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    Type 2 Diabetes
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    Diabetic Diet

DIABETES DIET - So Simple Even Your Kids Can Do It

DIABETES DIET - So Simple Even Your Kids Can Do It

Your diabetes diet is just a smart dieting plan that will enable you to control your glucose. Here's assistance beginning, from dinner intending to trade records and tallying sugars.

DIABETES DIET - So Simple Even Your Kids Can Do It


Definition 
A diabetes diet essentially implies eating the most beneficial nourishments in moderate sums and adhering to standard eating times.

A diabetes diet is a smart dieting plan that is normally wealthy in supplements and low in fat and calories. Key components are organic products, vegetables and entire grains. Truth be told, a diabetes diet is the best eating arrangement for generally everybody.

Reason 
On the off chance that you have diabetes or prediabetes, your specialist will probably prescribe that you see a dietitian to enable you to build up a smart dieting plan. The arrangement causes you control your (glucose), deal with your weight and control chance variables for coronary illness, for example, hypertension and high blood fats.

When you eat abundance calories and fat, your body reacts by making an unfortunate ascent in blood glucose. On the off chance that blood glucose isn't held within proper limits, it can prompt difficult issues, for example, a perilously high blood glucose level (hyperglycemia) and long haul entanglements, for example, nerve, kidney and heart harm.

You can help keep your blood glucose level in a protected range by settling on solid nourishment decisions and following your dietary patterns.

For a great many people with sort 2 diabetes, weight reduction additionally can make it less demanding to control blood glucose and offers a large group of other medical advantages. On the off chance that you have to shed pounds, a diabetes diet gives an efficient, nutritious approach to achieve your objective securely.

Diet subtleties 

DIABETES DIET - So Simple Even Your Kids Can Do It

A diabetes diet depends on eating three dinners per day at normal occasions. This enables your body to all the more likely utilize the insulin it delivers or gets past a prescription. 

An enrolled dietitian can enable you to assemble an eating routine dependent on your wellbeing objectives, tastes and way of life. The individual in question can likewise converse with you about how to enhance your dietary patterns, for instance, by picking segment sizes that suit the requirements for your size and dimension of movement.

Suggested sustenances 

DIABETES DIET - So Simple Even Your Kids Can Do It


Make the most of your calories with these nutritious nourishments:

Sound sugars. Amid assimilation, sugars (straightforward starches) and starches (complex carbs) separate into blood glucose. Concentrate on the most advantageous starches, for example, organic products, vegetables, entire grains, vegetables (beans, peas and lentils) and low-fat dairy items.

Fiber-rich nourishments. Dietary fiber incorporates all parts of plant sustenances that your body can't process or retain. Fiber directs how your body processes and enables control to glucose levels. Nourishments high in fiber incorporate vegetables, natural products, nuts, vegetables (beans, peas and lentils), entire wheat flour and wheat grain.

Heart-solid fish. Eat heart-solid fish no less than two times every week. Fish can be a decent option in contrast to high-fat meats. For instance, cod, fish and halibut have less absolute fat, soaked fat and cholesterol than do meat and poultry. Fish, for example, salmon, mackerel, fish, sardines and bluefish are wealthy in omega-3 unsaturated fats, which advance heart wellbeing by bringing down blood fats called triglycerides.

Keep away from fricasseed fish and fish with large amounts of mercury, for example, tilefish, swordfish and ruler mackerel.

"Great" fats. Sustenances containing monounsaturated and polyunsaturated fats can help bring down your cholesterol levels. These incorporate avocados, almonds, pecans, walnuts, olives, and canola, olive and nut oils. However, don't try too hard, as all fats are high in calories.

Nourishments to keep away from 

Diabetes expands your danger of coronary illness and stroke by quickening the improvement of stopped up and solidified supply routes. Sustenances containing the accompanying can neutralize your objective of a heart-sound eating regimen.

Soaked fats. High-fat dairy items and creature proteins, for example, hamburger, wieners, frankfurter and bacon contain immersed fats.

Trans fats. These sorts of fats are found in prepared tidbits, heated products, shortening and stick margarines. Maintain a strategic distance from these things.

