Teaching Scheme

Course Credits Assigned

Course Name (Hrs/week)
Code
L T P L T P Total
Let noble thoughts come to us from every side
2 -- -- 2 -- -- 2
Human Health Systems Approach Human Health Examination Scheme
BS32 ISE1 ISE2 Attendance Total
Systems Approach
20 20 10 50
Dr. Surendra Singh Rathod Quiz 1: 10 Marks
Dean Academics
Dr. S. S. Rathod Quiz 2: 10 Marks
Sardar Patel Institute of Technology
Munshi Nagar, Andheri West, Mumbai-400058 Dr. D. R. Kalbande Quiz 3: 10 Marks
surendra_rathod@spit.ac.in Dr. R. G. Sutar Activity (e.g. Model Making (3D Printed/ Software/ Hardware/ any
9920228275 Prof. Kumar Khandagale material, Design and Simulation, Animated Short Film, App making) :
10 Marks

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Module Unit Topics

No. No.
1 Levels of Organizational Systems
Course Outcomes 1.1
1.2
Molecular, Cellular and Organ Systems
Biological Molecules
CO1 Physiology as integrated interdisciplinary Science 2
1.3 Biochemistry, Biophysics, Molecular Biology and Bioengineering
Energy and Molecular Supply Chain Management
CO2 Physiological significance of balanced diet and exercise in 2.1
2.2
Balanced Diet
Respiratory System and effects of Pollution
health 2.3
2.4
Cardiovascular System, Blood Pressure, ECG and Blood Report
Musculo-skeletal System and exercise Physiology
CO3 Significance of cleanliness and hygiene in daily routine 3 Body Fluid Dynamics
3.1 Body fluids
CO4 Dynamics and homeostasis of human health 3.2
3.3
Kidneys as Filtration Units and their Physiological Functions
Urinary System
3.4 Kidney and Urinary Stones, and Dialysis
4 Control, Coordination and Regulatory Systems
References: 4.1 Sense Organs
4.2 Nervous systems
1. Text book of Anatomy and Physiology for Nurses and 5 Defense Systems
5.1 Basics of Immune System
allied Health Sciences by Indu Khurana & Arushi 5.2 Lab-on-Chip (for diabetes etc.)
6 Molecular Biology and Genetical Information
2. Simplified Course in Molecular Biology by V. K. Agarwal 6.1 Hereditary Molecules: DNA RNA
6.2 Horizontal flow of Genetic Information
- S. Chand Publication 6.3 Vertical flow of Genetic Information

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 Human Health Systems Approach
Anatomy

Human Health??? Systems Approach???

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Applications?????? Nomenclature

• Anatomy: study of structure of body • Interior: inner

y Health Monitoring • Physiology: study of functions of body • Exterior: outer
y Medical Instrument Design structure • Ventral: front
y Telemedicine • Superior: upper • Dorsal: back
y Neuromorphic Engineering • Inferior: lower • Brady: slow
y Bio-MEMS • Anterior: front • Tachy: fast
y Robotics • Posterior: behind or at back • In vivo: measurement
y Forensic • Lateral: farthest from the middle line on or within body
• Medial: nearest to the middle line • In vitro: measurement
y Genomics
• Distal: farthest from the source is performed outside
• Proximal: nearest to the head or source body

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 General block diagram of a medical
instrumentation system

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A list of departments in a hospital with

their functions and provider specialties

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 A list of departments in a hospital with A list of departments in a hospital with
their functions and provider specialties their functions and provider specialties

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A list of departments in a hospital with A list of departments in a hospital with

their functions and provider specialties their functions and provider specialties

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 A list of departments in a hospital with General Constraints in Design of Medical
their functions and provider specialties Instrumentation Systems
y Measurement Range
y Frequency Range
y Inaccessibility of the Signal Source
y Variability of Physiological Parameters
y Interference among Physiological Systems
y Transducer Interface Problems
y High Possibility of Artifacts
y Safe Levels of Applied Energy
y Patient Safety Considerations

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General Constraints in Design of Medical Human Physiology

