• 100 Questions and Answers about Anatomy of the Abdomen by Dr. Atef Ahmed

    Get Free Copy Now and share links
    https://www.amazon.com/dp/B0CW1BLTHJ

    100 Questions and Answers For Medical Students and Doctors (32 books)

    https://www.amazon.com/dp/B0CTS66BYM

    Other books
    https://amazon.com/author/dratef

    https://x.com/DrATEFAHMED/status/1767665824150454758?s=20
    https://www.instagram.com/reel/C4bfbs-tspC/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==
    https://www.threads.net/@dr.atefahmed/post/C4bfp7vt7G7

    Perfect your understanding of abdominal anatomy with this essential question and answer guide!

    The complex organs contained within the abdomen play integral roles in digestion, metabolism, fluid balance, and immunity. Mastery of abdominal anatomy is crucial for medical students and clinicians specializing in this complex bodily region.

    In this book, Dr. Atef Ahmed draws on his extensive teaching experience to deliver 100 expertly crafted questions and answers covering all essential topics in abdominal anatomy. The high-yield Questions and Answers format facilitates retention and self-testing on core concepts like:

    The anatomical divisions and functions of the peritoneum.

    The major gastrointestinal organs and their vasculature.

    The liver and biliary system.

    The pancreatic ductal anatomy and arterial supply.

    The kidneys, adrenal glands, and ureters.

    Abdominal vasculature including the portal venous system.

    Lymphatic drainage pathways and lymph nodes.

    Concise yet comprehensive explanations clarify challenging topics and provide clinical insights.

    Whether you are currently enrolled in an anatomy course or desire a refresher guide on abdominal anatomy, this book provides the essential knowledge and practice you need to master this vital bodily region. The Questions and Answers format also makes it easy to quickly look up topics during clinical rounds. A must-have resource for all medical students, general surgery residents, radiologists, gastroenterologists, and other specialists who require expert anatomical knowledge of the abdomen.

    Get Your Copy Now From Amazon At low Price.









    1. abdominal anatomy question and answer book

    2. abdominal anatomy study guide

    3. abdominal anatomy quiz book

    4. abdomen anatomy questions

    5. abdominal anatomy review book

    6. abdominal anatomy test prep

    7. abdominal anatomy questions and answers book




    abdominal anatomy, abdomen anatomy, abdominal dissection, abdominal organs, gastrointestinal anatomy, digestive anatomy, abdominal vasculature, peritoneal anatomy, abdominal lymphatics, abdominal muscles, abdominal wall, abdominal quadrants, gastrointestinal tract, digestive system, abdominal viscera, abdomen anatomy book, abdomen quiz book, abdominal review book, abdominal exam prep, abdominal anatomy study guide, abdomen study cards, abdomen flashcards, abdominal anatomy questions, abdomen question bank, abdominal anatomy mcqs, abdomen anatomy mock test, abdomen anatomy practice test, abdomen anatomy workbook, abdomen anatomy curriculum, medical abdomen anatomy, nursing abdomen anatomy, vet abdomen anatomy, radiology abdomen anatomy, abdomen mri anatomy, abdomen ct anatomy, abdomen dissection guide, clinical abdomen anatomy, applied abdomen anatomy, surgical abdomen anatomy, abdomen anatomy for surgeons, abdomen anatomy for physicians, abdomen anatomy for students, abdomen anatomy for dummies, vet student abdomen anatomy, nursing student abdomen anatomy, medical student abdomen anatomy, physio abdomen anatomy, radiographer abdomen anatomy, radiologist abdomen anatomy, cardiologist abdomen anatomy,


    #abdominalanatomy, #abdomenanatomy, #anatomy, #abdomendissection, #abdominalorgans, #gastrointestinalanatomy, #digestiveanatomy, #abdominalvasculature, #peritonealanatomy, #abdominallymphatics, #abdominalmuscles, #abdominalwall, #abdominalquadrants, #gastrointestinaltract, #digestivesystem, #abdominalviscera, #anatomybook, #anatomyquiz, #anatomyreview, #anatomyexam, #anatomystudyguide, #anatomystudycards, #anatomyflashcards, #anatomymcqs, #anatomymocktest, #anatomypracticetest, #anatomyworkbook, #anatomycurriculum, #medstudentanatomy, #nursingstudentanatomy, #vetstudentanatomy, #radiologyanatomy, #mrianatomy, #ctanatomy, #dissectionguide, #clinicalanatomy, #appliedanatomy, #surgicalanatomy, #surgeonanatomy, #physiciananatomy, #studentanatomy, #anatomyfordummies, #anatomy101, #physioanatomy, #radiographeranatomy, #radiologistanatomy, #cardiologistanatomy, #anatomyrocks, #lovetolearnanatomy, #anatomyessentials




