Abdomen

Question 1

BODY WALL RECONSTRUCTION MATERIALS
Arnold GA, Mathews KG, Roe S, Mente P, Seaboch T. Biomechanical comparison of four soft tissue replacement materials: an in vitro evaluation of single and multilaminate porcine small intestinal submucosa, canine fascia lata, and polypropylene mesh. Vet Surg. 2009 Oct 1;38(7):834–44.

Answer 1

• Fascia lata is very strong but it is small
• polypropylene mesh is anisotropic
• SIS is weak but its biologic properties are well-researched
• suture pull-out: FL>PMa=PMb>MLSIS>SIS
• tensile testing: FL>PMa>PMb>MLSIS>SIS
• push-through testing: FL>PM>MLSIS>SIS

Question 2

EVISCERATION
Gower SB, Weisse CW, Brown DC. Major abdominal evisceration injuries in dogs and cats: 12 cases (1998-2008). J Am Vet Med Assoc. 2009 Jun 15;234(12):1566–72.

Answer 2

• 8 dogs and 4 cats that had surgery for evisceration
• 8 from postsurgical dehiscence, 4 from trauma
• all survived to discharge
• trauma cases, cases with high lactate at admission, and small patients were more likely to stay longer

Question 3

DIAPHRAGMATIC HERNIA
Witsberger TH, Dismukes DI, Kelmer EY. Situs inversus totalis in a dog with a chronic diaphragmatic hernia. J Am Anim Hosp Assoc. 2009 Jan 1;45(5):245–8.

Question 4

PPDH
Banz AC, Gottfried SD. Peritoneopericardial diaphragmatic hernia: a retrospective study of 31 cats and eight dogs. J Am Anim Hosp Assoc. 2010 Oct;46(6):398–404.

Answer 4

• median age at diagnosis: 2 years (cats) 1.6 years (dogs)
• Maine Coons and Weimeraners
• nonspecific or respiratory signs in cats, GI signs in dogs
• 2 cats with large umbilical hernias, 1 cat with sternal deformity
• 2 cats with myocardium-liver adhesions
• 1 cat with chylothorax
• previously reported mortality = 14%. In this study 1 cat (3.2%) and 1 dog(12.5%)
  Schmiedt CW, Washabaugh KF, Rao DB, Stepien RL. Chylothorax associated with a congenital peritoneopericardial diaphragmatic hernia in a dog. J Am Anim Hosp Assoc. 2009 Jan 1;45(3):134–7.

Question 5

SEPTIC PERITONITIS
Buote NJ, Havig ME. The Use of Vacuum-Assisted Closure in the Management of Septic Peritonitis in Six Dogs. J Am Anim Hosp Assoc. 2012 Apr 25;48(3):164–71.

Answer 5

• 50% mortality in 6 dogs
• “VA laparostomy”. 2nd surgery within 2 days of the first
• 3 of the 6 patients got albumin transfusions

Question 6

Liu DT, Brown DC, Silverstein DC. Early nutritional support is associated with decreased length of hospitalization in dogs with septic peritonitis: A retrospective study of 45 cases (2000-2009). J Vet Emerg Crit Care (San Antonio). 2012 Aug;22(4):453–9.

Question 7

Szabo SD, Jermyn K, Neel J, Mathews KG. Evaluation of Postceliotomy Peritoneal Drain Fluid Volume, Cytology, and Blood-to-Peritoneal Fluid Lactate and Glucose Differences in Normal Dogs. Vet Surg. 2011 Jun;40(4):444–9.

Answer 7

• 9 healthy beagles with 10 minute exploratory celiotomy, lavage, and JP drain. Fluid analyzed for 7 days
• mean TNCC went over 13,000 cells/ul on days 1, 3 and 4 postop
• neutrophils were always degenerate
• glucose dropped below 20 mg/dl below blood level by day 4
• lactate rose above 2.0 mmol/L above blood level by day 4
• 4 of 9 dogs had JP drain contamination by day 7, but authors don’t think that means septic P
  
  • they saw intracellular bacteria

10. Pumphrey SA, Pirie CG, Rozanski EA. Uveitis associated with septic peritonitis in a cat. J Vet Emerg Crit Care (San Antonio). 2011 Jun;21(3):279–84.

Question 8

Grimes JA, Schmiedt CW, Cornell KK, Radlinksy MAG. Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs. J Am Vet Med Assoc. 2011 Feb 15;238(4):486–94.

