Posts tagged with "Nephrology"

November 28th, 20140490 Tunneled catheters serve as a temporary vascular access for haemodialysis. There is a subcutaneous tunnel under the skin before leading to the large veins. Complications, in particular infection is high with catheters. They should not be used as substitutes for permanent haemodialysis access except for patients who have no sizeable veins...

November 28th, 20140591 This patient has an aneurysmal dilatation of an arteriovenous fistula. The overlying thin layer of skin is at high risk of bleeding or rupture. This condition is treated by partial resection of the aneurysm and surgical revision of the fistula.

November 28th, 20140243 This patient had stenosis of the right brachiocephalic vein as a complication of previous intravenous catheter insertion. There are multiple collateral veins over his anterior chest. His right upper arm is grossly swollen compared to his left arm. He also had facial swelling.

November 28th, 20140770 This is the Tenckhoff catheter, a permanent access to the peritoneal cavity for peritoneal dialysis. It has side holes along the intraperitoneal end of the catheter (on the right side of the catheter shown). There are two Dacron cuffs to allow tissue ingrowth to hold the catheter in place and to prevent infection. Tenckhoff catheters are...

November 28th, 20140277 The peritoneal fluid (PDF) on the left is clear. You can see through the bag. The PDF on the right is turbid. The most common cause of turbid PDF is peritonitis. Patients usually present with a triad of fever, abdominal pain and turbid PDF. It is important not to miss peritonitis secondary to a surgical abdomen (e.g. appendicitis,...

November 28th, 20140361 This patient has infection of the dialysis catheter exit site. There is erythema around the exit site with tenderness. Pus can be expressed from the exit site.

November 28th, 20140540 This patient has erythema, swelling and tenderness along the dialysis catheter tunnel. There is risk of spread of the infection along the catheter into the peritoneum, leading to peritonitis. The patient must be treated aggressively with antibiotics, and in severe cases, with catheter removal....

November 27th, 20140202 This is a patient with polycystic kidney disease who is currently receiving peritoneal dialysis. Despite her large kidneys, she has been doing well on peritoneal dialysis for 3 years until she developed a small para-umbilical hernia. Due to the increased intra-abdominal pressure, patients on peritoneal dialysis may develop hernia or...

November 27th, 20140200 Hydrothorax secondary to pleuro-peritoneal communication can develop as a complication of peritoneal dialysis. Patients present with poor ultrafiltration from peritoneal dialysis and shortness of breath. The effusion is mostly on the right side. It does not improve with hypertonic peritoneal exchanges. Diagnostic tapping reveals a...

November 27th, 20140151 This patient also presented with poor ultrafiltration from peritoneal dialysis. CT peritoneogram (performed by adding iodinated contrast into dialysis solution and then infusing it into the peritoneal cavity) revealed leakage of dialysate into the anterior abdomen near the left anterior rectus muscle. Leakage may not be apparent...

November 27th, 20140150 This patient received a renal transplant after being on peritoneal dialysis for 17 years. She developed repeated episodes of intestinal obstruction afterwards. This is a rare complication called encapsulating peritoneal sclerosis, which may develop in patients who have received a long period of peritoneal dialysis. CT scan of the abdomen...
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