Instrumentation Systems
y Reliability Aspects y Systems:
y Human Factor Considerations y Hydraulic system (cardiovascular system)
y Government Regulations y Pneumatic system (respiratory system)
y Signal Considerations (linearity, accuracy, sensitivity, range, I/P y Chemical system (biochemical system)
impedance, differential of absolute, sensor, reliability etc.)
y Computer system (central nervous system)
y Environmental Considerations (SNR, stability wrt temp, pressure,
radiation, humidity, shock, vibration etc.) y Communication system and networking (nervous system)
y Medical Considerations (Invasive/Non-invasive, Patient discomfort, y Mechanical system (biomechanical system)
material toxicity, heat dissipation etc.) y Robotics (hand-eye coordination)
y Economic Considerations (Availability of consumables etc) y Fluid mechanics (circulatory system)

19 20 Sardar Patel Institute of Technology 22-Aug-19

 Biosignals Biosignals
¾ Gram means waveform y Time-domain and frequency-domain
¾ Graphy means procedure y Fourier series
used to record waveform y Fourier transforms
¾ Graph means machine or
instrument used to
record waveform

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Biosignals Sources of Biomedical Signals

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 Sources of Biomedical Signals
y Bioelectric Signals (cell membrane potential)
y Bioacoustic Signals (flow of blood in the heart, through the
heart’s valves and flow of air through the upper and lower
airways and in the lungs)
y Biomechanical Signals (displacement signals, pressure and flow
signals etc. e.g.movement of the chest wall)
y Biochemical Signals (living tissue) Bio-Potentials
y Biomagnetic Signals (brain, heart and lungs)
y Bio-optical Signals (scattered light from a tissue)
y Bio-impedance Signals (skin resistance)

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Origin of Bioelectric Signals Electrical activity associated with one

contraction in a muscle
Na+, K+ and Cl-

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 Bioelectric Signals Circulatory System

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The Cardiovascular System

Arteries: Thick walled carry de-oxygenated blood away from the heart
Veins: Thin walled carry oxygenated blood towards the heart
Pericardium: Outer
Myocardium: Middle
Endocardium: Inner

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 Blood Flow Through Heart
1. The S.A. Node
¾ Sinoatrial Node (SA)
¾ Located in the right atrium
¾ Specialized group of cardiac muscle
cells that don’t contract
¾ Adapted to automatically generate
impulses
¾ Functions as a pacemaker

2. The A.V. Node

¾ Atrioventricular Node (AV)
¾ Located between atria and ventricles
¾ Similar in function to SA node

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Representative electric activity from various regions

of the heart

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 Normal wave pattern of an ECG waveform
recorded in the standard lead position Normal and Abnormal Cardiac Rhythms

y Heart beat originate in SA node (72 beats/min)

y Bradycardia: Rate is slowed (e.g. during sleep)
y Tachycardia: Rate is accelerated (e.g. emotion, exercise, fever, by
stimulus etc.)

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Abnormal Cardiac Rhythms Normal and Abnormal Cardiac Rhythms

Atrioventricular block
y Atrioventricular Block
y Arrhythmias
y Ischemia

AV block wherein the node is diseased (examples include

rheumatic heart disease and viral infections of the heart).
Although each wave from the atria reaches the ventricles, the AV
nodal delay is greatly increased. This is first-degree heart block.
39
 y In another form of incomplete heart block involving AV node, PR
interval progressively lengthens until the atrial impulse fails to conduct
In case of second degree heart block, not to the ventricle (Wenckebach Phenomenon). The first
conducted beat after the pause (or dropped beat) has a shorter
all atrial impulses are conducted to the PR interval (sometimes of normal length) than any subsequent
ventricles. There may be e.g. one ventricular PR interval. Then the process of lengthening of the PR interval
begins new, progressing over several cardiac cycles until another
beat every second or third atrial beat (2:1 block, beat is dropped.
3:1 block and so on) y The electrocardiographic sequence starting with the ventricular
pause and ending with the next blocked atrial beat constitutes a
Wenckebach period. The ratio of the number of P waves to QRS
complexes determine the block (e.g. 6:5 or 5:4 Wenckebach
periods).

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Arrhythmias
Normal and Abnormal Cardiac Rhythms
Atrioventricular block

Normal ECG followed by an ectopic beat.