    Here are some professional prompts to generate AI photos for the book cover and banner for "100 Questions and Answers about Anatomy of the Abdomen" by Dr. Atef Ahmed:

    Book Cover Prompts:

    - Anatomy textbook cover titled "100 Questions & Answers About Anatomy of the Abdomen" by Dr. Atef Ahmed, close up view of a gray's anatomy style abdominal muscular figure with internal organs exposed including esophagus, stomach, liver, intestines, kidneys. Text is white, modern, and scientific.

    - Close up view of a human male abdomen anatomy model, shows detailed muscles, blood vessels, and internal organs. Orange and blue color scheme. Title text "100 Questions & Answers About Anatomy of the Abdomen". Author name "Dr. Atef Ahmed" in bold white letters at the bottom.

    - Illustration of the anterior view of male human abdominal anatomy, detailed internal organs visible including stomach, liver, intestines, kidneys, blood vessels. Bright lighting with shadows. Title "100 Questions & Answers About Anatomy of the Abdomen" in large white letters vertically covering abdomen. Author name small at bottom.

    Banner Prompts:

    - Wide banner with flat lay of an open abdomen anatomy book, notebook, pencil, muscles and organs model. Title text "100 Questions & Answers About Anatomy of the Abdomen" in bold white letters prominently displayed. Author name "Dr. Atef Ahmed" below in smaller font.

    - Facebook banner for new anatomy book release "100 Questions & Answers About Anatomy of the Abdomen" by Dr. Atef Ahmed. Flat lay of book with abdomen anatomy model, stethoscope, lab coat. Blue and white color scheme, modern, scientific aesthetic.