Cholesterol. Wellsprings of cholesterol incorporate high-fat dairy items and high-fat creature proteins, egg yolks, liver, and other organ meats. Go for close to 200 milligrams (mg) of cholesterol daily.

Sodium. Go for under 2,300 mg of sodium daily. Be that as it may, on the off chance that you likewise have hypertension, you should go for under 1,500 mg of sodium daily.

Assembling everything: Creating an arrangement 

A couple of various ways to deal with making a diabetes diet are accessible to enable you to keep your blood glucose level inside an ordinary range. With a dietitian's assistance, you may discover one or a mix of the accompanying strategies works for you:

The plate strategy. The American Diabetes Association offers a straightforward seven-advance technique for supper arranging. Generally, it centers around eating more vegetables. While setting up your plate, fill one-portion of it with nonstarchy vegetables, for example, spinach, carrots and tomatoes. Fill one-quarter with a protein, for example, fish or lean pork. Fill the last quarter with an entire grain thing or bland sustenance. Include a serving of natural product or dairy and a beverage of water or unsweetened tea or espresso.

Checking sugars. Since sugars separate into glucose, they have the best effect on your blood glucose level. To help control your glucose, eat about a similar measure of sugars every day, at customary interims, particularly in the event that you take diabetes prescriptions or insulin.

A dietitian can show you how to gauge sustenance divides and turn into an informed peruser of nourishment names, giving careful consideration to serving size and sugar content. In case you're taking insulin, the individual can show you how to include the measure of sugars every supper or nibble and change your insulin portion likewise.

The trade records framework. A dietitian may prescribe utilizing sustenance trade records to enable you to design dinners and bites. The rundowns are sorted out by classifications, for example, starches, protein sources and fats.

One serving in a classification is known as a "decision." A nourishment decision has about a similar measure of sugars, protein, fat and calories — and a similar impact on your blood glucose — as a serving of each other sustenance in that equivalent class. In this way, for instance, you could eat half of a substantial ear of corn or 1/3 measure of cooked pasta for one starch decision.

Glycemic record. A few people who have diabetes utilize the glycemic file to choose nourishments, particularly starches. This strategy positions sugar containing sustenances dependent on their impact on blood glucose levels. Chat with your dietitian about whether this strategy may work for you.

An example menu 

DIABETES DIET - So Simple Even Your Kids Can Do It

When arranging dinners, consider your size and action level. The accompanying menu is custom-made for somebody who needs 1,000 to 1,700 calories every day.

Breakfast. Entire wheat bread (1 medium cut) with 2 teaspoons jam, 1/2 container destroyed wheat grain with some 1 percent low-fat drain, a bit of natural product, espresso

Lunch. Cheddar and veggie pita, medium apple with 2 tablespoons almond spread, water

Supper. Salmon, 1/2 teaspoons vegetable oil, little prepared potato, 1/2 container carrots, side serving of mixed greens (1/2 mugs spinach, 1/2 of a tomato, 1/4 glass slashed chime pepper, 2 teaspoons olive oil, 1/2 teaspoons red wine vinegar), unsweetened frosted tea

Bite. 2 1/2 containers popcorn or an orange with 1/2 glass 1 percent low-fat curds

Results 

Grasping your good dieting arrangement is the most ideal approach to monitor your blood glucose level and anticipate diabetes difficulties. What's more, on the off chance that you have to get in shape, you can tailor it to your particular objectives.

Beside dealing with your diabetes, a diabetes diet offers different advantages, as well. Since a diabetes diet suggests liberal measures of natural products, vegetables and fiber, tailing it is probably going to lessen your danger of cardiovascular illnesses and specific kinds of malignant growth. What's more, devouring low-fat dairy items can diminish your danger of low bone mass later on.

Dangers 

DIABETES DIET - So Simple Even Your Kids Can Do It

On the off chance that you have diabetes, it's vital that you join forces with your specialist and dietitian to make an eating plan that works for you. Utilize solid nourishments, divide control and planning to deal with your blood glucose level. On the off chance that you stray from your recommended eating routine, you risk fluctuating glucose levels and that's only the tip of the iceberg genuine complexities.

