Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

346 Chronic Pancreatitis Chronic Renal Failure

➣surgery management: drainage of the pancreatic duct into the

intestine.

■duodenal and bile-duct obstruction (5–10% of patients)

➣usually surgically treated with gastrojejunostomy or choledo-

choenterostomy.

Chronic Renal Failure.................................

ROBERT D. TOTO, MD

history & physical

History

■Infections, toxins, environment: hepatitis B and C, lead, mercury, sili-

con, acetaminophen/paracetamol/caffeine combinations, NSAIDS,

lithium, pamidronate, herbal (e.g. Chinese herbs) remedies, Balkan

nephropathy

Risk Factors for Progressive Renal Disease

■Age, diabetes mellitus, hypertension, Family history (pattern of

inheritance); black race, cigarette smoking, persistent albumin-

uria.

Signs & Symptoms

■May be asymptomatic. Symptoms usual when Ccr≤25 mL/min/1.73

m^2.

■General: fatigue, malaise, weakness, fever (systemic diseases and

retroperitoneal fibrosis)

■HEENT: headache, visual disturbances, retinal changes of hyperten-

sive/diabetic retinopathy, cholesterol emboli, uremic fetor

■CV and PULM: dyspnea, edema, chest pain, hypertension, hyperp-

nea (metabolic acidosis) pulmonary edema

■GI: dysguesia, loss of appetite, nausea, vomiting, diarrhea occult GI

emorrhage

■GU: Nocturia, foamy urine, dysuria, hematuria, painful urination,

flank or back pain, hypospadias, urethral stricture, prostate enlarge-

ment

■MS: lower extremity edema, bone and articular pain, generalized

muscle wasting and weakness

■NS: encephalopathy: difficulty concentrating, insomnia, daytime

drowsiness; peripheral neuropathy