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home - Miscellaneous - Other - Peritoneal and Retroperitoneal Disease Written by Dr Sebastian Zeki

Defines the pathophysiology of fluid and nutrient malabsorption,
including causes, e.g. anatomical and functional short bowel
syndrome, high output stomas, enterocutaneous fistulae and
pancreatic insufficiency

Knows how to investigate patients with malabsorption
Describes the clinical consequences of malabsorption, including
malnutrition, fluid and electrolyte disturbance and micronutrient
deficiency and anaemia and how to manage these

Describes all other causes of anaemia, including bone marrow
disorders and haemolysis

Describes the metabolism, absorption and bioavailability of iron, B12
and folate and clinical conditions and diets associated with their

Identifies and appropriately investigates clinical features suggestive of

Manages fluid, electrolyte and micronutrient disturbances associated
with short bowel syndrome or high output stomas

Uses the appropriate investigations for the different types of anaemia
Takes a careful clinical approach to managing patients with
malabsorption and anaemia. Explains plan of management clearly to
patients and their relatives.



Knows the different causes of enteric dysmotility (myopathy and
neuropathy) and their presenting features

Have a knowledge of scleroderma amyloid and congenital motor
abnormalities of the gut that affect absorption

Knows the principles of investigation pain relief and prokinetic drug

Understands bacterial overgrowth and its treatment
Understands how emotional status can affect gut function
Knows how diabetic complications can affect the gut
Can determine when organic obstruction is occurring TO
Can understand the principles and interpret the results of
gastrointestinal motility investigations (including manometry transit
studies etc) and autonomic function tests
Advises on appropriate prokinetic drugs and analgesics
Can detect and treat bacterial overgrowth
Advises on appropriate surgery including bypass procedures
Can relieve symptoms while not causing/risking harm with other
medications (e g opiates)

Works with the multidisciplinary NST psychiatrists/psychologists
surgeons and the pain management team

Can give careful explanation of the problems to the patient carers
friends and family

Peritoneal and Retroperitoneal Disease

1)Masses:-Mets-Primary-Cysts2)Vascular-Torsion-Infarction3)Inflammatory Retroperitoneal Diseases:Retroperitoneal fluid collection.Retroperitoneal haemorrhage.Retroperitoneal fibrosis.Retroperitoneal infection.Retroperitoneal neoplasms. Lesser omentum Greater omentum Mesentery (holds vessels of visceral peritoneum Visceral peritoneum Parietal peritoneum Lesser sac Greater sac Liver Stomach D D 1.Peritonitis a)Acute suppurative peritonitis b)Granulomatous peritoni-tis (TB/fungal+parasitic infection/cellulose fibres/talc) c)Chemical peritonitis d)CPD peritonitis - usually keep dialysis catheters in unless refractory or recurrent2.Primary mesothelioma3.Pseudomyxoma peritonei- peritoneal tumour associated with appendiceal mucinous tumour Mesenteric diseases:Primary mesenteric inflammatory diseases.-Mesenteric panniculitis.-Retractile mesenteritis (unknown aetiology due to fat becoming fibrotic).Mesenteric cysts.-Infective and degenerative cysts.-Neoplastic cysts.-Traumatic/acquired cysts.-Embryonic/developmental cysts.Mesenteric tumours.Mesenteric fibromatosis (desmoids).Mesenteric vascular diseases. Diseases of the mesentery peritoneum and retroperitoneum a)Benign--Lipoma--Haemangioma--leiomyomab)Ganglioneuromac)Malignant--Mets--Rhabdomyosarcoma--Leiomyosarcoma--liposarcoma Omental Peritoneum Written by Dr Sebastian Zeki