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Type 1 & Type 2 Diabetes Treatment Insulin & Medication

Type 1 & Type 2 Diabetes Treatment Insulin & Medication

Type 1 & Type 2 Diabetes Treatment Insulin & Medication


Diabetes is a very fatal disease. But if the patient wants it, he can control it.
Yes, you read correctly, it is such a disease that only the patient can control. Friends need insulin in type 2 diabetes when sugar levels are not stable due to the consumption of medicines. Then the patient can have his sugar control through insulin.

Medication for Type 2 Diabetes Patients


But only insulin is used in type 1 diabetes.
Insulin is used when the patient's body is not able to make blood sugar normal, due to which the patient's sugar level is very high. And insulin is used to quickly normalize the patient's sugar level.

Some patients of type 2 diabetes have to take insulin. But it has also been seen that many patients also need oral medicines as well as insulin.


Control Your Diet

You should take great care of food in this disease.

If you do not have control over food then you can face a lot of problems.


Exercise

Exercise is very essential every day, so that your blood sugar and blood pressure will be both control. Therefore, work from day to day work must be practiced 1 hour

Type 1 & Type 2 Diabetes Treatment Insulin & Medication

Glucosidase Inhibitors

These medicines reduce our blood sugar levels and our body becomes energetic.
But these medicines should not be taken without the doctor's permissions.

And the doctor should take medicines in the same way as the dose of medicines. Do not consume medicines at your own discretion.

Must Read


The type 2 diabetes medicines are as follows............

  • Metformin
  • Metformin + pioglitazone
  • Metformin + Pioglitazone +Glimipride
  • Glimipride
  • Gliclazide
  • Glipizide etc.

These medicines help our pancreas make insulin

  • saxagliptin
  • saxagliptin-metformin
  • sitagliptin
  • sitagliptin-metformin
  • sitagliptin and simvastatin
  • alogliptin-pioglitazone
  • linagliptin
  • linagliptin-empagliflozin
  • linagliptin-metformin
  • alogliptin
  • alogliptin-metformin
Type 1 & Type 2 Diabetes Treatment Insulin & Medication

These medicines are considered to be equivalent to natural hormones.

  • exenatide
  • exenatide extended-release
  • liraglutide
  • albiglutide
  • dulaglutide
  • semaglutide
These medicines are very useful, they work to release insulin in our body.
Because there are many such drugs that work very well on our body's glucose level.

  • Repaglinide-metformin
  • Nateglinide 
  • Repaglinide
These medicines stop our sugars only on kidneys and through the urination, we release the sugar present in our blood.

  • canagliflozin-metformin
  • empagliflozin
  • empagliflozin-linagliptin
  • dapagliflozin-metformin
  • canagliflozin
  • empagliflozin-metformin
  • ertugliflozin
  • dapagliflozin
The more common these medicines are, the more effective. It works to make insulin quickly and in high quantities in the pancreas with the help of beta cells in our body.


Type 1 & Type 2 Diabetes Treatment Insulin & Medication


  • glipizide-metformin
  • glyburide
  • glyburide-metformin
  • chlorpropamide
  • tolazamide
  • glimepiride
  • glimepiride-pioglitazone
  • glimepiride-rosiglitazone
  • gliclazide
  • glipizide
  • tolazamide
  • tolbutamide

Type 2 diabetes should control their sugar levels very well, otherwise there are many types of diseases.
like
Heart Disease, Blindness, Kidney Disease,

Type 1 & Type 2 Diabetes Treatment Insulin & Medication


Must Read

Type 1 & Type 2 Diabetes Treatment Insulin & Medication



Friends, this is our post which is based on type 1 & Type 2 Diabetes, hoping that it will be helpful for you.
Thank you very much for reading this post.

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Completet Solution of TYPE 2 DIABETES

Type 2 diabetes

Completet Solution of TYPE 2 DIABETES


This disease is mostly in adults
There are some reasons for having type 2 diabetes.

As if any member of your family has diabetes, then 80% of the chances are that you may also get this disease.

Apart from this, there is more Chance Type 2 diabetes if you are overweight or your routine is not okay or you are not eating properly or you consume too much of the outside things. 

