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grafitti87
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PostSubject: .::dilysis::.   Sat Jun 21, 2008 6:02 am

salam...
sape ader info dilysis untuk pesakit buah pinggang?
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CraZyGhOst
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PostSubject: Re: .::dilysis::.   Sat Jun 21, 2008 12:17 pm

In medicine, dialysis (from Greek "dialusis", meaning dissolution, "dia", meaning through, and "lusis", meaning loosening) is primarily used to provide an artificial replacement for lost kidney function (renal replacement therapy) due to renal failure. Dialysis may be used for very sick patients who have suddenly but temporarily, lost their kidney function (acute renal failure) or for quite stable patients who have permanently lost their kidney function (stage 5 chronic kidney disease). When healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate) and the kidneys remove from the blood the daily metabolic load of fixed hydrogen ions. The kidneys also function as a part of the endocrine system producing erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol). Dialysis treatments imperfectly replace some of these functions through the diffusion (waste removal) and convection (fluid removal). Dialysis is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney

Principle

Dialysis works on the principles of the diffusion and osmosis of solutes and fluid across a semi-permeable membrane. Blood flows by one side of a semi-permeable membrane, and a dialysate or fluid flows by the opposite side. Smaller solutes and fluid pass through the membrane. The blood flows in one direction and the dialysate flows in the opposite. The concentrations of undesired solutes (for example potassium, calcium, and urea) are high in the blood, but low or absent in the dialysis solution and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of minerals like potassium and calcium that are similar to their natural concentration in healthy blood. For another solute, bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of bicarbonate into the blood, to neutralise the metabolic acidosis that is often present in these patients.

Types

There are two primary types of dialysis, hemodialysis and peritoneal dialysis.

Hemodialysis

In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a semipermeable membrane. The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows removal of several litres of excess fluid during a typical 3 to 5 hour treatment. In the US, hemodialysis treatments are typically given in a dialysis center three times per week (due in the US to Medicare reimbursement rules), however, as of 2007 over 2,000 people in the US are dialyzing at home more frequently for various treatment lengths.[2] Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. These frequent long treatments are often done at home, while sleeping but home dialysis is a flexible modality and schedules can be changed day to day, week to week. In general, studies have shown that both increased treatment length and frequency are clinically beneficial.



Peritoneal dialysis

In peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semipermeable membrane. The dialysate is left there for a period of time to absorb waste products, and then it is drained out through the tube and discarded. This cycle or "exchange" is normally repeated 4-5 times during the day, (sometimes more often overnight with an automated system). Ultrafiltration occurs via osmosis; the dialysis solution used contains a high concentration of glucose, and the resulting osmotic pressure causes fluid to move from the blood into the dialysate. As a result, more fluid is drained than was instilled. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient and it requires motivation. Although support is helpful, it is not essential. It does free patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week, and it can be done while travelling with a minimum of specialized equipment.

Hemofiltration

Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, facilitating the transport of dissolved substances, importantly ones with large molecular weights, which are cleared less well by hemodialysis. Salts and water lost from the blood during this process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during the treatment. Hemodiafiltration is a term used to describe several methods of combining hemodialysis and hemofiltration in one process.

source = wikipedia


Last edited by CraZyGhOst on Sat Jun 21, 2008 12:28 pm; edited 1 time in total
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PostSubject: Re: .::dilysis::.   Sat Jun 21, 2008 12:28 pm

Rawatan Gantian Ginjal : Hemodialisis

Berapa ramaikah pesakit kegagalan ginjal yang mendapat rawatan hemodialisis?

Sehingga akhir tahun 2004 jumlah pesakit kegagalan ginjal yang mendapat rawatan hemodialisis ialah 11554 orang

Untuk maklumat lanjut : lawat laman web:www.msn.org.my/nrr.

Apa itu hemodialisis ?

Hemodialisis ialah satu daripada kaedah rawatan gantian ginjal yang menggunakan mesin hemodialisis, tiga kali seminggu, sekurang-kurangnya 4 jam setiap sesi rawatan. Rawatan boleh dilakukan di pusat rawatan hemodialisis atau dirumah. Pesakit rawatan hemodialisis perlu menjalani pembedahan membuat 'fistula' terlebih dahulu.



Apa itu vascular access ?

