Abdomen and spleen Flashcards
What size particle is rapidly cleared in lymphatics
<10um
What rate does peritoneum absorb fluid
3-8% body weight/hr
What are consequences of acute abdominal compartment syndrome
- acute pulmonary failure to compressive atelectasis
- increased intrathoracic pressure leading to increased pleural/ pericardial pressure
- acute renal failure with marked oliguria
- intestinal ischemia with bacterial translocation
- hepatic ischemia
- decreased cerebral perfusion/ neuronal injury
- venous thrombosis/ thromboembolism
What % of primary peritonitis are monobacterial in dogs/ cats?
- Dogs- 53%
- Cats- 100%
What are risk factors for septic peritonitis (post GI surgery in Grimes 2011?
- Pre-operative septic peritonitis
- decreased albumin
- decreased protein
- intraoperative hypotension
What was a protective factor for septic peritonitis (post GI surgery in Grimes 2011)
presence of a foreign body
What are 2 most common bacteria found with septic peritonitis?
- E. coli
- Bacteroides fragilis
For septic peritonitis, what is the BG in chemistry usually? What is the B-F difference?
< 50mg/dL
- B-F >20mg/dL
For chylous peritoneal fluid, how do serum/ abdominal fluid compare?
Triglycerides fluid > 3X serum
Cholesterol fluid <serum
What is the recommended combination of antibiotics for septic peritonitis?
3rd generation cephalosporin or ampicillin and aminoglycoside
What is the recommended lavage amount?
200-300 ml/kg
What are different surgery methods to help prevent septic peritonitis?
-serosal patering?
- omentalization
- fibrin sealant
List 3 ways to manage continued effusion/ septic peritonitis post-op?
- Open peritoneal drainage
- Vacuum-assisted closure
- Closed peritoneal drainage
What is the downside of sump tube drainage?
Gives air vent to overcome vacuum phenomenon and allows airbone bacteria access to peritoneal cavity
What are the common complications of closed peritoneal drainage?
hypoprotenemia/ anemia
What has the literature suggested with epidurals and septic peritonitis cases?
- contraindicated and survival times
- decreased cardiac/ renal function from abdominal sympathetic blockade
What has been suggested with lidocaine?
When given intraop, improves survival.
When given post-op, survival odds are less.
What is the range of survival for septic peritonitis?
32-85% depending on the method of closure, drainage, etc.
Average ~50-60%
What are prognostic factors throughout VLT 67?? (sp?) that are associated with septic peritonitis?
- refractory hypotension
- CV collapse
- respiratory distress
- DIC
- pre-op Protein C > 60%
- TEG (?)
- Increased ALT/ GGT
- Lactate > 2.5
- Decreased Ca
- MODS
- Pre-op antithrombin > 41.5%
What is the most common bacteria in intra-abdominal abscesses?
Bacteroides fragilis
What is the difference between a fistula and a sinus tract?
Fistula- abnormal pathway between 2 anatomic spaces or path leading to internal cavity or organ to surface of the body (between 2 epithelial lined structures)
Sinus- abdominal channel that orignates or ends in one opening (mesothelium distinct from epithelium)
What is the prognosis for abdominal mesothelioma?
1 report for 42 months with surgery
List neoplasia differential diagnoses for hemic/ nonhemic spleen?
Hemic- lymphoid, mast cell, histiocytic, plasma cell
Nonhemic- hemangiosarcoma, sarcoma, benign of CT origin
What can be ascertained on AUS with splenic torsion?
Hilar perivenous hyperechoic triangle noted
What is the agreement between FNA/ histology for diagnosis?
- Complete 60%
- Partial 30%
- Disagreement 12%
What stain facilitates identification of cells of hemic origin?
Komanowsky
List options for partial splenectomy?
- TA stapler
- VSD
- Ultrasonic cutting device
- CO2 laser
- Bipolar cautery
- Suture ligation
What breeds most often get splenic torsions? Is there a sex predisposition?
- Great Dane, St. Bernards, GSD, Irish Setter
- Males> Females
What is the prognosis for a splenic torsion?
-Guarded to good with chronic torsions carrying a better prognosis (decreased incidence of cardiovascular shock/ toxemia)
What 3 breeds are overrepresented with splenic hemangiosarcoma?
