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CKD Diabetic Foot Disease — ESENeph MCQ

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HardDiabetic Kidney DiseaseCKD Diabetic Foot DiseaseESENeph

A patient treated with peritoneal dialysis for nine years develops recurrent subacute bowel obstruction, weight loss and haemorrhagic ascites. CT shows clustered small-bowel loops encased by a thickened calcified peritoneal membrane. What is the best management principle?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — PD cessation, nutritional support and experienced EPS-centre discussion

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

A is correct. The clinical and CT combination is encapsulating peritoneal sclerosis, not uncomplicated peritonitis. UK guidance recommends early discussion with a centre experienced in EPS surgery and early dietetic assessment because enteral or parenteral nutritional support is frequently required. Peritoneal dialysis is usually discontinued with transfer to haemodialysis, individualised to circumstances. B maintains the implicated modality and misclassifies obstruction as infection. C overstates the uncertain evidence for tamoxifen. D sends technically demanding surgery to an inexperienced setting. E uses CT as population screening despite inadequate predictive accuracy in asymptomatic patients.

Reference: UK Renal Association guideline on peritoneal dialysis: https://pmc.ncbi.nlm.nih.gov/articles/PMC5691857/