    - Wide illustrated banner with muscles and internal organs of abdomen anatomy. Bright lighting and colors. Title "100 Questions & Answers About Anatomy of the Abdomen" taking up most of banner space, by Dr. Atef Ahmed in small print near bottom. Clean, minimalist, modern design.
    100 Questions and Answers about Anatomy of the Abdomen by Dr. Atef Ahmed Get Free Copy Now and share links https://www.amazon.com/dp/B0CW1BLTHJ 100 Questions and Answers For Medical Students and Doctors (32 books) https://www.amazon.com/dp/B0CTS66BYM Other books https://amazon.com/author/dratef https://x.com/DrATEFAHMED/status/1767665824150454758?s=20 https://www.instagram.com/reel/C4bfbs-tspC/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA== https://www.threads.net/@dr.atefahmed/post/C4bfp7vt7G7 Perfect your understanding of abdominal anatomy with this essential question and answer guide! The complex organs contained within the abdomen play integral roles in digestion, metabolism, fluid balance, and immunity. Mastery of abdominal anatomy is crucial for medical students and clinicians specializing in this complex bodily region. In this book, Dr. Atef Ahmed draws on his extensive teaching experience to deliver 100 expertly crafted questions and answers covering all essential topics in abdominal anatomy. The high-yield Questions and Answers format facilitates retention and self-testing on core concepts like: The anatomical divisions and functions of the peritoneum. The major gastrointestinal organs and their vasculature. The liver and biliary system. The pancreatic ductal anatomy and arterial supply. The kidneys, adrenal glands, and ureters. Abdominal vasculature including the portal venous system. Lymphatic drainage pathways and lymph nodes. Concise yet comprehensive explanations clarify challenging topics and provide clinical insights. Whether you are currently enrolled in an anatomy course or desire a refresher guide on abdominal anatomy, this book provides the essential knowledge and practice you need to master this vital bodily region. The Questions and Answers format also makes it easy to quickly look up topics during clinical rounds. A must-have resource for all medical students, general surgery residents, radiologists, gastroenterologists, and other specialists who require expert anatomical knowledge of the abdomen. Get Your Copy Now From Amazon At low Price. 1. abdominal anatomy question and answer book 2. abdominal anatomy study guide 3. abdominal anatomy quiz book 4. abdomen anatomy questions 5. abdominal anatomy review book 6. abdominal anatomy test prep 7. abdominal anatomy questions and answers book abdominal anatomy, abdomen anatomy, abdominal dissection, abdominal organs, gastrointestinal anatomy, digestive anatomy, abdominal vasculature, peritoneal anatomy, abdominal lymphatics, abdominal muscles, abdominal wall, abdominal quadrants, gastrointestinal tract, digestive system, abdominal viscera, abdomen anatomy book, abdomen quiz book, abdominal review book, abdominal exam prep, abdominal anatomy study guide, abdomen study cards, abdomen flashcards, abdominal anatomy questions, abdomen question bank, abdominal anatomy mcqs, abdomen anatomy mock test, abdomen anatomy practice test, abdomen anatomy workbook, abdomen anatomy curriculum, medical abdomen anatomy, nursing abdomen anatomy, vet abdomen anatomy, radiology abdomen anatomy, abdomen mri anatomy, abdomen ct anatomy, abdomen dissection guide, clinical abdomen anatomy, applied abdomen anatomy, surgical abdomen anatomy, abdomen anatomy for surgeons, abdomen anatomy for physicians, abdomen anatomy for students, abdomen anatomy for dummies, vet student abdomen anatomy, nursing student abdomen anatomy, medical student abdomen anatomy, physio abdomen anatomy, radiographer abdomen anatomy, radiologist abdomen anatomy, cardiologist abdomen anatomy, #abdominalanatomy, #abdomenanatomy, #anatomy, #abdomendissection, #abdominalorgans, #gastrointestinalanatomy, #digestiveanatomy, #abdominalvasculature, #peritonealanatomy, #abdominallymphatics, #abdominalmuscles, #abdominalwall, #abdominalquadrants, #gastrointestinaltract, #digestivesystem, #abdominalviscera, #anatomybook, #anatomyquiz, #anatomyreview, #anatomyexam, #anatomystudyguide, #anatomystudycards, #anatomyflashcards, #anatomymcqs, #anatomymocktest, #anatomypracticetest, #anatomyworkbook, #anatomycurriculum, #medstudentanatomy, #nursingstudentanatomy, #vetstudentanatomy, #radiologyanatomy, #mrianatomy, #ctanatomy, #dissectionguide, #clinicalanatomy, #appliedanatomy, #surgicalanatomy, #surgeonanatomy, #physiciananatomy, #studentanatomy, #anatomyfordummies, #anatomy101, #physioanatomy, #radiographeranatomy, #radiologistanatomy, #cardiologistanatomy, #anatomyrocks, #lovetolearnanatomy, #anatomyessentials Here are some professional prompts to generate AI photos for the book cover and banner for "100 Questions and Answers about Anatomy of the Abdomen" by Dr. Atef Ahmed: Book Cover Prompts: - Anatomy textbook cover titled "100 Questions & Answers About Anatomy of the Abdomen" by Dr. Atef Ahmed, close up view of a gray's anatomy style abdominal muscular figure with internal organs exposed including esophagus, stomach, liver, intestines, kidneys. Text is white, modern, and scientific. - Close up view of a human male abdomen anatomy model, shows detailed muscles, blood vessels, and internal organs. Orange and blue color scheme. Title text "100 Questions & Answers About Anatomy of the Abdomen". Author name "Dr. Atef Ahmed" in bold white letters at the bottom. - Illustration of the anterior view of male human abdominal anatomy, detailed internal organs visible including stomach, liver, intestines, kidneys, blood vessels. Bright lighting with shadows. Title "100 Questions & Answers About Anatomy of the Abdomen" in large white letters vertically covering abdomen. Author name small at bottom. Banner Prompts: - Wide banner with flat lay of an open abdomen anatomy book, notebook, pencil, muscles and organs model. Title text "100 Questions & Answers About Anatomy of the Abdomen" in bold white letters prominently displayed. Author name "Dr. Atef Ahmed" below in smaller font. - Facebook banner for new anatomy book release "100 Questions & Answers About Anatomy of the Abdomen" by Dr. Atef Ahmed. Flat lay of book with abdomen anatomy model, stethoscope, lab coat. Blue and white color scheme, modern, scientific aesthetic. - Wide illustrated banner with muscles and internal organs of abdomen anatomy. Bright lighting and colors. Title "100 Questions & Answers About Anatomy of the Abdomen" taking up most of banner space, by Dr. Atef Ahmed in small print near bottom. Clean, minimalist, modern design.
    Like
    1
    0 Comments 1 Shares 10032 Views
  • Mr. Miller, a 45-year-old male with a history of alcohol abuse, presents with severe pain in the upper abdomen that radiates to the back. He also reports nausea and vomiting. His blood tests show elevated levels of amylase and lipase.