Even then there is a lot of chances you have diabetes. Now it comes to how to prevent it and what is the right treatment for this disease?



Symptoms Of Type 2 Diabetes

  • Urination & ThirstIt is very easy to recognize that you are thirsty again and again and Having urination, again and again, you can imagine that you have type 2 diabetes.


  • Appetite - In type 2 diabetes you feel hungry more than normal.


  • Weight Loss - The weight starts to decline very fast in this disease.


  • Slow-Healing Sores - In type 2 diabetes, the wounds do not recover quickly and the infection gets accelerated and if it is not treated at the right time, then the patient starts to suffer a lot.

  • Blurred eyes - If type 2 diabetes is not treated at the right time and the amount of sugar in the patient's body increases significantly then the patient starts to appear blurred and after a long delay in treatment the eyesight also goes away.

Treatment & Diagnostics

Completet Solution of TYPE 2 DIABETES


Type 2 Diabetes 
  • Glycated hemoglobin (A1C) test - Glycated hemoglobin (A1C) test is used to measure the level of sugar in our blood. 
  • Through this investigation, we can find out the level of sugar in our blood during the last 3 to 4 months.
  • Which makes it easy to guess whether we have diabetes or not. The normal range of Glycated Hemoglobin (A1C) test should be below 5.7%.
  • And if you do not have the glycated hemoglobin (A1C) test method then you can get your doctor checked. Which is as follows.
  • Fasting Blood Sugar Test To check the Fasting Blood Sugar Test, work should be done after 8 hours of food at night, means that empty stomach in the morning, which has a minimum range of 70 to 125mg/dl, if it exceeds the blood test level 125, mg/dl, then you have type 2 diabetes.
  • Random Blood Sugar Test - In order to perform this test, the patient should check it at least 2 hours after eating it. By which food will dissolve completely in our body. Its normal range is 125 to 170 mg/dl. If the patient has a blood test more than 170 mg/dl then he has type 2 diabetes.
  • Oral glucose tolerance test- Oral glucose tolerance test. In order to do this test, the patient is first given the sugar and the test is done after 2 hours of sugar intake.
  • After testing, if the blood glucose level is more than the normal range, it means that the patient has type 2 diabetes. These tests are done when the blood test comes after normal 2 hours after eating empty stomach and food.

Treatment

management of Type 2 diabetes

Completet Solution of TYPE 2 DIABETES


Blood sugar monitoring regularly

  • The patient should check his blood glucose from time to time. As if the patient has a high blood glucose, then every week should be examined.
  • But if the patient's blood glucose is normal, then check blood glucose once in less than 15 days is very necessary.
Regular daily exercise

  • Exercising daily for sugar patients is very important.
  • The patient of type 2 diabetes should exercise 1 hour day at work.
  • Thereby, their glucose level remains fine and the health is also good.


Healthy Diet

Completet Solution of TYPE 2 DIABETES



  • Patients with Type 2 diabetes should pay a lot of attention to their food items. Because this disease is completely dependent on diet.
  • In this, green vegetables need a lot of story in green vegetables.
  • The doctor said that the fruit should be eaten. Not all fruits should eat.
Regular drug intake

  • Patients of type 2 diabetes should take regular medicines regularly, as suggested by the doctor.

Complication

  • Hypoglycemia
  • Ocular (Diabetic cataracts retinopathy)
  • Diabetic nephropathy
  • Skin & Mucous membranes
When to Admit

  • Altered mental status
  • Diabetic ketoacidosis
  • Marked volume disorders
  • Marked electrolyte disorder
  • Unstable comorbid condition
So this was the complete analysis of type 2 diabetes.
I hope that you will get a lot of work from the people. If you have enjoyed this article and have proved to be helpful, then please share this post as much as possible so that every person can get the benefit of it, who is suffering from type 2 diabetes.

Completet Solution of TYPE 2 DIABETES


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What is Type 1 Diabetes ?

Type 1 Diabetes 

What is Type 1 Diabetes ?


The pancreas present in our body produces a hormone called insulin that controls our body's sugar level.