GSD, Labrador, Golden retriever
What % of cat splenic masses are neoplastic? What are the most common types?
73%
LSA, MCT
How is HCT connected with neoplasia of splenic masses?
One study showed odds of malignancy that increased 3 fold for every 10% decrease in PCV
What are locations reported to get HSA apart from the spleen?
Retroperitoneal space, prostate, adrenal glands, diaphragm, kidneys, GIT, urinary bladder
What are factors associated with prognosis for those that just had surgery?
- Number of gross lesions
- Stage of tumor
- Age at the time of diagnosis (some has older live longer post-op)
What are factors that are negative prognostic indicators for splenic hemangiosarcoma?
- tachycardia at presentation
- bicavitary effusion
- development of severe respiratory disease
- need for transfusion
- preop decreased platelets/ HCT- increased risk for death
What is the MST for splenic MCT? Is it guarded in cats?
~2 to 34 months (wide range)
What is T1, T2, T3 and Stage I, II, III for splenic hemangisarcoma?
T1 < 5cm
T2 > 5cm
T3 invasive
I T1 or 1, N0, M0
II T1 or 2, N0 or 1, M0
III T2 or 3, N any, M1
List complications of splenectomy
- hemorrhage
- vascular compromise
- portal system thrombosis
- arrhythmia
- systemic inflammation derangement
- GDV
- Infection
- O2 transport
What breed has been seen to have fucosidosis (autosomal recessive neurovisceral lysosomal storage disease)? Which is associated with umbilical hernias?
English Springer Spaniel
What is an omphalocele?
large midline umbilical/ skin defects permit organs to protrude from body?
How are gastroschists diferent from an omphalocele?
Looks the same but the defect is PARAmedian
What breeds are seen to occur more with umbilical hernias?
Airedale terrier, Basenji’s, Pekingese, Pointers, Weimaraners, Females > Males
What breeds are predisposed to inguinal hernias?
Basenji, pekingese, Poodle, Basset Hound, Cairn Terrier, CVKC, Chihuahuas, Cocker spaniels, Dachschunds, Pomeranian, Maltese, Westies
What sex predisposed to inguinal hernias?
Males> Females
What passes through the inguinal canal?
- Genital branch of the genitofemoral nerve, artery, vein
- External pudendal
Males- spermatic cord and cremaster muscle
Females- round ligament
What are the borders of the inguinal canal?
- Internal- medial R.A.
- orantally ???? IAO
- Caudal inguinal ligament and external mg? –> slit in and AO aponeurosis
What are 3 factors for inguinal hernia?
- Anatomy- enlargment of the vaginal process
- Hormone- Estrus or is pregnant= estrogen
- Metabolism- obesity
Which side inguinal hernia is worse usually?
Left > right
What are approaches to inguinal hernia treatment?
- Conventional- over hernia directly
- Midline abdominal
Which caudal abdominal hernias are immediate surgery?
- Nonstrangulated scrotal hernia
- strangulated inguinal hernias
- Anything strangulated
What are the most common complications after inguinal hernia treatment?
Seroma/ hematoma
For femoral hernias, where is the femoral canal located?
Caudal abdominal wall just lateral to the inguinal ligament
Where are muscular and vascular lacuna and what is contained within those?
- Muscular- within substance of ilipsoas m. and contains the femoral n.
- Vascular- craniolateral to the muscular lacuna and contains the femoral a./ v. and saphenous n.
Describe approaches for complicated and uncomplicated femoral hernias
- Uncomplicated- incise parallel to inguinal ligament
- Complicated- midline ventral then underneath to see femoral canal
What type of hernias often occur with trauma?
Inguinal, prepubic tendon avulsion, dorsolateral, paracostal
List 5 benefits of delaying surgery of large hernia for several days?
- Allow improvement of blood supply
- Reduction of edema
- Resolution of hemorrhage in accute trauma tissue
- Reduce risk for infection and better exposure of structures
- Stronger tissue for suture placement
List 2 ways to augment an avulsed pubic ligament?
- Mesh cuff
- Double layer mesh technique
What is the ideal suture-to-wound length ratio to reduce morbidity/ risk of incisional havia? (??)
