Ch. 84-86: Hernias, Abd Wall, Retro/Peritoneum Flashcards
Rossanese JSAP 2019
Congenital pleuroperitoneal hernia presenting as gastrothorax in 5 cavalier King Charles Spaniel dogs
All presented with what CT?
TXR showed what?
Intra-op comps & survival?
All presented with acute respiratory distress ; CXR showed tension gastrothorax
All cases primarily repaired
No intraoperative complications; all cases survived to discharge 48-72 hr post op
Follow-up ranged 18-36 mo no complications reported
Morgan VSURG 2020 PQ
Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia:
A multi-institutional study of 128 dogs
Sig signalment findings for ST treated?
Intraop comp %?
Postop comp %?
% recurrence?
Amt of deaths attributed to PPDH?
MST for each group?
What percentage survived sx? PQ
What is the difference in outcome between conservative and sx? PQ
Dogs in ST group younger & more likely sexually intact & more likely to have CS from PPDH instead of incidental
Intraop complications 22% (75% low grade)
Postop comps: 41% (83% low grade)
0% recurrence in ST
deaths of 9 dogs (5 ST, 4 CT) could be attributed to PPDH (18% of ST and 27% CT attributed to PPDH)
MST ST 8 years, MST CT 5 years
- 97% of Surg tx dogs were discharged from hospital. *
- long median survival times were observed in both the ST and CT groups (8 and 5 years).
both ST and CT dogs had good long-term survival.*
Seibert JAVMA 2021 PQ
Relationships between congenital peritoneopericardial diaphragmatic hernia or congenital central diaphragmatic hernia and ductal plate malformations in dogs and cats
Association bw DPM and PPDH/CCDH?
% dogs with it?
% cats with it? PQ
Histopath features in herniated liver lobes & conclusion?
DPM was strongly associated with PPDH and CCDH
- DPM occurred in 13/18 (72%) dogs with the proliferative-like phenotype predominating
* and in 15/18 (83%) cats with evenly distributed proliferative-like and Caroli phenotypes *
Histologic features characterizing malformative bile duct profiles yet without biliary proliferation were preserved in herniated liver lobes in animals with DPM
- know it exists and bx non herniated liver during sx for PPDH / CCDH
Hatch JAVMA 2018
Incidence of chyloabdomen diagnosis in dogs and cats and corresponding clinical signs, clinicopathologic test results, and outcomes: 53 cases (1984-2014)
MC CS?
How common was concurrent chylothorax?
MC underlying diagnosis?
#s from trauma or congenital dz?
MST all pts? MST neoplasia vs not?
MC CS: lethargy & anorexia
Chylothorax was a common comorbidity (25/53 [47%])
Most common underlying diagnosis 45% malignant neoplasia
- Most common malignant neoplasia carcinoma, next was hemangiosarcoma
Trauma and congenital disease did NOT cause chyloabdomen in any case
MST for all patients 31 d (0 – 4178)
MST significantly shorter for neoplasia (8 d) vs without (73 d)
Fleming VSURG 2018
Anatomic site and etiology of hemorrhage in small vs large dogs w/ spontaneous hemoperitoneum
Splenic hemorrhage rate?
Small dogs prevalence of splenic hemorrhage?
Small dogs prevalence of liver or other locations vs large dogs?
Differences in HSA diagnoses bw groups?
Splenic hemorrhage most common ID – 43.2% small dogs, 61.3% large dogs
Small had 30% lower prevalence of splenic hemorrhage (PR 0.7)
Small had higher prevalence of hemorrhage from liver (72% greater, PR 1.72) or from another location (retroperitoneal mass, kidney, or adrenal) (PR 2.73) vs large dogs
Prevalence of multiple or undetermined sources not different between small vs large dogs
HSA diagnosed greater proportion large dogs (67.5%) vs small dogs (50.8%) vs other malignancies greater small (33.3%) vs large dogs (17.3%)
Lisciandro JVECC 2021
The expected frequency and amount of free peritoneal fluid estimated using the abdominal FAST-applied abdominal fluid scores in healthy adult and juvenile dogs
Max fluid pocket dimensions & widths that may be considered normal?
Most positive view?
Difference in AFS scores between juvenile and adults?
Max fluid pocket dimensions of </= 3x3mm and fluid strip widths were </=3mm in dogs w/ abdominal fluids scores of 1 and 2 may be normal.
The diaphragmatico-hepatic view was most frequently positive.
AFS scores were sig different b/w juveniles and adults (juv had higher scores)
Summers JVECC 2021
Clinical features and outcome of septic shock in dogs: 37 cases (2008-2015)
Mortality %?
MC source of sepsis?
Survivors more likely to have what 2 things?
2 predictors of mortality?
Survivors more likely to have received what?
the acute patient physiologic and laboratory evaluation = APPLE
Mortality 80%
GI most common source of sepsis
Survivors more likely to have feeding tube and GI sepsis, and less likely to have respiratory dysfunction
APPLEFULL and time to antimicrobials were ID as predictors of mortality
Survivors were more likely to have received tx bundles
Summers JVECC 2021
Retrospective evaluation of the use of hydrocortisone for treatment of suspected critical illness-related corticosteroid insufficiency (CIRCI) in dogs with septic shock (2010-2017)
Baseline risk difference between HC and non-HC treatment?
Survival to dc difference?
Higher baseline APPLEFULL scores and predicted mortality in the HC-treated patients compared to non-HC
14% (3) HC-treated patients survived to discharge compared to 9 (35%) non-HC-treated patients, but this was not statistically significant - no difference in survival
Casna JVECC 2021
Feasibility study evaluating a veterinary point-of-care urine culture system for diagnosing septic peritonitis
Sn and Sp of POCUS-US?