When our body becomes insulin or it is finished, then our body cannot digest sugar.

Which increases the sugar level of our body. This action is called diabetes.

And diabetes that happens to young people like below 30 years old people are called type 1 diabetes.


Symptoms Of Type 1 Diabetes

There are many types of Type 1 diabetes that I have written below.....
  • Unwanted weight loss
  • Nausea or vomiting
  • Stomach pain
  • Unexplained bedwetting
  • Fruity smelling breath
  • Unquenchable thirst
  • Rapid, heavy breathing
  • Less energy
  • Frequent urination
  • Loss of consciousness
  • Blurry vision
  • A headache
  • Feeling Dizzy
  • Itching, Skin Infection
  • Feeling Hungry

When to call a doctor?


When you know that you have diabetes, you should contact your doctor immediately without any delay.



And just as your doctor advises you go according to what they say.

Causes


It is very difficult to know the exact cause of type 1 diabetes, but usually the digestive system of our body.

Which battles many types of pests and prevents our body from making insulin. By this, we find out what type 1 diabetes is.

I have also mentioned some other reasons by which we have diabetes.

  • Exposure to viruses and other environmental factors
  • Genetics.

What is the role of Insulin in type 1 Diabetes?

What is Type 1 Diabetes ?


About insulin, I have told you the rows above how insulin is formed.

When the amount of insulin is done in our body or it ends, then our body is not able to control the sugar in that situation.

Insulin is a type of hormone that is formed through the pancreas.
Insulin goes into our body and leads the sugar to our cells, which in turn leads to the amount of sugar in our bloodstream.

And when the level of sugar in our blood falls, then the pancreas produces insulin.

What is the role of Glucose in type 1 Diabetes?

As you all know that sugar is the main source of energy in our body, and tissues are formed in our body only through sugar and sugar.

Glucose comes from the main sources in our body

1. By our liver and
2. Food

Sugar is absorbed in the bloodstream and enters our cells through insulin. 

And our liver collects glycogen to glucose.
When our body's glucose levels begin to decline, then when we do not take it for a long time.

The liver breaks the stored glycogen in glucose to keep our glucose levels in the normal range.


In type 1 diabetes, there is no insulin to give glucose to our cells, so sugar is formed in our bloodstream. This can cause dangerous complications in our lives.

Diet of Type 1 Diabetes Patients 

What is Type 1 Diabetes ?


What to do.
  • Patients of type 1 diabetes should consume plenty of green vegetables.
  • Fish and chicken should be eaten but meat should not be eaten.
  • Do not eat any kind of sweet things.
  • Do not take the yellow part (YOLK) of the egg at all
  • Can eat white part of the egg
  • Eat medicines from time to time
  • Low-Calorie meal
  • Take 30 to 45 minutes walk per day.
  • Regular exercises.
  • Stay in touch with your doctor.
Do not do
  • Do not eat sweet things
  • Do not add to any kind of addiction
  • Do not eat meat
  • Do not eat smooth things
  • Avoid Junk Food
Also Read

Normal Range of diabetes

What is Type 1 Diabetes ?


In 2 ways we test our blood glucose, 1 by the veins and one by the fingers.

The test in which veins are considered accurate and which is tested by fingers is also almost perfect, only a slight difference occurs.

Fasting Blood test Range (FBS) 70 - 125 mg/dl
Postprandial blood test range (PPBS) 120-170 mg/dl

Type 1 Diabetes Risk Factors?

What is Type 1 Diabetes ?


Family History-If someone in your family has diabetes then it is possible that you may have diabetes.

Age- Type 1 diabetes can be seen in people of any age. But usually, it is more in young people.

Like it appears to be in children of 3-4 years or children in 10-15 years of age.

Genetics-Due to the presence of genes present in our body, there is the possibility of type 1 diabetes.

Geographic-When we travel longer than our scheduled condition, the risk of type 1 diabetes.

Complications

  • Diabetic Ketoacidosis.
  • Hypoglycemia and altered awareness of hypoglycemia.
  • Diabetic Retinopathy, Cataract.
  • Nephropathy
  • Neuropathy.
  • Coronary Artery Disease, Peripheral Vascular Disease.
  • Lipodystrophy at injection Sites.

