that have often had stable roles well studied in treatment of dementia-related agitation and for decades. The modest overall efficacy of these drugs must the practical implications of these changes may reduce be weighed against the small but statistically significant caregiver distress. In particular, engaging families with risk of increased mortality and cerebrovascular adverse support groups that provide mentoring and education re- events (Schneider et al. Caregivers and patients must be helped in the process of grieving lost functioning. As in the dementias, behav- Cognition ioral disturbances are a major cause of caregiver distress Acetylcholine has been recognized as a principal neuro- and an obstacle to successful community functioning. Likewise, such disturbances may accelerate the need for chemical mediator of learning and memory (Thiel 2003). However, dopaminergic functioning has also been identi- institutional placement, primarily mediated through the fied as an important component to the neurochemistry of impact of behavioral problems on caregiver distress (Yaffe et al. Therefore, providing caregivers with psycho- cognition (Nieoullon and Coquerel 2003). Management of Cognitive deficits may also respond to treatment with dopamine agonists. Amphetamine has been found to Depression enhance functional recovery in a chart review study (Horn- Depression is an independent risk factor for mortality in stein et al. In older patients who demonstrate re- advanced age and accounts for substantial functional im- duced initiative and attention, these medications may be pairment (Reynolds et al. Greater dependence on others for cognitive and, at times, physical tasks may engender feelings of loss The elderly represent a rapidly growing population with a and helplessness. The thoughtful application of principles of ge- ing and titration should be adjusted based on the time- riatric medicine will improve the assessment and manage- honored philosophy of “start low, go slow” in recognition ment of this complex patient group. Nevertheless, timely of heightened sensitivity to medication side effects and po- and appropriate rehabilitative and neuropsychiatric inter- tential drug-drug interactions with other nonpsychotropic ventions may provide older patients with substantial func- medications. Neurobiol Aging 18:431–435, 1997 in older adults: epidemiology, outcomes, and future implica- Friedman G, Froom P, Sazbon L, et al: Apolipoprotein E-epsilon4 tions. J Am Geriatr Soc 54:1590–1595, 2006 genotype predicts a poor outcome in survivors of traumatic brain injury. Brain Inj 10:145–148, 1996 outcome and mortality in elderly patients with head injuries. Biol Psy- functional recovery from brain injury following postacute re- chol 54:35–54, 2000 habilitation. Semin and time to onset of Alzheimer’s disease: a population-based Nucl Med 37:69–87, 2007 study. The prevention can include many aspects, but both disorders (Substance Abuse Task Force 1988). Moreover, of disorders as independent and interactive enhances the 58% of all surgical admissions and 72% of all hospital total treatment of the patient (Kreutzer et al. Those who are actively involved in mented because often specific testing and history taking the treatment must be skilled in the intervention, referral, for drugs are not part of either routine clinical practice or and, in some cases, the actual long-term management of research studies. Although a specialist may be em- the implications of drug histories when clear evidence ex- ployed for either category of disorder, he or she must know ists. The reasons for poor documentation are complex and the ramifications of both disorders. For instance, the ad- include poor skills in assessing the importance of drugs diction specialist must know and work with the limita- and alcohol as well as ignorance that effective treatment 461 462 Textbook of Traumatic Brain Injury for alcohol and drug disorders exists. Fifty percent of all fatal acci- do not often include measurement of urine or blood for il- dents in the United States are motor vehicle accidents. The common occurrence these fatal motor vehicle accidents, 50% are associated of multiple drug and alcohol use or addiction in high-risk with alcohol and drugs. The prevalence rate for alcoholism in the United States The high degree of association of alcohol/drug use and is approximately 15%. Studies of prog- 22 years in men and 25 in