'Vascular access' kekal ialah pembuluh darah vena yang mengandungi campuran darah arteri bagi tujuan menyalurkan darah yang mencukupi semasa rawatan hemodialisis. Ia di buat melalui pembedahan kecil untuk menyambung pembuluh arteri dengan vena. Penyambungan ini dinamakan 'native AV fistula' (sekiranya saluran darah pesakit sendiri digunakan). Untuk tujuan yang sama bahan sintetik (synthetic graft) boleh digunakan. Mereka yang mengalami kegagalan ginjal yang kronik di nasihatkan membuat persediaan awal untuk menjalani rawatan hemodialisis. Mereka juga dinasihatkan untuk melakukan pembedahan kecil (fistula) tersebut beberapa bulan sebelum rawatan hemodialisis diperlukan. Mereka yang enggan menjalani pembedahan ini menanggung risiko komplikasi jangka pendek atau jangka panjang apabila memulakan rawatan secara mengejut.



Dua jarum khas dicucuk ke dalam 'fistula' untuk mengalirkan darah dan disambungkan ke mesen hemodialisis melalui tiub darah. Satu jarum untuk mengalirkan darah yang mengandungi bahan kumuh dari badan. Darah ini dibersihkan (dituras) menggunakan buah pinggang tiruan pada mesin hemodialisis. Darah yang telah dibersihkan akan masuk semula ke dalam badan melalui jarum yang satu lagi.



'Native fistula' yang telah terbentuk



Graf Sintetik biasanya berbentuk 'Loop'

Adakah kriteria tertentu diadakan untuk membuat pilihan rawatan hemodialisis?

Berbagai faktor sosio ekonomi perlu diambil kira.

Ini termasuk :

* Kemampuan untuk menggunakan kemudahan hemodialisis
* Sokongan keluarga
* Bantuan kewangan
* Pilihan pesakit


Juga awak tidak harus mempunyai sebarang kontraindikasi untuk hemodialisis. Sila rujuk di bawah.

Dimanakan boleh saya mendapatkan rawatan hemodialisis?

Terdapat banyak pusat pusat yang memberi rawatan hemodialisis di Malaysia. Ini termasuk hospital hospital Kementerian kesihatan, Badan bukan kerajaan, pusat daialisis swsta, pusat rawatan di universiti universiti, dan pusat rawatan dialysis angkatan tentera.

Lihat www.msn.org.my/nrr atau sini.

Bagaimana saya tahu saya perlu memulakan rawatan Hemodialisis?

Rawatan dialisis diperlu apabila anda memperlihatkan tanda-tanda yang berikut :

* Tanda-tanda dan gejala keracunan darah seperti loya, muntah, hilang selera makan, sawan,tahap kewarasan menurun.
* Ujian darah fungsi ginjal menunjukan paras creatinine, urea dan potassium sangat tinggi.
* Pengumpulan air dalam badan, malnutrition atau kadar hemoglobin rendah (anaemia
* Peningkatan "metabolic acidosis"
* Kadar penurasan glomerular (GFR) kurang dari 10 - 15mls/min (doktor akan melakukan ujian berkala bagi menentukan tahap fungsi ginjal)

Sila berjumpa Pakar Nefrologi

Apakah faktor faktor kontraindikasi rawatan hemo?

* Pesakit yang mengalami masalah fungsi system jantung tidak stabil
* Penyakit kanser yang teruk
* Kegagalan fungsi organ peringkat akhir contohnya dementia
* Masalah 'vascular access' yang serius
* AIDS pada tahap serius

Kumpulan sokongan

Persatuan Nefrologi Malaysia (MSN) - laman web www.msn.org.my.

Yayasan Buah Pinggang Kebangsaan (NKF) - www.nkf.org.my.

source = http://www.myhealth.gov.my/...(KLIK UNTUK PENUH)


Last edited by acmay on Sat Jun 21, 2008 8:38 pm; edited 2 times in total (Reason for editing : Pendekkan URL supaya tidak ganggu margin forum. TQ.)
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grafitti87
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PostSubject: Re: .::dilysis::.   Sat Jun 21, 2008 8:20 pm

wah...complete...thanx ek for the answer Smile
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PostSubject: Re: .::dilysis::.   Today at 1:23 am

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