Q.665. What are the suggested modalities for diagnosis of abdominal & thoracic cavity defects in P.D. patients?
PERITONEAL DIALYSIS
Q.665. What are the suggested modalities for diagnosis of abdominal
& thoracic cavity defects in P.D. patients? 😎
A. Different
diagnostic modalities cn be used alone or in combination to diagnose abd.
wall and/or thoracic defects in PD.
Based on sensitivity, specificity & cost, we use & recomm. CT peritoneography as initial
diagnostic modality . It’s the most commonly used modality in
U.S. & offers distinct adv. over plain CT scans.
Although MR peritoneography hs similar sensitivity to CT pr. graphy
in Dgx these defects, use of gadolinium in DX ptn.s hs bn ass. é sev.
synd. of nephrogenic systemic
fibrosis. So, Gadolinium-based img. shd be avoided MR
peritoneography using DX. fluid as a contrast medium may offer a valuable,
cheap & user friendly alternative.
However, further study in additional centers is required to validate
its usefulness. Isotope scanning is
principally used in allergic ptn. to iodinated
contrast used in CT Pr.graphy.
Q. 666. When to remove the “Tenkoff” catheter? 👉
A. Catheter Removal:
1) Recurrent peritonitis.
2) Cloudy Dzt. 3-7 d..(high protein content).
3) Cloudiness is increasing. (high protein content).
4) Ptn. Sm.tically unwell.
5) Evidence of sepsis.
6) Cathter block &
malfunction.
7) Tunnel Sepsis.
……After
removal use “Oripulous Cth.” & consider A/V.
fistula & “H.DX.”
Q.667. What are the causes of “Sclerosing peritonitis”?
A. “Sclerosing peritonitis” us. occ.
due to:
1)
Repeated
infection.
2)
Endotoxin
effect.
3)
“Acetate” Dzt.
4)
Cholorohexene disinfectant.
5)
Long-standing
P.D.
6) “Encapsulating peritonitis:
rare, very severe [Thick wall momen-tum - COCON 👀raping a loop of
intestine intestinal
obstruction + Malnutrition,
us. occ. é “acetate” containing- Dzt. ].
Q.668.
What specific types in peritonitis of interest?
How to deal with?
A. - Pseudomonas sp. Hospz.+Cipro.
500 b.d. oral
+ Genamycin 0.6
mg/kg.
- Fungal infection [Hospitalization + Cth. Removal+ i.v. antifungal].
- Staph peritonitis [Rifambicin 600 mg. before breakfast].
- G-ve & enterococci [Gentamycin 0.6 mg/kg].
Vancomycin intrPr. via PD fluid: 15-30 mg/L (15-30 mcg/mL) of PD fluid
Systemic:{Loading: one g., foll. by ½-1 g./48-72 h. é monitoring s. levels}.
Q.669. What are the recommendations for rapid transporters P.D. patients?
A. Close
attention to: adequacy of U.F. &
nutrition. Loss
of Kru fluid retention & vol.-dependent H.T. need to use hypertonic
exchanges. Ptn. will hv a tendency
for malnutrition, So, transfer to short-dwell thpy, like NIPD or DAPD. Both NIPD & CCPD hv multiple
short dwells at night. The mj. adv. of NIPD in rapid transporters abd. is dry é day protein
losses & fluid & gluc. absorption. Supplemental parenteral nutrition
or, intraPr. a.a.
shd be considered.
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