Retinopathie en cardiomegalie zijn meestal matig aanwezig, maar specifieke catecholamine cardiomyopathie kan wel optreden. Diagnose, feochromocytomen worden vermoed bij patiënten met typische symptomen of in het bijzonder plotselinge, ernstige, intermitterende of onverklaarde hoge bloeddruk. Diagnose behelst het aantonen van hoge niveaus van catecholamineproducten in het serum of urine. Bloedonderzoek, bepaling van plasmavrije metanephrine heeft een sensitiviteit van. Deze test heeft een superieure gevoeligheid voor het meten van circulerende epinefrine en noradrenaline, omdat plasma metanephrines voortdurend zijn verhoogd, in tegenstelling tot epinefrine en noradrenaline. Urine-onderzoek, urine-metanephrine is minder specifiek dan plasmavrije metanephrine, maar de gevoeligheid is ongeveer. Twee of drie normale waarden, terwijl de patiënt hypertensief is maakt de diagnose zeer onwaarschijnlijk.
Carotis-lichaam, orgaan van Zuckerkandl (op de zemelen aorta-bifurcatie). Gastro-intestinaal systeem, hersenen, pericardium, dermoíde cysten, feochromocytomen in de adrenale medulla treden in beide geslachten evenveel. In 10 van de gevallen bilateraal (20 bij kinderen). Ze zijn kwaadaardig in 10 van de gevallen. Van de extra-adrenale tumoren is 30 kwaadaardig. Hoewel feochromocytomen zich op elke leeftijd kunnen voordoen, worden ze meestal maninfest tussen 20 en 40 jaar. In 25 van de gevallen wordt gedacht dat er sprake is van genetische mutaties. Feochromocytomen variëren in grootte, maar zijn gemiddeld 5 tot 6 cm in diameter. Ze wegen 50 tot 200 g, maar tumoren van enkele kilos zijn al beschreven. Het komt zelden voor dat ze groot genoeg zijn om te palperen of symptomen veroorzaken als gevolg van druk of obstructie.
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Inleiding, een feochromocytoom is een catecholamine-producerende tumor (bestaande uit chromaffinecellen). Het veroorzaakt blijvende of paroxysmale hypertensie. De diagnose wordt gesteld door de bepaling van catecholaminen (en afbraakproducten) in het bloed of urine. Beeldvorming (ct-of mri) helpen bij het lokaliseren van tumoren. De behandeling behelst signaal de resectie van de tumor. Therapie met behulp van medicijnen voor de controle van de bloeddruk omvat α-blokkade, meestal in combinatie met β-blokkade. De uitgescheiden catecholaminen omvatten noradrenaline, epinefrine, dopamine en dopa in wisselende verhoudingen. Ongeveer 90 van feochromocytomen bevindt zich in de adrenale medulla, maar makkelijk ze kunnen ook in andere weefsels zitten die afkomstig zijn van de neurale kiemcellen: Paraganglion van de sympathische keten, retroperitoneaal para-aortaal.
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Selection of the right catheter size should increase patient comfort and allow adequate drainage (a 12 Ch catheter has a drainage capacity of 100 litres in 24 hours). The smallest size of catheter allowing effective drainage should be used, as larger gauges are more likely to cause trauma and mucosal irritation. However, where there is infection or postoperative bleeding, a larger bore minimises the risk of obstruction. The following provides an approximate guide to which size of catheter to insert in specific circumstances: Initial catherisation (female with clear urine, containing no grit (encrustation debris or haematuria - 10-12 Ch/3.3. Initial catheterisation (male with clear urine, containing no grit, debris or haematuria - 12-14 Ch/4. Initial catheterisation (male) with clear or slightly cloudy urine, no or mild grit, light haematuria with no or small blood clots only - 16 Ch/5.3. Initial catheterisation (male) with moderate-to-heavy grit or debris, haematuria with moderate clots - 18 Ch/6.
The indication will influence the choice of catheter: For simple pre-operative catheterisation or in hospitalised patients requiring short-term catheterisation only, a silver catheter may be preferred. There is moskou evidence that this reduces the risk of catheter-acquired uti but overall cost-effectiveness has not been confirmed. If the bladder is to be emptied and/or a urinary specimen taken with no need for ongoing catheterisation, a straight catheter (also known as a nelaton catheter) is used and immediately discarded. This has no facility for retention and tends to be made of pvc with a large lumen to facilitate rapid urine flow. If the catheter is to be left in situ, an indwelling Foley catheter is used. A silicone foley catheter has a much longer life than a latex-silicone one, so tends to be preferred for longer-term use, although a cochrane review concludes there is insufficient comparative evidence to be able to make good decisions between catheters for this type of use.