    What is the most likely diagnosis for Mr. Miller's symptoms?


    https://twitter.com/DrATEFAHMED/status/1661399200624521218?s=20

    #Pancreatitis
    #Necrosectomy, #Pancreatectomy, or #Drainage of #pancreaticabscess
    #AlcoholAbuse, #Gallstones
    #lifes1
    Mr. Miller, a 45-year-old male with a history of alcohol abuse, presents with severe pain in the upper abdomen that radiates to the back. He also reports nausea and vomiting. His blood tests show elevated levels of amylase and lipase. What is the most likely diagnosis for Mr. Miller's symptoms? https://twitter.com/DrATEFAHMED/status/1661399200624521218?s=20 #Pancreatitis #Necrosectomy, #Pancreatectomy, or #Drainage of #pancreaticabscess #AlcoholAbuse, #Gallstones #lifes1
    0 Comments 0 Shares 3973 Views
  • Ms. Brown, a 20-year-old female, presents with pain, redness, and swelling in the upper part of the natal cleft. She reports that the pain has worsened over the past few days and now has associated purulent discharge.

    What is the most likely diagnosis for Ms. Brown's symptoms?


    https://twitter.com/DrATEFAHMED/status/1661392575545090048?s=20

    #PilonidalCyst
    #IncisionAndDrainage, or #ExcisionAndPrimaryClosure
    #SedentaryLifestyle or #Hirsutism
    #lifes1
    Ms. Brown, a 20-year-old female, presents with pain, redness, and swelling in the upper part of the natal cleft. She reports that the pain has worsened over the past few days and now has associated purulent discharge. What is the most likely diagnosis for Ms. Brown's symptoms? https://twitter.com/DrATEFAHMED/status/1661392575545090048?s=20 #PilonidalCyst #IncisionAndDrainage, or #ExcisionAndPrimaryClosure #SedentaryLifestyle or #Hirsutism #lifes1
    0 Comments 0 Shares 2577 Views
  • Mr. Williams, a 35-year-old male, complains of severe pain and swelling around his anus. On examination, a fluctuant mass can be palpated at the 6 o'clock position with surrounding erythema and warmth.

    What is the most likely diagnosis for Mr. Williams' symptoms?


    https://twitter.com/DrATEFAHMED/status/1661390445820125185?s=20

    #PerianalAbscess
    #IncisionAndDrainage
    #FistulaFormation
    #lifes1
    Mr. Williams, a 35-year-old male, complains of severe pain and swelling around his anus. On examination, a fluctuant mass can be palpated at the 6 o'clock position with surrounding erythema and warmth. What is the most likely diagnosis for Mr. Williams' symptoms? https://twitter.com/DrATEFAHMED/status/1661390445820125185?s=20 #PerianalAbscess #IncisionAndDrainage #FistulaFormation #lifes1
    0 Comments 0 Shares 4137 Views
  • A 7-year old girl is admitted after she was a restrained passenger in a T-bone motor vehicle crash with impact on her side of the car. She is tachycardic and has an acute abdomen.
    At surgery, she has an isolated duodenal perforation in the second portion opposite the ampulla of Vater involving 25% of the circumference.

    What is the best operative plan?

    A. Primary repair of the duodenum
    B. Pyloric exclusion
    C. Repair the duodenum, gastrostomy, jejunostomy, and
    duodenostomy
    D. Duodenal diverticularization
    E. Gastrojejunostomy, nasogastric decompression, nasojejunal feeding tube

    ANSWER: A

    The best operative plan for this 7-year old girl with an isolated duodenal perforation involving 25% of the circumference in the second portion opposite the ampulla of Vater would be to perform a primary repair of the perforation with omental patch.

