Gout ppt

Study material regarding GOUT

1. GOUT

2. Royal killer pain/ royal foot trap

3. DEFINITION Acute sudden inflammation of the joint caused by high level of uric acid concentration in the blood leading to the development of tophi( Tophus)

4. High level of uric acid concentration in the blood------Hyperuricemia Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male).  B lood uric acid level rises above 7 mg/dL .----Gout Uric acid deposition called tophi ( Tophus)

5. Uric acid deposition called tophi ( Tophus) Podagra - -gout of the foot, especially the big toe. Podagra ---‘ foot trap’, is gout which affects the joint located between the foot and the big toe, known as the metatarsophalangeal joint

6. ETIOLOGY Purine rich foods- Meat Kidney Liver Seafood Certain vegetables[peas, beans, cauliflower] Caffeine Drugs [loop diuretics, Chemo, salicylates corticosteroids ]

7. Trauma Infection Other disease [ DM, HTN, renal disease] Congenital/ hereditary

8. TYPES

9. Primary gout In primary gout, a hereditary error of purine metabolism leads to the overproduction or retention of uric acid.

10. Secondary gout Secondary gout may be related to another acquired disorder or may be the result of drugs known to inhibit uric acid excretion.

11. Acquired disorder

12. Drugs

13. PATHOPHYSIOLOGY

14. Abnormal metabolic process in the body Increase in uric acid in the blood , decrease in excretion of uric acid Uric acid react with sodium in the blood to form sodium crystals Uric acid crystals Deposited in the joints--Tophus

15. Activate inflammatory response, and release of inflammatory mediators and free radicles Free radicle damages the tissues Release of proteolytic and Lysosome enzymes Leads to further Damages to the tissues causing edema, redness and pain

16. Asymptomatic No symptoms Only by physical examination/ diagnostic studies Uric acid Level: 7-8 mg/dl

17. Acute stage Severe and sudden onset Only one or two joints will be involved Symptoms will appear usually at the night time Joints will be warm, red, oedematous, pain and tender increase in uric acid level (8-12mg/dl)

18. Intermediate stage Symptoms will worsen over an extended time Joints will be warm, red, oedematous, pain and tender Severe Pain Increased accumulation of uric acid crystals Uric acid level : 12-15mg/dl

19. Chronic stage Continuous and persistent pain Decrease in the mobility of joints Increase in redness and edema Difficulty to treat with medicine Uric acid level: >15 mg/dl

20. COMPLICATIONS

21. DIAGNOSTIC History and physical examination Family history of gout Blood test- Elevated serum uric acid levels Urine test- Elevated 24-hr urine for uric acid levels X-ray Presence of sodium urate crystals in synovial fluid

22. Management DRUG THERAPY 1. Non-steroidal anti-inflammatory drugs Ibuprofen –400mg 2. Corticosteroids ( prednisone )—1-2mg/kg 3. Probenecid—500mg increases uric acid excretion in the urine

23. 4.   Allopurinol ---300mg   is a purine analog decreases uric acid formation and may also inhibit purine synthesis. 5. colchicine   --500mcg interrupts urate crystal deposition in joint tissues.

24. 6. Adrenocorticotropic hormone (ACTH) ACTH helps to reduce the gout inflammation Dose –40 IU

25. Foods to be avoided Following foods should be avoided: Alcohol Red meat and organ meat such as liver or kidneys Seafood Certain vegetables[peas, beans, cauliflower] Caffeine Sugary drinks and foods high in fructose Processed foods and refined carbohydrates

26. NURSING MANAGEMENT: GOUT Supportive care of the inflammed joints. Pain Management with NSAIDS Avoiding weight bearing exercises Limiting exercises during acute stages Dietary management to limit uric acid in blood Prevention of infection during steroid therapy Local heat application to the joint

27. Health education The nurse should explain gout is a chronic problem that can be controlled with careful adherence to a treatment program. Thorough explanations regarding importance of drug therapy and the need for periodic determination of serum uric acid levels. -reducing/ eliminating the risk factors

28. Aware of the dietary restriction Prevention of infections Assistance while moving Home management of pain with analgesia and local heat applications

29. Thank you