Q.650. What are the general complications of P.D.?
PERITONEAL DIALYSIS
Q.650. What are the general complications of P.D.?
A. “Complications”
of P.D.:
1. Abdominal (Paraumblical hernia). (🠝IAP). 👀
2. Vaginal
hernia.
3. Rectal
prolapse.
4. Scrotal
swelling 🠞Patent processus vaginalis 🠞Scrotal Dzt leak.
5. Pleuro-pritoneal
leak.
6. Lumber
lordosis.
7. Inflow
pain 🠞Clamp the line to reduce flow.
8. Isolation Depression (Lonely hours). 😌
9. Decreased
appetite due to:
i. Increased abdominal fullness
ii. Decreaed DX. Adequacy.
iii. Loss of “nutrient” é Dzt.
10. Hemo🩸Pr.: é menses in ♀ (open “processus vaginalis” 🠞Cath. clot block).
Q.651.What is SEP.? How to manage?
A. SEP. (Sclerosing Encapsulating Pertonitis):
ch.ch. by [extensive intra-Pr. fibrosis + encasement of bowel loops
+ progressive loss of U.F.]🠞fluid
retention & edema. Etiology: {not
clear but may be: prior sev. peritonitis, acetate DZt.
buffer, a reaction to foreign ag. e.g. plasticizers fr. cth., B.B.,
premature withdrawal fr. P.D. &
extended
dur. of P.D.}.
Sn & Sm of SEP : [abdominal
pain, nausea, loss of appetite, constipation, drr., abd. mass, ascites, wt.
loss, vomiting & fatigue].
Dgx. SEP: by CT🠞[Pr.
calcification, bowel thickening, bowel tethering, and bowel dilatation]. Confirmation:
by laparotomy and/or laparoscopy. (rarely used).
ttt. SEP: Stop
P.D. & transfer to H.DX. (although it may develop or worsen
after stopping PD), bowel rest + TPN & (may be) im/m. therapy and/or surgery.
Q.652. What are the possible mechanisms of solute clearance
and U.F. in P.D?
A. Pr.
barrier 👌has
3 layers :[Pr. mesothelium,
interstitium & cpll. endothelium].
According to the 3-pore model of solute transport, cpll. endothelium
contains 👌3 different-sized pores which’re size-selective in
restricting solute transport. Aqua-porin-1 is the smallest sized pore and is
responsible for 40
% of free
water transport across Pr. membrane. Transport of different solutes is
based on diffusion &
convection. Trans-cpll. U.F. rate is determined by: [net
pressure gradient & by Pr. membrane ch.ch. & by Starling’s law. Both crystalloids
and/or
colloid
based Dx. solutions cn be used to provide the required osmotic
or oncotic gradients. Rate of solute transport varies between individuals,
which may hv therapeutic implications for Dx. adequacy as well as fluid
overload.
U.F. failure occur due] alterations in vascular surface
area (larger vasccular surface area 8more
pores available for transport), which🠞Rapid loss of gluc. gradient across
the membrane & fluid retention. Selective loss of aquaporin-1
function. & other f. can🠞U.F.
failure, which can be determined by sp. studies on Pr. membrane.
Q.653. How to evaluate hypervolemia in P.D. patients?
A.Volume overload in PD
is mostly due to preventable/treatable causes, which incl.:[excessive sod. or water intake, too
little sod. or water removal, or a new comorbid dis.].
Causes of 🠝salt
&
water intake incl.:[noncompliance
é dietary
restrictions & absorption of fluid dur. dwells caused by failure of PD
prescription 🠞adequate osmotic (or oncotic) stimulus
for U.F.].
Causes of insuff. salt & water removal incl.:[prescription failure to
provide adequate osmotic (or oncotic) stimulus
for U.F., failure of Pr membrane to resp. to osmotic stimulus & loss of Kru].
Comorbid disease:[new CVS
event or worsening of heart disease, hypoalbuminemia &🠞oncotic pressure or
mech. or anatomical problem]. Evaluation of volume overloaded
incl.:[history & physical exam., fill & drain test, PET &
radiogr. studies]. History: excl. CVS dis., determining loss of body
mas & adherence é DX.
prescription or salt & water intake. Exam. incl.:[exit site
for fluid(dextrose +ve on dipstick), pres. of hernias, especially in pericth.,
genital, inguinal & femoral areas & distribution of retained fluid:
generalized, unilateral, or localized. Mechanical
or anatomical problems may
be quickly excl. by performing a quick two liter "fill
& drain" to determine nature & rate of Dzt flow. Fibrin
clots, difficulty é
inflow, or incomplete or positional drainage may be obs..
PET test allows ch.ch. of Pr. transport, U.F. capacity & pres. of
sodium sieving or change fr. prior PET tests.
Radiographic evaluation: used é cth.
malposition or Dzt. leak. A flat plate of the abdomen us. used to evaluate
cth placement & positioning & may reveal constipation. Lateral
film may excl. rotation or kink in S.C. part. Abd. CT é intraPr. contrast or MRI
without contrast usually used to excl. Dzt leak. Gadolinium-based imaging should be avoided. Dzt. prescription & U.F. should be reviewed
monthly. Routine monitoring of all ptns should incl.:[ur. volume & overnight
drain vol. (CAPD)
or
daytime drain vol.(APD)]. Baseline PET should be done é initiation of Dx. & repeated
if indicated. Measures to help prevent overload includ: [diuretics, avoid
nephrotoxic ag., monthly dietary counseling, enhancing compliance, optimizing
s. glucose control (to maximize
osmotic gradients) &
matching dwell time to transport type].
Q.654. What are the noninfectious complications of P.D.
catheters?
Erosion of
cth. cuff thr. the skin may be a sequela
of exit-site infection or excessive
superficial cuff placement. Conservative ttt may be attempted if there’s no
evidence of infection. Cuff shaving or cth. removal may be required in
presence of infection. Intestinal
perforation can occur at time
of cth. implantation due to direct injury, or weeks to m.s after
placement due to bowel erosion. It’s life-threatening & shd requires
a high index of suspicion & urgent 🔔 attention. Clues of perforation 🠞feculent or bloody Dzt, Dzt retention, drr. occ. after Dzt.
instillation, or G.-ve peritonitis. Thpy: [cessation of
P.D., cth. removal, i.v. A.B. & bowel repair.] .
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