Answer 8

• 225 full-thickness GI surgeries (197 dogs):
  postop septic peritonitis mortality
• overall 12% 16%
• dogs with preop septic peritonitis 38% 33%
• dogs without preop peritonitis 6% 11%
• stomach surgery alone (40 dogs) 10% 8%
• sm. int. surgery alone (104 dogs) 12% 16%
• large int. sugery alone (4 dogs) 25% (1 dog) 0%

• Major risk factors for S.P.: preop septic peritonitis, preop low albumin & protein, intraop hypotension
• foreign body was protective (conflicts w/previous study about anastomoses: Ralphs JAVMA 2003)

Ragetly GR, Bennett RA, Ragetly CA. Septic peritonitis: etiology, pathophysiology, and diagnosis. Compendium (Yardley, PA). 2011;33(10):E1–7.
Ragetly GR, Bennett RA, Ragetly CA. Septic peritonitis: treatment and prognosis. Compendium (Yardley, PA). 2011;33(10):E1–6.

19. Ong RKC, Raisis AL, Swindells KL. Candida albicans peritonitis in a dog. J Vet Emerg Crit Care (San Antonio). 2010 Feb;20(1):143–7.

Culp W, Holt D. Septic peritonitis. Compendium (Yardley, PA). 2010;32(10):E1–E15

Question 9

Culp WTN, Zeldis TE, Reese MS, Drobatz KJ. Primary bacterial peritonitis in dogs and cats: 24 cases (1990-2006). J Am Vet Med Assoc. 2009 Apr 1;234(7):906–13.

Answer 9

• “primary” is still usually bacterial, but can’t find the cause
• associated with systemic dz in humans esp. alcoholic cirrhosis (poor clearance & ascites)
• sx is not recommended in humans with 1 peritonitis
• these dogs & cats with 1 peritonitis did not have ascites or cirrhosis and are similar to dogs/cats with secondary septic peritonitis except:
  
  • dogs with 2 peritonitis were more likely to have peritoneal exudate
• gram positive bacteria in most 1 peritonitis cases, most cases were also monobacterial

Question 10

Ruthrauff CM, Smith J, Glerum L. Primary bacterial septic peritonitis in cats: 13 cases. J Am Anim Hosp Assoc. 2009 Jan 1;45(6):268–76.

Answer 10

• 31% mortality (69% survival)
• findings and outcomes seem similar to cats with 2 peritonitis (but no control group like in Culp)
• only one cat (of 9 cultured) with pure culture, mostly gram positive anaerobic

Question 11

Landmark paper* Bonczynski JJ, Ludwig LL, Barton LJ, Loar A, Peterson ME. Comparison of peritoneal fluid and peripheral blood pH, bicarbonate, glucose, and lactate concentration as a diagnostic tool for septic peritonitis in dogs and cats. Vet Surg. 2003 Feb 1;32(2):161–6.

Answer 11

• 18 dogs (7 w/septic peritonitis and 11 w/nonseptic effusion)
• 12 cats (7 w/septic periotonitis and 5 w/nonseptic effusion)
• dogs: Blood-to-fluid glucose difference > 20 mg/dl (i.e. blood minus fluid) was 100% sens & spec
• dogs: Blood-to-fluid lactate difference < -2.0 mmol/L (i.e. blood minus fluid) was also 100% sens & spec
  (but only 7 dogs tested for lactate)
• cats: Blood-to-fluid glucose difference > 20 mg/dl was 86% sensitive & 100% specific
• TNCC > 13,000 cells/ul was 86% sensitive/100% spec in dogs, and 100% sens & spec in cats

Question 12

HEMOABDOMEN
Hirst C, Adamantos S. Autologous blood transfusion following red blood cell salvage for the management of blood loss in 3 dogs with hemoperitoneum. J Vet Emerg Crit Care (San Antonio). 2012 Jun;22(3):355–60.

Answer 12

• first case series in 3 dogs using a semi-automated RBC salvage system for autotransfusion

Question 13

Culp WTN, Weisse C, Kellogg ME, Gordon IK, Clarke DL, May LR, et al. Spontaneous hemoperitoneum in cats: 65 cases (1994-2006). J Am Vet Med Assoc. 2010 May 1;236(9):978–82.

Answer 13

• 54% non-neoplastic!
  
