Bladder cancer more common in men.
White men
Exposure to dyes and industrial chemicals
Long term foley.
Previous radiation
Bladder has transitional cells and most are papilliomatous
Bladder cancer most common symptoms painless hematuria
Stage 1 is in the lining.
Stage 2 is muscle.
Stage 3 is adjacent tissue
Stage 4 is lymph nodes
Cystoscopy is how bladder cancer is diagnosed with a biopsy
Treatments
1. Surgery
2. Radiation
3. Immunotherapy.
4. TURBT -transuretheral resecetion of bladder tumor.
5. Partial cystectomy- partial bladder removal.
1056 and 1054 learn about urine diversion devices
Ilieal conduit- bypasses the bladder through the ileum and into the ureters. Is a stoma
Indiana pouch -is where you catheterize.
Neobladder?
Complications of bladder surgery
1. bleeding
2. pain opiods
3. constipation
Surgery
Radiation and chemo(nivolumab and Pimbrolizumab
And intravesicular chemo BCG bacilli Calmette-guerin.
Empty their bladder reposition q15
Increase fluids to manage dysuria
Stop smoking, no public bathrooms for 6 hours, sit when peeeing
Add 2 cups of bleach to urine let sit for 15 minutes
Pd1 blockers are cancer immunosuppressive.
KIDNEY CANCER
More likely in men
Greater than 64 years old
Hypertension
Obesity
Smoking
1st degree relative which is a risk factor only in kidney.
EXPOSURE TO GASOLINE
ASBESTOS AND CADMIUM
PRESENTATION
FLANK PAIN
HEMATURIA
ABDOMINAL PAIN.
DIAGNOSED BY CT SCAN, RENAL ULTRASOUND.
PARTIAL NEPHRECTOMY CAN BE DONE LAPRASCOPICALLY OR OPEN INCISION
Simple nephrectomy (kidney)
Total radical nephrectomy (kidney ureters)
If there is severe increase in pain there is concern for retroperitneal bleed.)
Can also use ablation with a laser or cryotherapy
Also treated with bevacizumab (avastin) Angiogenesis inhibitor.
Staging kidney tumors
Stage 1 kidney
Stage 2 kidney >7 cm
Stage 3 invades tissue adjacent
Stage 4
Lymph nodes
End Stage Renal Disease
Less than GFR 15
Less than 400 ml per day= oliguria
Less than 100 is anuria.
Uremia becomes azotemia
Azotemia is build up of waste
Signs and symptoms
Confusion, lethargy, weakness, headache n/v, muscle cramps and spasm.
Pruritis and uremic frost anorexia.
Hyperglycemia
Hyperkalemia
Hypermagnesemia
Dysrhythmias
Edema
Hypertension
Active vitamin D is in the gut leads to low calcium leads to increased parathyroid hormone and
increased phosphorus.
Higher risk for fractures.
Anemia leads to hypoxia
Can cause tetany
Decreased platelets.
Hyperkalemia can be treated by kayexalate
Patiromer- cant be taken with food 6 hours before or after
Sodium polystyrene sulfate
For high phosphorus give phosphate binding Inhibitor SEVELAMAR CARBONATE - RENAGEL
Sensipar – CALCIUMMIETIC.
A normal peritoneal dialysis exchange
2 Liters over 15-20 min.
Dwell 4-6 hours.
Drain up to 30 minutes.
Dextrose helps draw fluid off.
Strict aseptic technique.
Automated 4 exchanges usually at night leave fluid in all day
Continuous is 4-5 exchanges instill dc dwell reconnect drain.
Peritonitis can be caused from not using a septic technique.
Staph is usual cause.
These patients usually have pain nausea vomiting gas abd distention and hyperactive
bowel sounds.
Effluence is what you drain.
Ask patient if they are having their period because that could be a cause of blood in the
effluent.
10- 20 grams of protein loss is normal. Anything less is worrisome.
Hemodialysis red is for removing.
Blue returns the blood,
Arteriovenous graft higher infection rates than fistulas often have clots or graft
rejection.
Steal syndrome- the fistula shunts blood away from the distal part of extremity such as
fingers and hands and STEALS the blood from this area.
Continuous renal replacement therapy prolonged dialysis to not mess with blood
pressure.
Procrit helps with erythropoietin.
Hyperacute rejection is within 24 hours they must remove the kidney,.
Acute is after 24 hours to 6months they can give steroids and other medications
Chronic rejection they can remove it and go on dialysis.