Lowest detectable bacteria amount?
How does it compare to BG & lactate assessment of septic effusion?
8/10 septic samples positive on the POCUCS
Sens 80% and spec 100%
Lowest detectable bacteria was 1000 CFUs/mL
Less sensitive/less rapid than blood glucose to peritoneal effusion glucose ratio and lactate - therefore not recommended
Human JVEC 2021
A feasibility study investigating the utility of a point-of-care rapid immunoassay for detecting septic peritoneal effusion in dogs
RIA PPV, NPV, Sn and Sp #s? meh
Which diagnostic is best?
Overall conclusion?
Rapid immunoassay (RIA) had a low PPV (36.8%) but good NPV (97.4%) and was 77.5% accurate
Sens 87.5%
Spec lower 76%
similar sensitivity to cytology and bacterial culture (85-87%), but lower specificity (100% and 98%)
Cytology best overall predictive values and accuracy
PPV 100%, NPV 97.9%, and accuracy 98%
RIA testing was similarly sensitive in identifying septic peritonitis compared to cytology and bacterial culture but was not very specific or accurate. As a stand-alone test, RIA commonly had false-positive test results, making it unreliable in identifying septic peritonitis
Correa JFMS 2020
Retrospective assessment of the clinical relevance of surgical biopsies of abdominal lymph nodes in cats: 51 cases (2014-2018)
% found with enlarged LN in sx? what % of those were “normal” on AUS?
% diagnosed via biopsy with histo? How did that compare to FNA results for those cases?
86% had lymph node enlargement at time of surgery
20% of those had normal lymph node sizes on US
US-FNA in 19
- 26% (5/19) diagnosed with neoplasia following sx biopsy, only 1 of those was correctly identified on FNA (1/5, 20% found; 80% missed)
Menard JAVMA 2023
Assessing major influences on decision-making and outcome for dogs presenting emergently with nontraumatic hemoabdomen
Most impt factor O reported for decision making?
% dogs that died or euthanasia within 24 hours of presentation?
% of cases that went to sx? % discharged for hospice?
Of sx case, % periop death? % of hemoab due to spleen?
QOL scores differed bw sx vs PC?
MST of Sx vs PC? Any survival benefit found?
Which tx group O were most satisfied?
Owners reported QOL as the most important factor influencing their decision-making (92%), followed by risk of cancer (57%) or time remaining with their pet (56%).
70/132 (53.0%) dogs either died or were euthanized within 24 h of presentation
22/132 (17%) dogs were discharged for palliative care and survived > 24 hours
40 /132 (30%) dogs underwent surgery.
Of 40 dogs that underwent surgery, 4 (10%) either were euthanized or died while in the hospital perioperatively
- primary source of hemorrhage was identified as the spleen in 37/40 (93%)
QOL scores were significantly higher with surgery versus those with palliative care
Median survival time (MST) was 213 days with surgery and 39 days with PC
Survival benefit of surgery was lost when considering only dogs with malignant histopathology (MST 81 days)
Owners were more likely to be satisfied when they chose surgery over either euthanasia or palliative care (P = .039).
34 owners (26%) second-guessed or were unsure of their decision.
Parry JVECC 2023
Retrospective evaluation of the diagnostic utility of computed tomography in dogs with nontraumatic hemoperitoneum: 26 cases (2015–2020)
Histo dx benign vs malignant %?
How correct were the 2 radiologists in benign vs malignant?
Any imaging descriptors found associated with diagnosis?
Conclusion?
Spontaneous hemoperitoneum that had CT performed -
on histopathological diagnosis
20/26 lesions were found to be malignant (77%)
6 of 26 were benign (23%)
Radiologist 1 correctly identified 5 of 6 (83%) benign cases and 18 of 20 (90%) malignant cases.
Radiologist 2 correctly identified 2 of 6 (33%) benign lesions and 18 of 20 (90%) malignant cases.
Of the 10 imaging descriptors evaluated, none were significantly associated with the histological diagnosis.
Conc: abdominal CT imaging of spontaneous hemoperitoneum cases is not a reliable indicator of malignancy versus benignancy (!) (Note, did not evaluate metastatic disease)
Travis 2018 VSURG PQ
*randomized control trial, 432 dogs *
A quilting subcutaneous suture pattern to reduce seroma formation and pain 24 hours after midline celiotomy in dogs: A randomized controlled trial
PQ What suture pattern prevented what complication?
Quilting suture, reduced seroma formation (same group had a paper in cats and dogs)
No differences were detected between the quilting group (n = 183) and the nonquilting group (n = 175) in terms of illness severity, surgical procedure performed, surgeon’s experience, duration of surgery, intraoperative complications, or methods of surgical closure other than the intervention under study.
In an intent-to-treat analysis, the incidence of incisional seroma was lower in the quilting group (odds ratio = 0.30). Pain assessed 24 hours postoperatively was lower in the quilting group.
The incidence of SSI did not differ between groups.
Conclusion: Tacking the subcutaneous tissues to the deep fascia is indicated to reduce seroma during celiotomy closure.
Lopez VSURG 2020
- randomized control trial, 297 cats *
Effect of subcutaneous closure technique on incisional complications and postoperative pain in cats undergoing midline celiotomy: A randomized, blinded, controlled trial
Findings?
3 SQ closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting [Q] group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95).
Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03).
Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28-0.86, P = .01).
Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 [interquartile range (IQR), 0.2-2.6 N], NC = 0.83 [IQR, 0-1.87 N], P = .04) on the day after surgery.
Conclusion: Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy.