Treatments

What is Type 1 Diabetes ?


  • Use Of Insulin -
Preprandial rapid-acting insulin plus basal insulin replacement with intermediate or long-acting insulin.

  • Rapid Acting Insulin-
Insulin Lispro,Insulin aspart,Insulin glulisin.

  • Short Acting Insulins-
Regular,Regular Humulin,Regular IIetin II.

  • Intermediate Acting Insulin-
Lente Humulin,Lente IIetin II ,Lente Novolin,Neutral Pratamine Hagedorn (NPH) Humulin,NPH IIetin II,NPH Novolin.

  • Premixed Insulin-
Novolin 70/30,Humulin 70/30 ,Novolog Mix 70/30.

  • Long Acting Insulins-
Ultra Lente Humulin,Insulin glargine.

When to Admit ?

  • Altered Mental Status.
  • Diabetic Ketoacidosis.
  • Marked Volume Disorder.
  • Marked Electrolyte Disorder.
  • Unstable Comorbid Condition.

When To Refer ?

  • Team Educational Approaches critical.Enlist Nutritionist.
  • Poorly Controlled Diabetes.
Now you must have understood what type 1 diabetes is and what is the solution.

I hope these posts will helpful for to you.

Thank you very much for reading this post.









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Abdominal Aortic Aneurysm

Key Feature


Abdominal Aortic Aneurysm


Essentials Of Diagnosis

  • Defined as an aortic diameter > 3 cm.
  • Most are asymptomatic,detected during a routine physical examination or imaging performed for anoother reason 
  • Sever back and abdominal pain and hypotension indicate rupture
  • Concomitant atherosclerotic occlusive disease of lower extremities in 25 %
General Considerations

  • More then 90% of abdominal aneurysms originate below the renal arteries many extend into the common iliac arteries.
  • Half are <5 Cm in diameter.
  • On routine ultrasound surveillance,two third will increase in size to require repair.
  • Yearly rupture risk is 2% for 4 to 5.4 cm aneurysms ,7% for 6 to 6.9 cm aneurysms,25% for 7 cm aneurysms
  • Patients with chronic obstructive pulmonary disease are more likely to experience rupture are small aneurysms.
  • More then one third of patients with popliteal aneurysms have abdominal aortic aneurysms. 
Demographic
  • Aortic aneurysms is present in 5-8% of the population older than 65.
  • Incidence has tripled over the last 30 years. 
Clinical Finding

Symptoms & Signs
  • Asymptomatic aneurysms prominent aortic pulsation on routine physical examination and incidental finding on abdominal ultrasonogram or CT scan,coexisting renal or lower extremity arterial occlusive disease present in 25% ,popliteal artery aneurysms in 15%.
  • Symptomatic aneurysms : midabdominal or lower back pain (or both).
  • Inflammatory aortic aneurysms : Low grade fever,elevated sedimentation rate and recent upper respiratory tract infection.
  • Infected aneurysms (rare) : Fever of unknown origin.peripheral emboli,positive blood cultures,caused by septic emboli to a normal aorta or bacterial colonization of an exisiting aneurysms.
  • Ruptured aneurysms : Severe back,abdominal or flank pain and hypotension ; 90% patients die before reaching the hospital are in the perioperative period.
Differential Diagnosis 
  • Asymptomatic abdominal aortic aneurysms: intraabdominal tumor,iliac aneurysms,Or mesenteric artery aneurysms.
  • Symptomatic/Ruture abdominal aortic aneurysms: acute myocardial infarction,Aortic dissection,Renal stones,Gastrointeritis,Bowel obstruction,and bowel infarction.
Diagnosis
Laboratory Tests
preoperative evaluation : Electrocardiogram,Serum Creatinine,Hematocrit and Hemoglobin and type and acrsross match.

