10 peritonitis Flashcards
What are the clinical signs of megacolon in cats?
- Severe constipation (obstipation)
- Tenesmus
- Pain when attempting to defecate
- Arching back
- Vocalising
- Stiff gait
- Reluctance to move
- Enlarged abdomen
- Anorexia
- Vomiting
- Weight loss
- Dehydration
- Some paradoxical diarrhoea around the feces
None
What is the most common cause of megacolon in cats?
Idiopathic causes (62% of cases)
Acquired megacolon can result from mechanical or functional causes.
What are some mechanical causes of acquired megacolon in cats?
- Pelvic canal stenosis
- Colonic or rectal neoplasia
- Foreign bodies
- Extracolonic masses
These causes can lead to obstruction.
What is pseudohyperreflexia?
A condition where the patellar reflex appears hyperreflexive due to decreased tone in the muscles that flex the stifle.
It can occur with a sciatic nerve or L6 to S1 spinal cord segment lesion.
What are the clinical signs of reverse shunting in a dog with PDA?
- Differential cyanosis
- Exercise intolerance
- Lethargy
- Weakness
- Diminished or absent continuous murmur
- Tachypnoea
- Collapse during exercise
- Dyspnoea
Cyanotic caudal mucous membranes but pink cranial mucous membranes.
What is the pathogenesis of reverse shunting in dogs with PDA?
Pulmonary arterial over-circulation can lead to pulmonary hypertension, reversing blood flow through the PDA, causing right-to-left shunting.
This results in hypoxaemia, especially in organs caudal to the heart.
What factors contribute to the development of GDV in dogs?
- Breed/size
- Deep-chested
- Anxious/aggressive behavior
- History of GDV in a first-degree relative
- Increased gastrohepatic ligament length
- Previous splenectomy
Husbandry factors include few meals, exercise after eating, rapid ingestion of food, and small food particles.
What are the subjective methods to determine if gastrectomy is required during GDV surgery?
- Examine gastric wall thickness
- Assess color of the stomach wall
- Evaluate presence/lack of muscular peristalsis
- Incise the serosa to check bleeding
- Check blood supply to the stomach
These methods have an accuracy of 85%.
What are the ideal properties of suture for gastric surgery?
- Monofilament
- Long lasting
- Swaged on needle
- Resistant to acid and enzyme-rich environments
- Sterile
Examples include Polyglyconate (75 days), Polyglecaprone (15 days), Polyglycolide, and Polydioxanone (12 days).
Define gastropexy.
Creating a permanent adhesion between the stomach and the side of the abdominal wall to prevent gastrointestinal volvulus.
It reduces the recurrence rate of GDV.
What are the four different types of gastropexy surgery?
- Incisional gastropexy
- Belt loop gastropexy
- Circumcostal gastropexy
- Gastrocolopexy
Each type has specific techniques and indications.
What is a cm incision made over in surgical procedures involving the rib?
11th/12th rib at level of costochondral junction
What are the major salivary glands in dogs and cats?
- Parotid
- Mandibular
- Sublingual
- Zygomatic
What is gastrocolopexy?
An incision/suture line between the greater curvature of the stomach and the transverse colon
Which gland is triangular shaped and located superficial to the vertical ear canal?
Parotid gland
Where does the parotid duct open into the mouth?
Through a small papilla at level of upper 4th premolar
What is the location of the zygomatic gland?
Ventral and rostrolateral to the globe and medial to zygomatic arch
What are the two portions of the sublingual gland?
- Monostomatic
- Polystomatic
What is one reason for dehiscence of oesophageal wounds?
Lack of serosa
What role does the serosa play in intestinal surgery?
Facilitates tissue healing by providing a smooth, protective surface
What are the four types of hiatal hernias?
- Type 1: Sliding hiatal hernia
- Type 2: Paraesophageal hiatal hernia
- Type 3: Combination of Type 1 and 2
- Type 4: Non-stomach organ herniation
What can contribute to the pathogenesis of perianal fistulas?