    The primary repair of the perforation involves suturing the edges of the perforation together to close the defect. An omental patch can then be placed over the repair to reinforce it and provide additional blood supply to the area, which can aid in healing.

    In this case, it is important to address the perforation as soon as possible to prevent further complications such as peritonitis or sepsis. The use of an omental patch can also help reduce the risk of further complications and improve the chances of a successful outcome.

    It is important to note that the final operative plan should be determined by the surgeon based on the patient's individual condition and surgical expertise.


    Blunt injuries to the duodenum are uncommon in all ages.
    They account for approximately 3 to 5% of all intraabdominal injuries. Blowout injuries after blunt trauma can occur due to the retroperitoneal fixed nature of the duodenum
    and compression against the vertebral column. Five grades of duodenal injury were described in 1990 using a standardized organ injury scale .
    *Advance one grade for multiple injuries up to grade III.
    D1, first portion of duodenum;
    D2, second portion of duodenum;
    D3, third portion of duodenum;
    D4, fourth portion of duodenum.

    Duodenal Injury Scale (AAST-OIS).
    A grade I injury is a hematoma or laceration without perforation;
    a grade II laceration equates to a disruption of less than 50% of the duodenal circumference; grade III 50 to 75% circumference of D2 or 50 to 100% of D1, D3, or D4;
    and
    grade IV disruption more than 75% circumference of D2 involving the ampulla or distal common duct.

    A grade V injury involves massive disruption of the duodenopancreatic complex or duodenal devascularization.
    In a retrospective review at one institution, children with grade II, III, and IV injuries were successfully managed with primary repair, and children with grade II, III and IV injuries
    repaired primarily did as well as or better than children with similar injuries managed by pyloric exclusion or gastrojejunostomy.
    Duodenal diverticulization refers to suture closure of the duodenal injury, antrectomy with end-to-side gastrojejunostomy, and tube duodenostomy.
    It is a complex, time-consuming procedure that is generally unnecessary. The triple tube technique of drainage is unnecessary in a grade II injury.
    A 7-year old girl is admitted after she was a restrained passenger in a T-bone motor vehicle crash with impact on her side of the car. She is tachycardic and has an acute abdomen. At surgery, she has an isolated duodenal perforation in the second portion opposite the ampulla of Vater involving 25% of the circumference. What is the best operative plan? A. Primary repair of the duodenum B. Pyloric exclusion C. Repair the duodenum, gastrostomy, jejunostomy, and duodenostomy D. Duodenal diverticularization E. Gastrojejunostomy, nasogastric decompression, nasojejunal feeding tube ANSWER: A The best operative plan for this 7-year old girl with an isolated duodenal perforation involving 25% of the circumference in the second portion opposite the ampulla of Vater would be to perform a primary repair of the perforation with omental patch. The primary repair of the perforation involves suturing the edges of the perforation together to close the defect. An omental patch can then be placed over the repair to reinforce it and provide additional blood supply to the area, which can aid in healing. In this case, it is important to address the perforation as soon as possible to prevent further complications such as peritonitis or sepsis. The use of an omental patch can also help reduce the risk of further complications and improve the chances of a successful outcome. It is important to note that the final operative plan should be determined by the surgeon based on the patient's individual condition and surgical expertise. Blunt injuries to the duodenum are uncommon in all ages. They account for approximately 3 to 5% of all intraabdominal injuries. Blowout injuries after blunt trauma can occur due to the retroperitoneal fixed nature of the duodenum and compression against the vertebral column. Five grades of duodenal injury were described in 1990 using a standardized organ injury scale . *Advance one grade for multiple injuries up to grade III. D1, first portion of duodenum; D2, second portion of duodenum; D3, third portion of duodenum; D4, fourth portion of duodenum. Duodenal Injury Scale (AAST-OIS). A grade I injury is a hematoma or laceration without perforation; a grade II laceration equates to a disruption of less than 50% of the duodenal circumference; grade III 50 to 75% circumference of D2 or 50 to 100% of D1, D3, or D4; and grade IV disruption more than 75% circumference of D2 involving the ampulla or distal common duct. A grade V injury involves massive disruption of the duodenopancreatic complex or duodenal devascularization. In a retrospective review at one institution, children with grade II, III, and IV injuries were successfully managed with primary repair, and children with grade II, III and IV injuries repaired primarily did as well as or better than children with similar injuries managed by pyloric exclusion or gastrojejunostomy. Duodenal diverticulization refers to suture closure of the duodenal injury, antrectomy with end-to-side gastrojejunostomy, and tube duodenostomy. It is a complex, time-consuming procedure that is generally unnecessary. The triple tube technique of drainage is unnecessary in a grade II injury.
    0 Comments 0 Shares 3431 Views
  • Pelvic Abscess Tips and Tricks /Causes/diagnosis /Treatment /surgey/Laparoscopy/Draniage/Radiology