An irritable focus, or ectopic pacemaker, within the ventricle
Complete heart block. Cells in the AV node are dead and or specialized conduction system may discharge, producing an
activity cannot pass from atria to ventricles. Atria and extra beat, or extrasystole, that interrupts the normal rhythm.
ventricles beat independently, ventricles being driven by an This extrasystole is also referred to as a premature ventricular
ectopic (other-than-normal) pacemaker. contraction (PVC).
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 Arrhythmias Arrhythmias

Paroxysmal tachycardia. An ectopic focus may

repetitively discharge at a rapid regular rate for Atrial flutter. The atria begin a very rapid, perfectly
minutes, hours, or even days. regular "flapping" movement, beating at rates of
200 to 300 beats/min.
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Arrhythmias
Arrhythmias

Atrial fibrillation. The atria stop their regular beat and begin Ventricular fibrillation. Mechanically the ventricles twitch in
a feeble, uncoordinated twitching. Concomitantly, low- a feeble, uncoordinated fashion with no blood being
amplitude, irregular waves appear in the ECG, as shown. pumped from the heart. The ECG is likewise very
This type of recording can be clearly distinguished from the uncoordinated, as shown
very regular ECG waveform containing atrial flutter.
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 Ischemia
ECG LEADs
y Tracking of voltage difference at any two
sites due to electrical activity of the heart is
called as “LEAD”.
y Bipolar Leads
y Unipolar leads
(a) Action potentials recorded from normal (solid lines) and
ischemic (dashed lines) myocardium in a dog. Control is before
coronary occlusion. (b) During the control period prior to
coronary occlusion, there is no ECG S-T segment shift; after
ischemia, there is such a shift.
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Bipolar Limb Leads

Bipolar LEADs
y Bipolar Leads called standard leads (Einthoven
leads): ECG is recorded by using two electrodes such that
the final trace corresponds to the difference of electrical
potentials existing between them.
y Lead I: Electrodes=> RA and LA
y Lead II: Electrodes=> RA and LL
y Lead III: Electrodes=> LA and LL
y RL always present
y QRS of a normal heart is such that the R wave is positive and
is greatest in lead II

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 Standard Notation

Lead I: 00
Dipole moment Lead II: 600
Lead III: 1200
Cardiac Vector: 300

Dipole field of the heart when R wave is maximum

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The Einthoven triangle for defining ECG

leads Unipolar Leads
vector sum of the projections on all three lines is equal to zero
y Better sensitivity as compared to the standard leads
y Chest electrodes give higher potentials than at the limbs.
y Wilson Leads
y Single exploratory electrode and the central terminal, which has
a potential corresponding to the centre of the body.
y Reference electrode or central terminal is obtained by a
combination of several electrodes tied together at one point.
KVL
y Two types: (i) limb leads (ii) precordial leads.

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 Unipolar Limb Leads
y Also called augmented leads or ‘averaging leads’.
Unipolar Limb Leads
y Two of the limb leads are tied together and recorded with respect
to the third limb.
y AVR Lead : RA is recorded with respect to the common junction
of the LA and LL .
y AVL Lead : LA is recorded with respect to the common junction
of the RA and LL.
y AVF Lead: LL is recorded with respect to the two arm electrodes
tied together.
y The resistances inserted between the electrodes-machine
connections are known as ‘averaging resistances’.
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Precordial leads: Unipolar Chest Leads

y It employs an exploring electrode to record the potential of
the heart action on the chest at six different positions.
y These leads are designated by the capital letter ‘V’ followed
by a subscript numeral, which represents the position of the
electrode on the pericardium.

Vector diagram showing standard and augmented lead-

vector directions in the frontal plane
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 Unipolar Chest Leads

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Electrocardiograph (ECG)
Electrocardiograph (ECG)
y ECG is an instrument which records electrical activity of heart
y Provides valuable information about a wide range of cardiac disorders
y Used in catheterization labs, coronary care units and routine diagnostic
applications in cardiology
y Frequency response=0.05 to 150 Hz
y Should faithfully reproduce the signal in the range
y Good low freq response to ensure stability of baseline
y Isolation from other biological signals (differential amplifiers and notch
filters)
y Overcome limitations of recorders

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 Isolation preamplifier (transformed-coupled)
Electrocardiograph (ECG) commonly used in modern ECG machines
Block diagram of an ECG machine

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Effects of Artifacts on ECG Recording

Problems Frequently Encountered
y Frequency distortion (HF: rounding of ECG, Interference from power line:
LF: baseline not horizontal) • Easily recognizable
y Saturation or cutoff distortion (ECG portion cutoff) • Poor quality tracings
y Ground loops (e.g. multiple equipments connected)
y Open lead wires
y Artifact from large electric transients (e.g. Defibrillation)
y Interference from electric devices
y Other sources e.g. nearby high-power radio station,
television or radar facilities