Imaging Studies


  • Abdominal Ultrasonography : Indicated for screening and for monitoring aneurysm growth (annually for aneurysms > 3.5 cm in diameter)
  • Abdominal Radiograph : Curvilinear calcification are much less accurate
  • Contrast - enhanced CT scanning : precisely sizes the aneurysm,define it`s relationship to the renal arteries.
  • MRI : as sensitive and specific as CT and useful is renal insufficiency precludes contrast-enhanced CT.
  • Aortography/CT angiogram : indicated before elective aneurysmrepair when arterial occlusive disease of the visceral or lower extremity arteries is suspected or when endograft repair is being considerd .
  • Preoperative Evaluation : Assessment of cardiac risk and ultrasound examination of the carotid arteries.

Medication

  • Beta-Blocker and oral Roxithromycin ,300 mg daily for 30 days,Decrease the expansion rate of small  aneurysm.

Surgery

  • In asymptomatic good risk patients,surgery advised when  aneurysm diameter > 5 cm.
  • In poor risk patients,surgery advised when  aneurysm diameter > 6 cm.
  • Urgent repair advised for symptomatic  aneurysms irrespective diameter.
  • Ruptured  aneurysms require emergent surgery.
  • Open repair : Surgical reaction and synthetic graft replacement for most thoracic,abdominal,juxtarenal,and infrarenal aortic  aneurysms with diameter > 5 cm.
  • Endovascular Repair : Uniiliac or bifurcated endovascular stent grafts,deployed via the common femoral arteries,can be considered for infrarenal  aneurysms with favorable anatomy.
  • Endovascular repair can be done by a percutaneous route or by bilateral inguinal incisions under epidural anesthesia,and thus has made repair of aortic  aneurysms feasible in elderly high risk patients.
  • Long-Term durability of endovascular grafts needs to be established.

Therapeutic procedure 

  • Physical examination.
  • Ultrasonogram of abdominal aorta every 6 month.

Follow Up

  • Open repair : Yearly physical examination.
  • Endovascular repair : Routine surveillance,CT abdomen,and physical examination.

Complication

  • Open repair : Acute myocardial infraction,Arrhythmia,Bleeding,Respiratory failure,Limb ischemia,Renal failure,stroke,Ischemic colitis,Bowel infraction,Liver dysfunction,acalculous cholecystitis,Grafts infaction,Graft enteric fistula.
  • Endovascular Repair : Persistent filling of the  aneurysm(Endoleak),Graft Migration,Graft Thrombosis,Graft Infaction (Rare),Renal failure,conversion to open repair.

Prognosis

  • Mortality following elective open or endovascular repair is 1-5 %
  • A patient with >5 cm aortic aneurysmand life expectancy of > 1 year has a 3 fold greater chance of dying of rupture than of dying from surgical reaction .
  • 5 year survival after surgical repair is 60-80 %.
  • 5-10 will develop another aortic aneurysm adjacent to the graft or in the thoracic aorta.

When to Refer

  • Any patient with an aneurysm_> 4.0 cm .
  • Any patient with a symptomatic or suspected ruptured abdominal aortic aneurysm.

When to Admit

  • All patients with symptomatic or suspected ruptured abdominal aortic aneurysms or suspected infected aneurysms.

Prevention

  • Blood pressure Control.
  • Cardiovascular risk assessment and treatment.
  • Smoking cessation .
  • Screening of family members older than 65.

Evidence

Practice Guidelines

  • Brewster DC et al : Guideline for the treatment of abdominal aortic aneurysms.Report of a subcommittee of the joint Council of the American association for the vascular surgery and Society for Vascular surgery.



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Hypertension/High Blood Pressure