women, according to the Epide- nosis and outcome after brain injury frequently exclude miologic Catchment Area study (Miller 1991b). The re- individuals who are addicted to drugs, alcohol, or both be- ported prevalence rate for drug addiction in the general fore accidents, even though this practice produces signif- population ranges from 9% to 20%. The majority of drug- icant and relevant distortions of data (Sparadeo and Gill addicted individuals are addicted to alcohol, and substan- 1989; Substance Abuse Task Force 1988). In one evaluation of primary care physicians studies suggest that ethanol may have a neuroprotective (Miller 2002), 94% were unable to identify a substance effect, though these results are conflicting and warrant disorder as one of five diagnostic possibilities in case stud- more prospective studies (O’Phalen et al. When case studies described early signs of a drug disorder in teenagers, 41% of pediatricians failed to provide sub- stance disorder as one of five diagnostic possibilities. Also, Intervention in the Acute State nearly three-fourths of patients seeking treatment for a drug disorder did not receive guidance from their primary The first clinical caveat is that if alcohol or drug addiction, care physician. Frequent complications include tions is 50%–75% and 25%–50% in medical populations. Other average age for men in treatment is 30–35 years, and the possible complications include behavioral dyscontrol, average age for women is 25–30 years. One hundred thousand peo- tory depression after acute intoxication and overdose are ple die annually in accidents in the United States. Importantly, some vehicle accidents are the leading cause of death for teens in intoxicated patients are discharged from the emergency the United States, accounting for more than one-third of department when in fact they have undiagnosed brain in- the deaths in this age group. In a study of 167 patients (Gallagher and Browder between the ages of 15 and 19 were killed and almost 1968), alcohol obscured changes in consciousness, lead- 400,000 were treated in emergency rooms for injuries sus- ing to misdiagnosis or delayed diagnosis of complications tained in motor vehicle accidents (Centers for Disease Con- of brain trauma. Criteria for substance dependence Drug-drug interactions A maladaptive pattern of substance use, leading to clinically Drug overdose significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12- Increased sensitivity to medication effects month period: Seizures from either drug intoxication or drug or alcohol (1) tolerance, as defined by either of the following: withdrawal (a) a need for markedly increased amounts of the Hallucinations substance to achieve intoxication or desired effect Delusions (b) markedly diminished effect with continued use of the Anxiety same amount of the substance Depression induced by intoxication and withdrawal from drugs (2) withdrawal, as manifested by either of the following: Alcohol and drug seeking from the presence of an addictive (a) the characteristic withdrawal syndrome for the disorder substance (refer to Criteria A and B of the criteria sets for withdrawal from the specific substances) diagnosed only at postmortem (Galbraith 1976), and oth- (b) the same (or a closely related) substance is taken to ers have reported similar results (Rumbaugh and Fang relieve or avoid withdrawal symptoms 1980). Two of the seven criteria reflect With physiological dependence: evidence of tolerance or development of tolerance and dependence on alcohol and withdrawal (i. Any three of the seven criteria are required to make the Without physiological dependence: no evidence of tolerance or diagnosis of alcohol or drug dependence, or both. The manifest loss of control often is reflected by the circum- Early partial remission stances surrounding and including the actual trauma that Sustained full remission culminates in the brain injury. Sustained partial remission It has been well documented that the most effective On agonist therapy clinical approach to both diagnosis and treatment of an al- In a controlled environment cohol or drug disorder involves the acknowledgment of Source. Reprinted from Diagnostic and Statistical Manual of Mental substance dependence as a disease state rather than as a Disorders, 4th Edition, Text Revision, pp. Copy- provide adequate support for the powerful role of inherit- right © 2000 American Psychiatric Association.