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 Effects of Artifacts on ECG Recording Effects of Artifacts on ECG Recording
Interference from power line:
Interference from power line:
Causes:
• CMRR circuits almost ineffective
•
Stray effect of alternating current on patient
• Practical Solution: Physical separation between sources and
•
Alternating current fields due to loops in patient cable
patient.
•
Loose contact on patient cable
•
Dirty electrodes Electrical power systems also induce extremely rapid pulses
•
Improper ground or spikes on the trace, as a result of switching action.
•
Disconnect electrode (common cause) Use of a transient suppressor in the mains lead of the
•
static charges on the synthetic uniform of the operator (random machines helps to solve this problem.
noise)
69 • Other electrical equipments (AC,X-ray, elevator) 70

Effects of Artifacts on ECG Recording Effects of Artifacts on ECG Recording

Shifting of baseline: Shifting of baseline:
•A wandering baseline •Usually observed immediately after application of
•Due to the movement of the patient or electrodes the electrodes.
•Solution: patient lies relaxed and the electrodes are •It is due to a relatively slow establishment of
properly attached electrochemical equilibrium at the electrode-skin
interface.
•This can be minimized by selecting the proper
electrode material, which will reach equilibrium
quickly with a good electrode jelly.
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 Effects of Artifacts on ECG Recording Effects of Artifacts on ECG Recording
Muscle Tremor: Muscle Tremor:
•Irregular trembling of the ECG trace , without wandering of •It is generally found in the case of older patients.
the baseline •For long-term monitoring, the electrodes are
•Occurs when the patient is not relaxed or is cold. applied on the chest and not on the limbs.
•On limb leads when a patient moves or the muscles are
stretched.
•For normal routine ECG recordings, the patient
must be advised to get warm and to relax so that
muscle tremor from shivering or tension is
eliminated.

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Microprocessor based three channel

Vectorcardiogram [VCG]
ECG machine
y VCG is the technique of analyzing the electrical activity of
the heart by obtaining ECG’s along three axes at right angles
to one another and displaying any two of these ECGs as a
vector display on an X-Y oscilloscope.

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 Vectorcardiogram [VCG] Phonocardiograph (PCG)
¾Each cardiac cycle
y Recording the sounds connected with the pumping action of
¾Illustrates the phase differences between the voltages
the heart
¾Each VCG exhibits three loops, showing the vector orientation
of the P wave, the QRS axis and the T wave. y These sounds provide an indication of the heart rate and its
¾Research tool rhythmicity.
y They also give useful information regarding effectiveness of
blood pumping and valve action.
y Heart sounds are diagnostically useful.
y Sounds produced by healthy hearts are remarkably identical
and abnormal sounds always corelate to specific physical
abnormalities.

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Phonocardiograph (PCG) Phonocardiograph (PCG)

y Acoustical stethoscope y Origin of heart sound:

y Electronic stethoscope Mechanical events that occur during the heart
cycle e.g. movement of the heart wall, closure of
y Phonocardiograph
walls and turbulence and leakage of blood flow

y Microphone (crystal, dynamic [moving coi] etc.),

amplifier (20 to 2000Hz, 4 to 5 with different
cutoff freq., gain compensation) recording system
(direct recorders, ink-jet).
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 Phonocardiograph (PCG)
Korotkoff sounds

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y Aortic wave: ejection of blood from left ventricle is

rapid at first. As the rate of pressure change
decreases the rounded max is obtained. When
systole period is completed, the aortic valve is closed
by back pressure of blood against valve….dicrotic
notch.
y When the valve is closed the blood pressure
decreases.
y Differences in measurement of arterial blood
pressure and venous blood pressure.
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 Angiogram
Angiography is performed for a variety of reasons,
including:
y Detection of occlusions of blood vessels, in patients with
chest pain and suspected as having heart disease.
y For a possible tear in a blood vessel and bleeding.
y Organ tumours can be diagnosed and surgical therapy can be
planned

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Angiogram
What is Angiogram?
y The radiologic examination of vessels after the
introduction of a contrast medium.
y It is an imaging test that uses x-rays to produce the road
map of body’s blood vessels.
y Physicians often use this test to study narrow, blocked,
enlarged, or malformed arteries or veins in many parts of
your body, including your brain, heart, abdomen, and legs.
y When the arteries are studied, the test is also called an
arteriogram, if the veins are studied, it is called a venogram

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 Pulmonary Circulation Pulmonary Arteriogram