- Broad based tails
- Deeper anal sacs in GSDs
- Immune mediated cause
What are the types of congenital extrahepatic portal vein shunts in cats?
- Splenocaval
- Left gastrophrenic
- Left gastrocaval
- Left gastroazygous
What is the first phase of wound healing following small intestinal anastomosis?
Inflammation/Exudative/Lag phase (day 1-5)
What happens during the proliferative phase of wound healing?
Fibroblasts deposit collagen, replacing fibrin clot with granulation tissue
What is the last phase of wound healing characterized by the formation of a permanent scar?
Remodelling phase (day 14-weeks)
What is the typical strength of ileal/small intestinal anastomoses by 4 weeks?
Near normal strength
What are short term complications of oesophageal foreign bodies?
- Tearing/damage to oesophageal wall
- Inflammation/pain
- Regurgitation
- Possible aspiration and pneumonia
What are the two types of thoracotomies for foreign bodies located cranial to the heart base?
- Intercostal thoracotomy
- Left sided or right sided
What is the ideal suture pattern for esophagotomies?
Simple interrupted pattern using strong suture like 2/0
What increases the risk of dehiscence in esophageal surgery?
- Lack of serosal layer
- Segmental blood supply
- Constant movement of the esophagus
What is the main reason for choosing a gastrostomy feeding tube over an enterostomy tube?
Allows for a large gauge ostomy tube that can deliver decent amounts of food and water
What is the main cell type during the remodelling phase of wound healing?
Fibroblasts
What happens to collagen during the remodelling phase of wound healing?
Type 3 collagen is replaced by type 1 collagen
What is the typical timeline for healing in the colon?
- Lag/inflammatory phase: 1-4 days
- Proliferative phase: 3-14 days
- Maturation: 17 days +
What is the most proximal function part of the GI tract for enterostomy tube placement?
The stomach
It is distal to the diseased section (oesophagus) and allows for a large gauge ostomy tube.
What are the typical gauge sizes for an enterostomy tube?
14-24G
These sizes allow decent amounts of food and water to be given parenterally.
What are the complications associated with enterostomy/duodenostomy or jejunostomy tubes?
Obstruction with food/liquid, kinking, intestinal irritation, and perforation
These tubes are more technically difficult to place and use smaller sizes (8Fr).
What are the techniques for gastrotomy tube placement?
Surgically or Percutaneously
What is the surgical approach for gastrotomy tube placement?
Midline celiotomy or left paracostal approach
During a celiotomy, how is the stomach secured?
The stomach is pexied to the lateral or ventrolateral left body wall
What type of catheter is used during surgical gastrotomy placement?
Mushroom tipped Melecot or Pezzer catheter
What is the purpose of a full thickness purse string suture during gastrotomy placement?
To secure the feeding tube in the wall of the proximal half of the left gastric body
What is the method of securing the catheter to the skin after gastrotomy placement?
Fingertrap pattern
What is a limitation of percutaneous endoscopic gastrotomy placement?
Does not allow sutured gastropexy for an early and permanent seal between stomach and abdominal wall
What is the animal position for percutaneous endoscopic placement?
Right lateral recumbency
What are the signs of gastric dilatation volvulus (GDV)?
Distended abdomen, tachycardia, pale mucous membranes, delayed CRT
What is the initial assessment for a dog suspected of GDV?
Unwell, unstable patient needing emergency intervention and urgent diagnostics
What is the problem list in a case of GDV?
- Recumbent
- Depressed
- Large, distended abdomen
- Pale mucous membranes
- Delayed CRT
- Reduced peripheral pulses
- Tachycardia
- Tachypnoea
What should be done immediately for a dog with suspected GDV?
Place large bore catheters and infuse crystalloids while getting abdominal radiographs
What type of fluid is associated with pure transudate?
Low protein <2.5g/dL and low number of nucleated cells
What are the characteristics of modified transudate?
- Total protein <2.5g/dL
- < 5x 10^3 nucleated cells
- Mostly macrophages and neutrophils
What defines chylous effusion?