5 Triple lumen catheters are commonly used for continuous bladder irrigation following bladder or prostate surgery. Catheters come with various tips. The standard straight is suitable for most occasions. Beware of types such as the tiemann or coudé tip with a curved tip designed to facilitate passage through the prostate. It is easy to produce false passages and to do much damage. The Whistle-tipped catheter has openings laterally and above the balloon to drain debris and blood clots. Sizing Foley catheters are sized in Charrieres, also known as French Grade (fg 1 Ch 1/3 mm diameter.
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3, some patients are allergic to latex. The silicone layer tends to become damaged after a while and the underlying latex may again come into contact with the urothelium, which restricts the use of silicone latex catheters to 1-2 weeks when they should either be removed or replaced. Hydrogel is an alternative latex coating. Silicone foley catheters (where all latex is replaced by silicone) are 5-10 times as expensive as the silicone latex but their relative price has fallen as they have become more popular. As well as having a longer life of 6-8 weeks (some manufacturers claim up to three months they are more rigid which can be advantageous.
The balloon tends to empty by loss of water due to a semi-membranous effect of the wall of the balloon and so it will need to be refilled periodically. With longer life, encrustations tend to form at the tip of the catheter which may narrow the orifice or increase the diameter of the catheter, causing pain and bleeding upon removal. Therefore, they should not be left beyond the recommended limit. Coating catheters with materials with antimicrobial properties has been tried to prevent biofilm and encrustation related problems. 4, methods include use of: Silver alloys (so-called 'silver catheters. 3, antibiotic-coated or electrified catheters.
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Urethral versus suprapubic catheters (SPCs) : spcs offer advantages such as comfort and more convenient catheter changes; they can be clamped to test voiding and may offer better self-image and sexual function. Disadvantages include risk of cellulitis, leakage, and prolapse through the urethra; higher levels of expertise are required for insertion. Catheters come in a large variety of sizes, materials (latex, silicone, teflon) and types (Foley catheter, straight catheter, coudé tip catheter). Types, self-retaining Foley catheters are perhaps the best known and are soft plastic or rubber tubes inserted into the bladder to drain urine, held in place afslanken by a balloon at the tip of the tube, inflated with sterile water. Materials, the original Foley catheters were made of latex rubber but this has become obsolete. Latex is flexible and cheap but is prone to infection and hypersensitivity reactions. Silicone latex Foley catheters are very similar but have a silicone layer on top of the latex to overcome the endothelial irritation and microscopic lacerations/stricture development associated with latex.
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Selection of the type of catheter should be based upon clinical need, anticipated duration of use, patient preference and risk of infection. Choices include: External versus indwelling bloedgroep catheters : Condom or penile sheath catheters can be an option in incontinent men without urinary retention but with severely impaired function and are particularly suitable for night-time use only. They are typically more comfortable and with lower rates of bacteraemia than indwelling catheters but are prone to leakage; risks include skin breakdown, urethral diverticulae and penile ischaemia. Intermittent catheterisation (IC) versus indwelling catheters : Intermittent self-catheterisation is preferable to chronic indwelling catheterisation in many with a neuropathic bladder: it provides freedom from urinary collection systems. It is the standard of care in those with spinal cord injuries. However, it may not be acceptable or feasible functionally for some patients. If used following surgery (eg, post-hysterectomy or repair of hip fracture ic appears to be associated with reduced levels of bacteraemia and a quicker return to normal voiding. Used in the longer term, it appears to be associated with bacteriuria but less frequent uti and less severe uti than indwelling catheterisation. Ic and indwelling catheters are not mutually exclusive and many combine both methods to accommodate individual needs and lifestyles.
Be clear from the outset as to the aim of catheterisation. Short-term indications include: Treatment of acute urinary retention. Pre-operative prophylactic emptying of the bladder prior to urological or pelvic surgery - eg, hysterectomy, caesarean section. Monitoring urine output in critically ill patients. Checking urinary residual volumes. Long-term indications include: Treatment of chronic urinary retention due to bladder outlet obstruction not alvleesklier amenable to other treatment or those with neuropathic bladder. Management of incontinence: Intractable skin breakdown exacerbated by incontinence. The terminally ill or very frail where repeated bedding and clothing changes would be distressing. Patient preference after failure of other specific continence interventions.
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Urinary catheterisation should not be undertaken lightly and should be avoided wherever possible: it is painful (rated above lumbar puncture and arterial blood telefoon gases). 1, it may also cause significant morbidity and even mortality. However, it is a procedure that is frequently necessary and unavoidable. Nurses undertake the majority of catheterisation in primary care but GPs may be called upon to undertake it at times and then the doctor needs to be confident and competent. Sometimes difficulty can occur inserting a catheter, especially if there are problems such as urethral stricture, carcinoma of the prostate or following trauma. In such cases, rather than persevering, it is more judicious to seek help from someone with greater urological experience. As ever, act within your competency: the uninitiated should not use introducers and suprapubic catheterisation is also best left to the more experienced practitioner.