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Tere are fnger bows and a pair of hold a considerable length of the stomach site to each other according to surgeon’s shaf purchase fosamax cheap online women's health lansing mi. On proper apposition generic 70mg fosamax women's health clinic qld, the stomach and Uses Uses jejunum are held close to each other by Tis instrument is used for resection and It is used to hold and occlude stomach during this instrument discount 70mg fosamax women's health clinic vancouver wa. What are the indications of intestinal resec- Tis instrument is used during gast- tion and anastomosis? What are the indications of gastrojejunos- See small bowel resection and anastomo- one each for stomach and small intestine trusted fosamax 35 mg healthy tips daily women's health. They look more or less same, the dif- ference being Henry Gray’s forceps is a little lighter and the blades are more angular. The first cholecystectomy forceps is used clamp to hold the fundus of gallbladder and a second one is used to hold the neck of the gallbladder at the Hartmann’s pouch. Dissection of the cystic duct and artery Apart from the general set of instruments afer the anterior layer of the lesser omen- the following instruments are used in biliary tum has been incised and refected. What are the steps of operation of open ment with four joints, so that a maximal Features cholecystectomy? The blades have longitudinal serrations with transverse serrations on their inner 3. The curvature of the blades helps in tying However, surgeons rarely use these clamps the vessels at depth. The short limb of the T – Tube is cut to Because the bile duct is a delicate structure its desired length and is passed inside within which the instrument is to move. The long limb of the T – Tube is brought out through a stab wound in Features Uses the skin in the lateral abdominal wall a. Following choledochotomy, the bile duct and is connected to a plastic bag for tube and the inner obturator. For minor operations like taking rectal Features biopsy, polypectomy and sclerosant injec- a. Tis tube is used to correct sigmoid volvulus in adults (nonoperative decompression). It is used to aid passage of fatus to reduce the distension of gut in paralytic ileus. How will you diferentiate simple and swab holding or tongue holding forceps strangulated obstruction? The tube is sterilized and well-lubricated The instrument is made malleable and tomy. However, Allis tissue forceps can also with 2 percent xylocaine jelly and then olive pointed instead of sharp tip so as to be used for this purpose. Tere is a circular groove along the inner side of See ‘hemorrhoids’ in the chapter on rec- each blade around the fenestration in the blade. The tip of the catheter is smooth and It is passed like a urethral dilator (Clutton rounded. Tere is an opening at the side Sterilization or Lister’s metallic dilator) – see urethral near the tip. Tere is no bleeding through the ure- thra and urine will come out through the catheter. May be used to relieve retention of urine if advantages of Foley catheters are that the a rubber catheter cannot be passed. The dilated winged end may be made channel is used to infate the balloon patient where prolonged catheteriza- straight by introducing a Malecot catheter which keeps it indwelling or self-retain- tion is required. In three ways Foley’s balloon catheter, catheter is used as bladder irrigation is Uses there is an additional third channel for required. Its uses are the same as Foley’s catheter, except bladder irrigation or drainage, e. Urethral catheterization following ure- that it is never used for urethral catheterization. For intercostal drainage in case of kept in place afer introduction due to dilated empyema, hemothorax or pneumotho- bulbous end. Sterilization Sterilization It is available in a presterilized pack which is By autoclaving. Foley’s catheter is removed afer with- Tis is a French scale measurement and drawing the water from the balloon. Tis catheter is nonballooned and used Tis is identical to Lister’s metallic bougie By autoclaving. What are the complications of urethral which is least irritant and more tough in b. When does a stricture is said to be stylet is removed afer the catheter is cation as in Lister’s metallic bougie. Tis is long instrument with a pair of Sterilization cholithotomy this is used as a sound to blades, a pair of shafs and fnger bows. It is a solid cylindrical metallic instrument with a defnite curvature near the tip. The denominator number indicates the circumference in mm at the base, and the numerator indicates the circumference in mm at 680 the tip. It is made of stainless steel and has a han- during pyelolithotomy, nephrolithotomy or dle and stem system. Use See also ‘renal stone’ in the chapter on kidney It is used for taking the split thickness skin graf. It is a metallic instrument with spoon-like ring-like for the thumb, the other meant ends having sharp edges. Used to curette a chronic abscess either in Use It is one meter long fexible wire with detach- bone or the sof tissue. It is a straight, long, delicate instrument with a pair of blades, shafs and fnger Fig. It is made of India rubber and con- to skin wound by silk suture so that it does a. It drains by capillary action or gravity removed as soon as the discharge is none strikes the instrument. The cutting edge is sharp and bevelled on hydrocele, in the retropubic space afer a long period can cause complications one side in contrast to osteotome, which is bevelled on both sides. It is used to remove bone chips in opera- tions like bone grafing, saucerization, etc. The shaf is grooved and its cutting edge is bones like the metacarpals, metatarsals and It is used for osteotomy which means opera- rounded. Use Sterilization Sterilization It is used like a chisel to cut out small irregu- By autoclaving. It consists of a pair of blades, handles and Tese instruments are used for the purpose valgus deformity. Afer removal of the bone necessary manipulations will correct the angular deformity. The blade is rectangular and its sharp edges elevate the periosteum with slid- ing movement.

