Overview.
Digestive complications of peritoneal dialysis are digestive disorders complicating peritoneal dialysis.
Classification
1. Esophageal reflux
Some patients with continuous ambulatory peritoneal dialysis may have abdominal distension, acid reflux, and hiccups. During peritoneal dialysis, high volume of peritoneal dialysis fluid is instilled into the abdominal cavity, and the intra-abdominal pressure increases, which increases the pressure at the cardia at the lower end of the esophagus, leading to spasm of the lower esophagus, and thus esophageal reflux occurs. Subdiaphragmatic abscesses, electrolyte disorders, and amyloidosis can also lead to esophageal reflux. Gastric power drugs can be given, and the volume of peritoneal dialysis fluid exchanged can be reduced each time if necessary, and the volume of dialysis fluid exchanged can be increased as appropriate after the symptoms disappear.
2. Intestinal perforation
It is rare in clinic and often related to peritoneal dialysis catheter. During peritoneal dialysis, the dialysis catheter presses the wall of small intestine for a long time, resulting in compressive necrosis and perforation of small intestine. Intestinal vascular dysplasia, ischemic colitis, and diverticulitis of the cecum can also lead to perforation. Patients often present with progressive abdominal pain, but it is not as severe as acute peritonitis. Once diagnosed, surgical management is required. The prognosis is often poor and the mortality rate is high.
3. Pancreatitis
Rarely, during peritoneal dialysis, the peritoneal dialysate enters the small omental sac where the pancreas is located through the omental pore. Hypertonic sugar, certain toxic substances, bacterial metabolites, and low pH of the dialysate can stimulate the pancreas and cause acute pancreatitis. In addition, hypertriglyceridemia, hypercalcemia due to calcium supplementation or administration of vitamin D3 are also risk factors for acute pancreatitis. Patients mainly present with elevated temperature, abdominal pain, nausea, and vomiting, which can also be recurrent. Some patients may be asymptomatic. Blood amylase up to 8 times the upper limit of normal value has diagnostic value.CT, ultrasound may show pancreatic congestion, edema or pseudocyst formation. The treatment of acute pancreatitis in patients on continuous ambulatory peritoneal dialysis (CAPD) is the same as that in non-dialysis patients, but the mortality rate is higher and early diagnosis and treatment are needed.
4. Liver abscess
Long-term peritoneal dialysis leads to decreased body resistance, intestinal collaterals are immersed in dialysis fluid for a long time, the intestinal barrier function is reduced, bacteria in the intestinal lumen invade the bloodstream through the mucous membrane, invade the liver along the portal vein, and liver abscess can be formed. Refractory peritonitis with a long course of disease, bacteria in the peritoneal dialysis fluid can directly invade the liver parenchyma to form abscesses. Patients present with chills and fever, which may be accompanied by right upper abdominal mass, right upper abdominal pain, nausea, vomiting, lack of appetite, hiccups.CT and ultrasound are helpful in diagnosis. After the diagnosis is confirmed, highly effective antibiotic treatment can be given, and if the abscess is large, ultrasound-guided puncture can be used to drain the pus. Surgery can be performed if the treatment effect is unsatisfactory.
5. Subperitoneal fat deposition of liver
It is seen in diabetic peritoneal dialysis patients, mostly due to the use of insulin in the peritoneal cavity. The thickness of fat deposits is proportional to the degree of obesity and the dose of insulin used. The concentration of insulin in the fat deposits is higher than that in the peripheral tissues, and sometimes fatty necrosis may occur, but it usually does not cause serious lesions, and liver function is usually normal. It is often misdiagnosed as liver metastatic cancer.
6. Hemorrhagic transudate
It is often caused by the damage to peritoneal and omental blood vessels during tube placement operation; violent coughing of patients, which leads to the rupture of peritoneum and damage to peritoneal blood vessels due to the increase of intra-abdominal pressure; rupture and bleeding of adhesion bands after adhesion of chronic inflammation in peritoneal cavity; inflow of menstrual blood into the peritoneal cavity during menstrual period of female patients, and so on. Generally, low-temperature peritoneal dialysis fluid is used for dialysis, and a lap band is used to maintain intra-abdominal pressure, and hemostatic drugs can be used if necessary. If the hemostatic drugs have no effect probe for hemostasis. Hemodialysis fluid during menstruation in women does not need to be treated.
7. Coeliac dialysis fluid
It is mostly related to intravenous albumin supplementation, eating animal high protein, high fat diet and other factors, and can also originate from celiac leakage in the abdominal lymphatic vessels. The dialysate is milky white, and the patient has no fever and abdominal pain. Routine examination of dialysis fluid reveals very few leukocytes, negative bacterial culture and positive coeliac test.
8. Intestinal bleeding
Rarely, factors related to peritoneal dialysis can lead to intestinal bleeding.