4:1
What are 3 ways to manage heavily contaminated open defects?
- treatment with open peritoneal drainage
- treatments with negative-pressure wound therapy
- manage with lavage, continuous suction drain placement, and skin closure until wound environment is stable
List muscular flaps for abdominal wall defects (major vascular pedicle?)
- Latissimus dorsi (lateral thoracic) - only select ventral and lateral part of cranial abdomen
- Cranial sartorius flap and branch of femoral artery and vein
- External abdominal oblique and cranial abdominal artery
- Rectus abdominis flap- cranial/ caudal epigastric
List 3 synthetic meshes used for abdominal wall defects
- polypropylene mesh
- New ultralight macroporous mesh (coloplast restorelle)
- Composite meshes (absorbable and nonabsorable)
List tissue mesh or bioprosthetic meshes for abdominal wall defects?
SIS, dermis, pericardium
List 3 mesh reconstruction techniques
- Onlay (superficial to rectus fascial)
- Intrapositional (mesh edge to fascial edge)
- “sublay” or underlay ( deep to rectus abdominis m.)
Which has increased risk for infection and which has the lowest rate of reherniation and complications?
- Increased risk of infection- interpositional
- Decreased rate of reherniation- sublay/ underlay
Hydrothorax and ascites occurs in ___% of animals with liver herniation
30%
What are ways to diagnose a diaphragmatic hernia?
- radiographs
- contrast with barium
- pneumoperitoneography
- positive- contrast pleurography
- portography
- cholecystography
- angiography
- AOS
- CT
What are the alternative methods for closure for diaphragmatic hernias?
- omentum
- transversus flap
- autologous fascia
- lyophilized collagen sheet (porcine SIS)
- rectus abdomonis
- latissimus dorsi
- synthetic implants–> Teflon- reinforced silicone sheets, propylene mesh, Gore-Tex
Why be careful with prolonged expansion of lungs while tying sutures?
Valsalva effects from the decreased venous return due to increased intrathoracic pressure
What are recommendations made for intraabdominal pressures post diaphragmatic repair?
If 5-10 mmHg, monitor, hydrate
If 11-20 mmHg- medical therapy, analgesis, evacuate intraperitoneal fluid, IVD, BP monitoring
If >20 mmHg- If MM not helping, do surgical decompression! (remove organs (spleen, advase (??) diaphragm
Describe the attachment of tendons that form the diaphragmatic crura?
- bifurcate tendon arise from bodies of 3rd and 4th lumbar vertebrae
- medial to psoas minor muscles
What are the 3 adjuvants of peritonitis? How do they exacerbate the inflammation?
- Gastric mucin- heparin like anti-complement effect–> inhibits phagocytosis
- Bile salts- lower surface tension–> alter cell adhesion and lyses RBCs
- Hemoglobin- interferes with phagocyte cell chemotaxis and phagocytosis- provides FC to microorganisms - inhibits bacterial clearance by interfering with lymphatic drainage
When biopsies of the spleen are taken, what stain ehlps ID cells of hemic origin?
Romanowsky
Name 4 mechanisms of splenic congestion and give examples of each
- CHF- right sided
- portal hypertesion- infections (adenovirus, lepto)
- toxic (carprofen, acetaminophen, pheno) - Vascular outflow obstruction- splenic torsion, masses, caudal vena cava obstruction
- relaxation of splenic capsule- barbiturates, thipental, phenobarb, phenothiazine
What makes up the deep inguinal ring?
- ventral inguinal ligament
- fleshy border of internal abdominal oblique
- lateral border of rectus abdominis
-What are the origins of the 3 muscles that form the aponeuroses of the linea alba?
- external abdominal oblique- 4/5th- 12th rib and thoracodorsal fascia superficial to rectus abdominis
- Internal abdominal oblique- TL fascia and caudal to the last rib and tuber coxae
- cranial 1/3 of abdomen S & D
- umbilicus caudally–> superficially to rectus abdominis - Transversus- lumbar- transverse process lumbar vertebrae and TL fascia
- costal- medial 12th/13th rib and 8th-11th costal cartilages
- cranial 2/3 deep to rectus abdominis, caudal 1/3 superficial