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For example 35mg fosamax overnight delivery women's health center duluth, riole cheap 35 mg fosamax free shipping pregnancy symptoms at 5 weeks, an efferent arteriole order fosamax on line women's health blood in the urine, a glomerulus cheap fosamax 35mg on-line breast cancer uggs pink ribbon, a glo- edema can be detected in skin, around the eyes, merular capsule, a proximal convoluted tubule, and on the ankles. As toxins accumulate in the a renal loop (loop of Henle), and a distal con- blood, neurologic abnormalities arise, including voluted tubule that leads to a collecting duct. Alterations nephron and enters the glomerulus, a network in pH levels result in acidosis, which triggers of specialized selectively permeable capillaries, hyperventilation. Chapter Ten Diseases and Disorders of the Urinary System í 201 Glomerular capsule Efferent arteriole Afferent arteriole Glomerulus Proximal tubule Distal tubule Vein Collecting tubule Loop of Henle Pyramid in renal medulla Renal capsule Hilum of kidney Renal cortex Renal artery Renal Renal pelvis vein Ureter Calyx Figure 10–1 The kidney with an expanded view of the nephron. Urinalysis and Laboratory Tests Urine is centrifuged and examined microscop- ically for red blood cells, white blood cells, bacte- Renal disease can be detected through analy- ria, crystals, and casts. Casts form within kidney sis of blood for creatinine, uric acid, and blood tubules from which the casts take their cylindri- urea nitrogen. Casts consist of coagulated protein, can be obtained by urinalysis, in which a urine blood cells, and epithelial cells. For example, diabetics produce large examination enables visualization of the inside volumes of pale and dilute urine. The cystoscope is kidney diseases, the ability of the renal tubules a long, lighted instrument resembling a narrow to concentrate urine is absent. As a result, the hollow tube inserted through the urethra into urine is dilute and pale, and the specific gravity the bladder. Chemical tests may employ a urine dipstick Acute Diseases and Disorders to detect a variety of chemicals. For example, albumin in the urine (albuminuria) can indicate Acute Kidney Injury inflammation of the urinary tract, particularly Acute kidney injury is the sudden onset of of the glomeruli. One is shock, which Chapter Ten Diseases and Disorders of the Urinary System í 203 interrupts blood flow to the kidneys. Risk factors oliguria (low urine output), a sudden drop in include being female, having multiple sex part- urine volume, and rarely a complete cessation ners, and having sexually transmitted infectious of urine production, a condition called anuria. The symptoms of urethritis include a Systemic symptoms arise as the body fails to discharge from the urethra, an itching sensa- clear toxins and acid from the blood. Symp- tion at the opening of the urethra, and a burning toms include nausea, vomiting, diarrhea, and sensation during urination. Cystitis is charac- the odor of ammonia on the breath caused by terized by urinary frequency, a sense of urinary accumulation in the blood of nitrogen-containing urgency, and dysuria, a painful, burning sensa- compounds. Other symptoms include neuropathy, seizures, and coma may occur if low fever and pressure with pain in the lower untreated. Risk factors include being female, kidney urea nitrogen, serum creatinine, potassium, and stones, having a urinary catheter, or immuno- low pH, all of which are signs of the kidneys’ fail- deficiency. In pyelonephritis, infected abscesses ure to clear these substances and acid from the form and rupture, draining pus into urine. Urinalysis will reveal casts, low specific the urine is called pyuria, which makes the urine gravity, and possibly proteinuria. Pyelonephritis is often caused by pyo- vented by treating the causative diseases and by genic (pus-forming) bacteria, such as Escherichia avoiding known kidney