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Angiogram
Hand Arteriogram How is the procedure done?
y During this procedure also known as
coronary angiography, the patient is
positioned on an x-ray table.
y Depending on the condition of the
arteries, either the under arm or groin
area will be disinfected and then numbed
with an anesthetic.
y A long, narrow tube (catheter) is then
inserted into a large artery (in either the
upper leg or upper arm) and gently
threaded up into the coronary arteries
around the heart muscle.
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 Angiogram Angiogram
y A special type of dye that is visible on x-rays is then
released from the catheter and the x-rays are then taken
of the heart and surrounding vessels.
y The doctor will review the x-rays taken during the
angiogram to pinpoint the location and severity of any
narrowing or blockages within the coronary arteries.
y If a blockage is found, the doctor can then determine the
best way to remove the blockage material or dilate
(widen) the narrowed blood vessel(s)

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Types of Angiograms Angiogram

Benefits of Angiogram:
y Shows no of coronary arteries blocked by fatty plaque
accumulations
y Pinpoint the area of blockages located in the blood vessels
y Indicate the extent ( %) of blockages
y Also eliminates the need for surgery. If surgery remains
necessary, it can be performed more accurately.
y It presents a very detailed, clear and accurate picture of the
blood vessels. This is especially helpful when a surgical
procedure is being considered.

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Angioplasty
Three Dimensional (3-D) Intraarterial Angiography

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 A, Guidewire advanced through stenosis.
B, Small catheter advanced through stenosis.
C, Large catheter advanced through stenosis.
D, Postangioplasty stenotic area.
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Balloon Angioplasty Procedure

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 Femoral Artery Angioplasty
Placing a Stent after Angioplasty with Balloon

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Kidney Dialysis
Intravascular Stents Dialysis comes from two Greek words namely ‘Dia”
and “Lysis” meaning splitting or separating materials
through a membrane
What is a Dialysis??
Dialysis is a treatment which replaces the function of
the kidneys, which normally serve as the body's
natural filtration system. The treatment removes
waste products and excess fluids from the
bloodstream, while maintaining the proper chemical
balance of the blood.
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 Kidney Dialysis Kidney Dialysis
Principle of Dialysis:
It’s purpose??
y Dialysis is the process of separating molecules in solution by the difference
Dialysis is most commonly prescribed for patients with in their rates of diffusion through a semipermeable membrane.
temporary or permanent kidney failure. People with y In dialysis, a sample and a buffer solution (called the dialysate) are separated
by a semi-permeable membrane that causes different diffusion rates,
end stage renal disease have kidneys that can’t remove thereby permitting the separation of molecules in both the sample and
fluids from their body. dialysate.
y It is due to the pore size of the membrane that large molecules in the
For these individuals, dialysis is the only treatment sample cannot pass through the membrane, thereby restricting their
option available outside of kidney transplantation. diffusion from the sample chamber.
Also, dialysis may be used in the treatment of patients y Once equilibrium is reached, the final concentration of molecules is
dependent on the volumes of the solutions involved, and if the equilibrated
suffering from poisoning or overdose in order to dialysate is replaced (or exchanged) with fresh dialysate, diffusion will
quickly remove drugs from the bloodstream. further reduce the concentration of the small molecules in the sample.

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Kidney Dialysis Kidney Dialysis

y Hemodialysis: The treatment involves
y Two types of dialysis treatment circulating the patient's blood outside of the
a)Hemodialysis (HD) body through an extracorporeal circuit (ECC),
b)Peritoneal Dialysis (PD) or dialysis circuit. Two needles are inserted into
the patient's vein, or access site, and are
attached to the ECC.

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 Kidney Dialysis Kidney Dialysis

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Kidney Dialysis Kidney Dialysis

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 Kidney Dialysis Kidney Dialysis

Peritoneal Dialysis: In peritoneal dialysis, the

patient's peritoneum, or lining of the abdomen,
acts as a blood filter. A catheter is surgically
inserted into the patient's abdomen. During
treatment, the catheter is used to fill the abdominal
cavity with dialysate.

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Kidney Dialysis Kidney Dialysis

• Abdominal cavity is lined by a vascular peritoneal membrane which

acts as a semi-permeable membrane
• Diffusion of solutes (urea, creatinine, …) from blood into the
dialysate contained in the abdominal cavity
• Removal of excess water (ultrafiltration) due to osmotic gradient
generated by glucose in dialysate
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 Thank you

121 22-Aug-19
Sardar Patel Institute of Technology