Hypertension Chronic

Essentials Of Diagnosis

  • Usually asymptomatic
  • Severe Hypertension : Occipital headache at awakening,blurry vision
General Consideration
  • Mild to moderate hypertension nearly always asymptomatic.
  • Severe hypertension usually due to parenchymal renal disease,endocrine abnormalities.renal artery stenosis,drug use,or abrupt cessation anti hypertensive medications.
  • Table 42 provides classification based on blood pressure (BP) measurements.
  • Table 43 summarizes potential identificable causes of hypertension.
  • Resistant hypertension is defined as failure to reach BP control in patients.
  • Adherent to full doses of a 3 drug regimen (including a diuretic).
  • Table 44 summarizes reason for failure to reach BP control. 
Demographics
  • 70 % of aware of their condition.
  • 50 % of those aware are receiving treatment.
  • 25 % of all hypertensive patients have BP under control.
  • Incidence of hypertension increases with age.
  • More men than women in early life.
  • More Women than men later life.
Symptoms & Signs
  • Usually asymptomatic.
  • Occipital headaches characteristic but uncommon.
  • Elevated BP
  • Loud A2 on cardiac examination.
  • Retinal arteriolar narrowingwith "Silver wiring" arteriovenous nicking.
  • Plame-Shaped Hemorrhages.
  • Laboratory findings usually normal.
  • In severe hypertension,renal dysfunction and hemolysis. 
Hypertension Chronic

Differential Diagnosis
Primary (Essential)Hypertension
  • White Coat Hypertension.
  • BP cuff too small.
Secondary Hypertension

  • Adrenal

-Primary hyperaldosteronism.
-Cushing`s Syndrome.
-Pheochromocytoma.

  • Renal
-Chronic renal disease

-Renal artery stenosis(Atherosclerotic or fibromuscular dysplasia)

  • Other
-Oral Contraceptives
-Alcohol
-Non-Steroidal Anti-Inflammatory drugs.
-Pregnancy associated.
-Hypercalcemia
-Hyperthyroidism
-Obstructive Sleep apnea
-Obesity
-Coarctation of the aorta.
-Acromegaly
-Increased Intracranial Pressure.

Diagnosis 
Laboratory Test.
  • Heamoglobin
  • Urinalysis
  • Serum Creatinine,Blood Urea Nitrogen.
  • Serum Pottasium.
  • Fasting Blood glucose
  • Serum Uric acid 
  • ECG.
  • When a secondary cause is suspected,consider.
-Chest X-Ray.
-ECG
-Plasma metanephrine levels.
-Plasma aldosterone Concentration,Plasma renin activity
- Urine electrolytes.

Treatment
Medication
  • Initiation of drug therapy based on level of BP,Presence of target end-organ damage,and overall cardiovascular risk profile.
  • Mejor risk Factors include.
-Smoking
-Dyslipidemia
-Diabetes mellitus
-Age > 60 years.
-Family history of cardiovascular disease.
  • Specific choice of pharmacotherapeutic agent should be based on other risk factors,Compliance and cost.
  • Diuretics.
  • β-Adrenergic blocking agents.
  • Angiotensin-converting enzyme(ACE)inhinitors and angiotensin receptor blockers.
  • Calcium channel-blocking agents.
  • α-Adrenergic blockers,vasodilators,centrallyacting agents.
Hypertension Chronic



Therapeutic Procedure
  • Dietary changes(DASH diet):high in fruits and vegetables,low fat,low salt.
  • Weight reduction
  • Alcohol restriction 
  • Salt reduction
  • Adequate potassium intake.
  • Increase physical activity
  • Smoking cessation
  • Aggressive risk factor management should be consideredin all patient with hypertension
  • Anti Hypertensive medications should be indivisualized.
  • Diabetes and hypertension should be treated aggressively,aiming for target BP < 140/80 mm Hg,given hish risk of cardiovascular events and ACE inhibitors or angiotensin receptor blockers should be part of regiemen.
Follow Up
  • frequent visits until BP is controlled 
  • Once Controlled,Visits can be infrequent,Limited laboratory tests.
  • Lipid monitoring every year
  • ECG every 1-2 year,depending on initial ECG
Complication
  • Stoke 
  • Dementia
  • Myocardial Infarction
  • Congestive heart failure
  • Retinal Vasculopathy
  • Aortic dissection
  • Renal Disease.Including Proteinuria and nephrosclerosis
When to Refer
  • Refer if BP remains uncontrolled after three concurrent medications.
  • Refer if patient has uncontrolled BP and symptoms and signs of end organ damage 
When to Admit
Consider Hospitalization if symptoms and signs of of a hypertensive emergency(see Urgencies & emergencies)including,in the setting of very high BP ,Severe Headache ,Neurologic symptoms,Chest pain altered mental status,or acutely worsening renal failure.

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