toxins. Prevention relies on prompt treatment of marily by bacteria from the skin or colon. If not cleared from the urethra, bacteria can ascend the ure- Inflammatory Kidney Diseases thra and infect the urinary bladder and the kid- Immune system–mediated inflammation of the neys. IgA nephropathy is more common in men, especially those in their late teens to early 30s, although it affects all age groups. Because it takes years to become recog- nized and cause complications, younger people From the lymph seldom display symptoms. The most common early symptoms are blood in the urine and later From the blood swelling of the hands and feet. No treatment is recommended for mild cases with normal blood pressure and proteinuria, but elevated blood pressure requires hypertension medica- From the urine (ascending) tions. Nephritis occurs in about 45% of those with systemic lupus erythe- Acute Poststreptococcal Glomerulonephritis matosus. Antigens from the streptococci and the tests, ultrasound, and might include kidney antibodies form complexes in the bloodstream biopsy to determine the type of kidney injury. Renal transplant toms include chills and fever, loss of appetite, may be performed if the kidney function does not and a general feeling of weakness. Treatment depends on IgA Nephropathy IgA nephropathy is an inflam- the cause and usually involves anti-inflammatory matory disease of the kidney resulting from drugs and immune suppressants. It may also be Chapter Ten Diseases and Disorders of the Urinary System í 205 States. Men are four times more likely than Chills, fever, Edema in face women to produce renal calculi, with the first and weakness and ankles episodes occurring between ages 20 and 40. The lodged stones cause intense pain that Hematuria Albuminuria radiates from the kidney to the groin area. In addition to intense pain, other signs and symp- toms include hematuria, nausea, vomiting, and diarrhea. Casts Kidney stones may cause urinary tract infec- tions by blocking urine flow and permitting bac- Figure 10–4 Signs and symptoms of acute terial growth in the urinary tract. The presence of bladder stones causes urinary tract infec- necessary to treat hypertension. The prognosis tions because they frequently obstruct the flow is good, with most cases resolving with prompt of urine. Urinary calculi may be treated with medication that partially dissolves the stone, permitting it to be passed in the urine. Lithotripsy, the crush- Kidney Stones ing of kidney stones, is particularly effective for Kidney stones are deposits of minerals within the 20% of kidney stones that do not pass on the kidney. If performed while the patient but there may be some bruising, and the patient is immersed in a tank of water, the procedure might require a hospital stay. In this Prognosis is good, although recurrence of technique, the partially submerged patient is stones is not uncommon. To prevent recur- subjected to the sonic waves that shatter the rence, fluid intake should be increased to keep hard stones into sand-sized particles that can the urine dilute, and dietary calcium and protein be eliminated with the urine. Beam focused on kidney stones – + Reflector Shock-wave generator A Figure 10–7 Extracorporeal shock-wave lithotripsy. Acoustic shock waves generated by the shock-wave generator travel through soft tissue to shatter the renal stone into fragments, which are then eliminated in the urine. If you are well hydrated, your kidneys will the developing kidney and bladder stones. As urine flows regularly, most circumstances is plain water because it adds no salt, it flushes microorganisms from the bladder and urethra, sugar, calories, or caffeine to the diet. Chronic Diseases and Disorders impaired, the serum creatinine level rises and the creatinine clearance rate falls. Treatment Renal Failure depends on the underlying cause of renal failure but usually includes renal dialysis.

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