- Protein >2.5g/dL
- > 3 x 10^3 nucleated cells
- Small lymphocytes mainly
What indicates exudate in body cavity effusions?
- Usually >2.5g/dL
- > 5 x 10^3 nucleated cells
- Neutrophils mostly
What is the initial approach for diagnostic abdominocentesis?
Use ultrasound to find a good area for fluid aspiration
What is the importance of preserving the left gastroepiploic arteries during splenic mass surgery?
To maintain blood supply to the pancreas
What is the prognosis for a dog with a ruptured splenic mass?
Poor prognosis, likely 1-3 months survival without further treatment
What are the four functions of the gastrointestinal tract?
- Digestion
- Absorption
- Motility
- Secretion
What is the purpose of omental patching during enterotomy augmentation?
Drape omentum over the enterotomy site
Omental patching helps provide a rich blood supply and promotes healing.
What are the four functions of omentum?
- Lymphatic drainage
- Provides leukocytes
- Angiogenic activity
- Absorbs bacteria and particulate matter
What are the physical properties of septic peritonitis?
Cloudy opaque fluid with vegetable fibers likely visible on cytology, high protein > 5mg/dL
What is the first step in managing a cat presenting with megacolon?
Address fluid/electrolyte/acid-base abnormalities
This is crucial for stabilizing the patient before further interventions.
What are the immediate treatments for managing a cat with megacolon?
- Manually remove feces
- Administer stool softeners/enemas
- Administer laxatives
- Administer prokinetic drugs
- Ensure access to litter
- Modify diet
- IV Abs during enema
What blood supply supplies the terminal ileum?
Jejunal arteries
What physiological benefits come from preserving the ileocolic junction during a subtotal colectomy?
Prevents reflux of colonic contents and bacterial overgrowth
Removal may lead to postoperative diarrhea and complications.
What is the healing timeline for the colon?
- Lag phase: 1-4 days
- Proliferative phase: 4-14 days
- Maturation phase: 17 days +
What are the four radiographic signs of intestinal obstruction?
- Multiple loops of gas-dilated small intestine
- Stacked loops of small intestine
- Ratio of intestinal diameter to vertebral height
- Visible radiopaque foreign body
What are the two methods for assessing small intestinal viability?
- Color assessment
- Pulsing arterial blood supply visible
What are the layers of the small intestine?
- Inner mucosa
- Submucosa
- Muscularis
- Serosa
What are the two methods for augmenting enterotomy closure?
- Omental patching
- Serosal patching
What are the predisposing factors for GDV?
- Large pure breeds
- Close genetic relatives
- Anxious/fearful/aggressive dogs
- Exercising shortly after eating
- Eating fewer larger meals
- Longer gastrosplenic ligament
- Deep-chested breeds
What are the underlying causes of small intestinal intussusception?
- Enteritis secondary to intestinal parasitism
- Viruses
- Linear foreign bodies
- Cecal inversion
- Previous abdominal surgery
- Neoplasia
What are the three circumstances when resection anastomosis is needed to treat intussusception?
- Lesion cannot be reduced
- Necrosis of bowel
- Underlying neoplasia suspected
What is the justification for using monofilament suture material?
Has less chance of wicking bacteria along its length
What is enteroplication?
Creation of planned adhesions of bowel loops to avoid kinking/sharp bends
Involves suturing loops of intestines together.
What are the diagnostic tests for septic peritonitis?
- Increasing abdominal free fluid
- Abdominal fluid aspiration and analysis
- Lactate and glucose levels in abdominal fluid
- Blood tests for increasing CRP
- Clinical signs like pyrexia or hypothermia
What are the SIRS criteria for cats?
- HR >225
- RR >40
- WBCs >19500 or <5000
- Band neuts >5%
- Temp >39.7 or <37.8
What are the SIRS criteria for dogs?
- HR >120
- RR >20
- Temp >39.2 or <38.1
- WBC >18000 or <5000
