Done

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College of Health Sciences Medical Diagnostic
Imaging Department Medical Imaging CP2 Case
study presentation
Choronic Kidney Disease for Permanent
Hemodialysis Access

• Done Presented by
• Fathiya Mohammed Al-Harthy

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Content

• Introduction
• Anatomy of the urinary system jugular vien.
• Diseases Treatment of the urinary system
• symptoms
• Diagnosis and examination
• Clinical Assessment investigation requested
• Medical Diagnostic Imaging
• a)- Brief description of MDI procedure
• b)-Results of MDI
• c)-Description of physician's diagnosis
• d)-A comparison of MDI Physicians diagnosis
• Patient outcome
• a)-Patient prognosis
• b)-Discussion of effectiveness of MDI
  investigation
• Conclusion
• References

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Introduction

• A 61years old expatriate lady was admitted in
  female ward in Rashid hospital as a known case of
  (CKD) chronic kidney disease/failure with a
  past history of polycystic disease . She was
  brought to the angio room for Permanent
  Hemodialysis access for the first time. The nurse
  in angio room checked the patient ID conform
  the procedure with her and wither a consent form
  is signed. The nurse started preparing the
  patient(after making sure that the neck site
  right side at the jugular vein is shaved) by
  cleaning with betadine keep the sterile drape
  on the patient's body while the puncture site is
  exposed.
• The Radiologist done U/S of the puncture site to
  localize the jugular vien.Then he inserted the
  permanent catheter under fluoroscopy. Finally,
  the radiologist sutured the insertion site in
  the fixation part of the catheter. The doctor
  sent the patient back to the word reported that
  the patient is ready for dialysis she can
  proceed with her routine life.

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Cont

• Catheter placement
• The right internal jugular vein is the preferable
  insertion site for permanent dialysis catheter.
  Catheter placed via this route have a direct path
  to the distal S.V.C right atrium can be tuned
  with gently slopping course towards either a
  lateral chest wall (as in this case) or
  parasternal exit site. Catheter insertion via the
  left jugular vein is less desirable because of
  the high number of curves the need to
  transverse the innominate vein.

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Anatomy physiology of the urinary system

• The urinary system is the main excretory system
  consists of the following
• 2 kidneys
• 2 ureters
• 1 urinary bladder
• 1 urethra.

left Renal calyces
Right kidney
Left Renal pelvis
Right Renal cortex
Left ureter
Urinary bladder
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The body takes nutrients from food and uses them
to maintain all bodily functions including energy
and self-repair.
The urethra is a canal exdending from bladder
neck to the exterior,at the urethral orifice
Urinary system function
The kidneys remove urea from the blood through
tiny filtering units called nephrons
The urenary bladder is a pear shaped structure.It
opens into the urethra at its lowest point, the
neck.
The hilum is the concave medial border of the
kidney where blood lymph vessels ,the ureter
nerves enter .The renal pelvis is a funnel
shaped structure that acts as a receptacle for
the urine formed. It has number of distal
branches called calyces.
The ureters are the tubes that convay urine from
kidneys to the urenary bladder
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Anatomy physiology of the jugular vein

• The internal jugular veins begin at the jugular
  foramina in the middle cranial fossa and each is
  continuation of a sigmoid sinus .They run down
  words in the neck behind the sternocleidomastoid
  muscles. Behind the clavicle they unite with the
  subclavian veins ,carrying the blood from the
  upper limb to form the brachiocephalic veins.

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Pathology related to the urinary system

1. Benign prostate hyperplasia (BPH)
2. Painful bladder syndrome/Interstitial cystitis
   (PBS/IC)
3. Kidney stones or calculi
4. Prostatitis
5. Renal (kidney) failure
6. Urinary tract infections (UTI) Urinary
   incontinence
7. Hydronephrosis
8. Urinary system carcinoma
9. Renal cyst
10. Polycystic disease
11. Chronic kidney disease (CKD) is the gradual
    reduction of kidney function that may lead to
    permanent kidney failure, or end-stage renal
    disease (ESRD). Treatment, There is no cure for
    chronic kidney disease. Strategies for slowing
    progression Control of blood glucose, Control of
    high blood pressure, treat complications of
    disease and replace lost kidney function

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Symptoms of urinary system

• Flank pain , Abdominal mass, Nausea and vomiting,
  Urinary tract infection, Fever, Painful urination
  (dysuria), increased urinary frequency, increased
  urinary urgency
• Sometimes unilateral hydronephrosis does not have
  symptoms
• Related to the case
• Patient was a known case of C.K.D

• Examination to confirm diagnosis
• Lab test
• Urinalysis is a test that studies the content of
  urine for abnormal substances such as protein or
  signs of infection, Urodynamic tests,
• Urine culture lab test
• Plain KUB x-ray
• Special X-ray examination Cysto urethrogram,
  Intravenous Pylogram, Retrograde Pylogram.
• Abdominal MRI
• CT scan of the KUB or Abdomen
• Isotope renography
• Ultra sound KUB or abdomen
• Related to the case
• Angiogram for permanent Hemodialysis acess .
• U/S of neck to locate the jugular site.

