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.