    https://twitter.com/DrATEFAHMED/status/1655606803470729216?s=19

    https://www.youtube.com/watch?v=rCAtQOEyqkY

    #pelvicabscess #abscess #pelvis #pelvic_abscess
    #abscess #abscesso #abscessedtooth #dentalabscess #abscesses #abscessodentario #abscessdrainage #hoofabscess #abscessoanal #abscessed #perianalabscess #abscesstooth #abscessessuck #abscession #abscessopericoronario #surgery #dentistry #teeth #tooth #dentistryworld #lip #nurselife #dental #gross #veterinary #dentistasfit #tannlege #dentalinfection #dentiststory #mastitis
    #herniainguinal #inguinalhernia #swelling #andreaswellinger #reduceswelling #groin
    #famous_doctors #topdoctors #no1doctor #harmanns
    #syndrome #shorts #Surgical_problem
    #surgery #MCQS #Mrcs #medical_student_exam #Medical_Student_Exam
    #No1doctor #dratef #usmle…

    https://www.youtube.com/watch?v=rCAtQOEyqkY
    Pelvic Abscess Tips and Tricks /Causes/diagnosis /Treatment /surgey/Laparoscopy/Draniage/Radiology https://twitter.com/DrATEFAHMED/status/1655606803470729216?s=19 https://www.youtube.com/watch?v=rCAtQOEyqkY #pelvicabscess #abscess #pelvis #pelvic_abscess #abscess #abscesso #abscessedtooth #dentalabscess #abscesses #abscessodentario #abscessdrainage #hoofabscess #abscessoanal #abscessed #perianalabscess #abscesstooth #abscessessuck #abscession #abscessopericoronario #surgery #dentistry #teeth #tooth #dentistryworld #lip #nurselife #dental #gross #veterinary #dentistasfit #tannlege #dentalinfection #dentiststory #mastitis #herniainguinal #inguinalhernia #swelling #andreaswellinger #reduceswelling #groin #famous_doctors #topdoctors #no1doctor #harmanns #syndrome #shorts #Surgical_problem #surgery #MCQS #Mrcs #medical_student_exam #Medical_Student_Exam #No1doctor #dratef #usmle… https://www.youtube.com/watch?v=rCAtQOEyqkY
    0 Comments 0 Shares 15667 Views
  • A 65-year-old woman with well controlled type 2 diabetes mellitus presents with perforated appendicitis. She is taken to the operating room for exploration, drainage of intraabdominal abscess, and ileocecectomy. She is admitted to the surgical intensive care unit postoperatively in septic shock.
    Overnight, she is resuscitated with 9 L crystalloid. She is now on norepinephrine and vasopressin infusions to keep her mean arterial pressure above 65 mm Hg. On postoperative day 1, she is hypoxic with pulmonary edema on chest x-ray.
    Her serum potassium is 5.9 mmol/L, her serum creatinine increased from 1.5 to 5.4 mg/dL (0.4-1.3 mg/dL), her serum blood urea nitrogen is 60 mg/dL (7-20 mg/dL), her serum bicarbonate is 13 mmol/L (20-29 mmol/L), and her pH is 7.21. Her urine output is 0.3 mL/kg/hour for the last 12 hours.

    What is the next step in managing her renal failure?

    A. Continuous renal replacement therapy
    B. Intermittent hemodialysis
    C. Furosemide 80 mg intravenously
    D. Dopamine infusion
    E. Sodium bicarbonate infusion

    ANSWER: A
    Acute kidney injury in the postoperative period is associated with increased morbidity and mortality. Two classification systems were proposed in the early 2000s: the RIFLE criteria
    and the Acute Kidney Injury Network (AKIN) staging system. These systems provide concise definitions of the extent of injury and prognosis. Both systems consider increases in serum creatinine, either an absolute number or an
    increase from baseline, and urine output criteria. This patient had a marked increase in serum creatinine and has oliguria.
    According to the RIFLE criteria, she has Failure; she is in AKIN stage III.
    Additionally, she is acidemic, with a serum pH of 7.21 and bicarbonate of 13 mmol/L (20-29 mmol/L), and hyperkalemic. She also shows evidence of volume overload with hypoxemia and radiographic evidence of pulmonary
    edema.
    This patient has several indications for renal
    replacement therapy.