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• Clinician's assessment symptoms /presentation for
  current investigation
• A 61years old expatriate lady was admitted in
  female ward in Rashid hospital as a known case of
  (CKD) chronic kidney disease/failure. She was
  brought to the angio room for Permanent
  Hemodialysis access for the first time.

Clinical assessment diagnosis by physician for
current investigation Patient is a known case of
C.K.D she was a case of poly cystic disease.
Investigation requested Angiogram for
Hemodialysis access
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Medical diagnostic imaging

• Brief description of MDI examination
• Prior to the exam
• No medication .
• Anticoagulant therapy is discontinued because the
  risk of hemorrhage is considerably increased.
• Patient can be discharged next day after making
  sure no heamatoma or bleeding on the puncture
  site. Patient should be on bed rest.
• Patient should be fasting 12hours before the
  angio.
• Blood investigation should be done prior to the
  procedure(urea, ceriateneen , PT, PTT, Hepatitis,
  and HIV)
• The procedure
• The Radiologist done U/S of the puncture site to
  localize the jugular vein then
• he introduced the sheath. Next ,through it
  under fluoroscopy (Ap position) he
• introduced the guide wire and placed it at
  the beginning of the right internal jugular vein
  area by injecting 10ml of heparinated saline for
  placement checking . After making sure that the
  catheter is in situ, he placed the permanent
  Hemodialysis catheter. He insured that his is in
  the correct place again by the flashed blood
  which came out from the big vein. Finally, the
  radiologist sutured the insertion site in the
  fixation part of the catheter. The doctor sent
  the patient back to the word commented that the
  patient is ready for dialysis she can proceeds
  with her routine life.

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Cont

• Results of MDI radiologist opinion
• The placement of the catheter was successful as
  the flashed blood from the catheter was strong
  can be used for dialysis purpose.
• Description of physicians' diagnosis
• Patient was a known case of C.K.D as she was a
  past case of poly cystic disease.
• Comparison of MDI physicians diagnosis
• After the angiogram was done the catheter was
  placed successfully the radiologist commented
  that the patient can proceed with her routine
  life even she is ready for the dialysis.
  Therefore the access is of a benefit to simplify
  the dialysis for the patient with only one
  interventional MDI procedure so she need not redo
  the examination again unless her referring
  doctor suggested.

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Patient outcome

• Patient prognosis
• Patient can proceed with her life. She can be
  discharged immediately after angiogram .She can
  go for renal dialysis normally at the opinion of
  the urologist.
• Discussion of the effective of the MDI
  investigation used
• With angiogram the permanent was placed
  successfully with out the need to go for surgery.
  Therefore the patient can be discharged
  immediately or can start the dialysis. The access
  is of a benefit to simplify the dialysis for the
  patient with only one interventional MDI
  procedure so she need not redo the examination
  again unless her referring doctor suggested or
  has anther treatment plan.

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Conclusion

• A 61years old expatriate lady was admitted female
  ward in Rashid hospital as a known case of (CKD)
  chronic kidney disease/failure. She was brought
  to the angio room for renal dialysis catheter
  placement. Patient was prepared by the nurse
  before doctor starts the procedure. The doctor
  done the case the placement of the catheter
  done successfully patient was shifted back to
  the ward for her referring doctor's opinion as
  she is welling to go home as the radiologist
  commented/ reported on her file or to go for
  dialysis immediately.

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References

• lndianetzone.com
• http//kidney.niddk.nih.gov/kudiseases/pubs/yourur
  inary/
• fmhs.auckland.ac.nz
• http//www.mayoclinic.org/diseases-treatments/alph
  alist-i.html /
• ispub.comispub.co
• www.theacpa.org
• www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/
• imagingpathways.health.wa.gov.au
• www.emedicinehealth.com/chronic_kidney_disease/art
  icle_em.htm
• kidney.niddk.nih.gov/kudiseases/.../choosingtreatm
  ent
• www.UrologyHealth.org
• www.healthline.com/channel/kidney-cancer.html
• manju- imagingxpert.blogspot.com.
• med-ed.virginia.edu
• (ROSS WILSON Anatomy and physiology in Health
  and Illness,10th edition,2006)
• unckidneycenter.org
• frca.co.uk
• renalinfo.com

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Thank you for your listening