  • coagulopathies – sepsis, rodenticide, pancreatitis
  • hepatic necrosis, hepatic amyloidosis, hepatic hematoma, hepatitis
  • ruptured bladder
  • gastric ulcer, others
• 46% neoplastic (these cats significantly older and had significantly lower PCV’s than nonneoplastic cats)
  
  • HSA (60%) – spleen, liver, intestine, omentum, ureter
  • Hepatocellular carcinoma, hepatic cholangiocarcinoma
  • splenic lymphoma, others
• liver overall the most common source of bleeding
• spleen the most common place for neoplasia
• from disc: in dogs with spontaneous hemoperitoneaum 80% neoplasia and 88% of those are HSA
• from disc: dogs can tolerate up to 70% hepatectomy
• overall survival 8/65 (12%) (because most were not treated)

Question 14

Aronsohn MG, Dubiel B, Roberts B, Powers BE. Prognosis for acute nontraumatic hemoperitoneum in the dog: a retrospective analysis of 60 cases (2003-2006). J Am Anim Hosp Assoc. 2009 Jan 1;45(2):72–7.

Answer 14

• HSA in 63.3% (spleen 28, liver 6, kidney 2, prostate 2)
• overall neoplasia in 68% (there were 2 hepatic carcinomas and 1 carcinomatosis in addition to HSA)
• 32% nonneoplastic disease (splenic hematoma 16, splenic torsion 3)

Question 15

Hammond TN, Pesillo-Crosby SA. Prevalence of hemangiosarcoma in anemic dogs with a splenic mass and hemoperitoneum requiring a transfusion: 71 cases (2003-2005). J Am Vet Med Assoc. 2008 Feb 15;232(4):553–8.

Answer 15

• 71 dogs with spontaneous hemoperitoneum & splenic mass
• 76% malignant masses
  
  • 92.6% were HSA (70% of all dogs)
• 24% benign masses
• dogs with HSA had lower TP and platelet numbers

Question 16

Herold LV, Devey JJ, Kirby R, Rudloff E. Clinical evaluation and management of hemoperitoneum in dogs. J Vet Emerg Crit Care (San Antonio). 2008;18(1):40–53

Answer 16

• when using DPL for hemoabdomen: every 1% PCV in DPL fluid represents 10-20 ml blood in abdomen

Question 17

TRAUMA
Risselada M, de Rooster H, Taeymans O, van Bree H. Penetrating injuries in dogs and cats. A study of 16 cases. Vet Comp Orthop Traumatol. 2008 Jan 1;21(5):434–9.

Answer 17

• 15 dogs and 1 cat
• 12 fight wounds (11 bites & 1 claw), 4 gunshot wounds
• abdomen 3, abdomen + thorax 5, thorax 6, trachea 2
• most cases had severe damage to body wall and/or internal organs
• in conclusion, exploration is highly recommended in gunshot and fight wounds
• fight wounds more body wall damage, gunshot wounds more internal organ damage

Question 18

Lisciandro GR. Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals. J Vet Emerg Crit Care (San Antonio). 2011 Apr;21(2):104–22.

Answer 18

• describing the FAST (focused assessment with sonography for trauma) which is part of the curriculum
  for many ER related human specialties
• describing it for vet med AFAST (abdominal) and TFAST (thoracic)

Question 19

Simmonds SL, Whelan MF, Basseches J. Nonsurgical pneumoperitoneum in a dog secondary to blunt force trauma to the chest. J Vet Emerg Crit Care (San Antonio). Wiley Online Library; 2011.

Question 20

CAVITARY EFFUSIONS
Dempsey SM, Ewing PJ. A review of the pathophysiology, classification, and analysis of canine and feline cavitary effusions. J Am Anim Hosp Assoc. 2011;47(1):1–11.

Answer 20

Question 21

OMENTUM
Campbell BG. Primary omental abscessation or omental infarction in four dogs. J Am Anim Hosp Assoc. 2009 Jun;45(4):168–75.

Answer 21

• omental infarct mimics appendicitis in humans
• hypoechoic mass on ultrasound
• guess who was diagnosed in one? Bacterioides! Also E.coli and Prevotella in another
• hard for the omentum to get abscessed – probably from infarct first or interaction w/foreign material

Question 22

Frank JD, Stanley BJ. Enterocutaneous fistula in a dog secondary to an intraperitoneal gauze foreign body. J Am Anim Hosp Assoc. 2009 Jan 1;45(2):84–8.

Answer 22

• in humans, risk for leaving a sponge: ER surgery, change in sx procedure, obesity
• gauze F.B. should be suspected in any patient with draining tract, nonspecific signs & hx of surgery