    Data regarding the optimal modality and timing of renal replacement therapy are conflicting. However, when patients are hemodynamically abnormal and require vasopressor support, a continuous mode of renal replacement therapy is preferred. Continuous modes require smaller volumes of
    blood to be removed at a time compared with intermittent hemodialysis and are better tolerated in hypotensive patients.
    A sodium bicarbonate infusion is used for patients with acidosis; however, starting a sodium bicarbonate infusion is generally not recommended until the serum pH is less than
    7.15. Also, there are no data confirming any reduction in morbidity and mortality for its use in renal failure.
    Aggressive diuretic therapy used in the early stages of AKI to treat volume overload and hyperkalemia is possible.
    However, once a patient advances to renal failure, renal replacement therapy is the preferred modality of management. Low-dose dopamine infusions were once
    erroneously thought to be renal protective via a mechanism of increased renal blood flow. There are currently no data to support the use of a dopamine infusion as prevention or
    treatment of AKI.
    A 65-year-old woman with well controlled type 2 diabetes mellitus presents with perforated appendicitis. She is taken to the operating room for exploration, drainage of intraabdominal abscess, and ileocecectomy. She is admitted to the surgical intensive care unit postoperatively in septic shock. Overnight, she is resuscitated with 9 L crystalloid. She is now on norepinephrine and vasopressin infusions to keep her mean arterial pressure above 65 mm Hg. On postoperative day 1, she is hypoxic with pulmonary edema on chest x-ray. Her serum potassium is 5.9 mmol/L, her serum creatinine increased from 1.5 to 5.4 mg/dL (0.4-1.3 mg/dL), her serum blood urea nitrogen is 60 mg/dL (7-20 mg/dL), her serum bicarbonate is 13 mmol/L (20-29 mmol/L), and her pH is 7.21. Her urine output is 0.3 mL/kg/hour for the last 12 hours. What is the next step in managing her renal failure? A. Continuous renal replacement therapy B. Intermittent hemodialysis C. Furosemide 80 mg intravenously D. Dopamine infusion E. Sodium bicarbonate infusion ANSWER: A Acute kidney injury in the postoperative period is associated with increased morbidity and mortality. Two classification systems were proposed in the early 2000s: the RIFLE criteria and the Acute Kidney Injury Network (AKIN) staging system. These systems provide concise definitions of the extent of injury and prognosis. Both systems consider increases in serum creatinine, either an absolute number or an increase from baseline, and urine output criteria. This patient had a marked increase in serum creatinine and has oliguria. According to the RIFLE criteria, she has Failure; she is in AKIN stage III. Additionally, she is acidemic, with a serum pH of 7.21 and bicarbonate of 13 mmol/L (20-29 mmol/L), and hyperkalemic. She also shows evidence of volume overload with hypoxemia and radiographic evidence of pulmonary edema. This patient has several indications for renal replacement therapy. Data regarding the optimal modality and timing of renal replacement therapy are conflicting. However, when patients are hemodynamically abnormal and require vasopressor support, a continuous mode of renal replacement therapy is preferred. Continuous modes require smaller volumes of blood to be removed at a time compared with intermittent hemodialysis and are better tolerated in hypotensive patients. A sodium bicarbonate infusion is used for patients with acidosis; however, starting a sodium bicarbonate infusion is generally not recommended until the serum pH is less than 7.15. Also, there are no data confirming any reduction in morbidity and mortality for its use in renal failure. Aggressive diuretic therapy used in the early stages of AKI to treat volume overload and hyperkalemia is possible. However, once a patient advances to renal failure, renal replacement therapy is the preferred modality of management. Low-dose dopamine infusions were once erroneously thought to be renal protective via a mechanism of increased renal blood flow. There are currently no data to support the use of a dopamine infusion as prevention or treatment of AKI.
    0 Comments 0 Shares 10159 Views