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Phase 1 > Ch. 86 Peritoneum > Flashcards

Ch. 86 Peritoneum Flashcards

1
Q

What mesoderm gives rise to the peritoneal cavity?

A

the somatic (parietal) and the splanchnic (visceral) mesoderms

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2
Q

What is the coelom?

A

this is the space that is enclosed by the somatic and splanchnic mesoderm - party will be enclosed as the body cavity and the rest is transient but in the embryo, it is all continuous

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3
Q

what is an omphalocele

A

embryonic herniation of abdominal contents through the umbilicus into the umbilical stalk
an umbilical hernia results from a defect in development of the muscular wall around the umbilicus

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4
Q

What are the nine regions of the abdominal cavity and how is it divided?

A

Divided by two transverse and two sagittal planes
right and left hypochondriac regions, epigastric or xiphoid region, umbilical region, left and right lateral regions (includes flanks and paralumbar fossae), right and left inguinal regions, and pubic region

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5
Q

Where do the sympathetic and splanchnic nerves enter the abdominal cavity?

A

through paired slit like openings dorsal to the diaphragm and ventral to the psoas muscles

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6
Q

What passes through the inguinal canal

A

vaginal process with the spermatic cord or round ligament in the female
external pudendal vessels
genital nerve

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7
Q

What passes through the vascular lacunae?

A

in the caudal abdomen, the vascular lacunae contains the femoral artery and vein, lymphatics, and saphenous nerve

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8
Q

what is a cullen sign

A

a ring of subcutaneous hemorrhage around the umbilicus may appear in cases of a hemoperitoneum or septic abdomen if there is a direct extension from the abdominal cavity into the subcutis - this would be from an incomplete mesodermal lining at the level of the umbilicus

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9
Q

what is the peritoneal cavity?

A

a potential space between the visceral and parietal peritoneum and contans no organs except at the time of ovulation when the egg ruptures from the ovary

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10
Q

what are the three portions of greater omentum?

A

bursal, splenic, veil

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11
Q

what is the bursal portion of the greater omentum

A

the omental bursa is a potential space between the paries superficiales and paries profundus layers
opens at the epiploic foramen when is bounded dorsally by the caudal vena cava and ventrally by the portal vein
The bursal portion is what is used for omentalization

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12
Q

what are the boundaries of the epiploic foramen

A

dorsally: caudal vena cava
ventrally: portal vein

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13
Q

what is the splenic portion of the greater omentum

A

extends to the hilus of the spleen to form the gastrosplenic ligament

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14
Q

what is the veil portion of the greater omentum

A

the smallest portion of the greater omentum

contains the left limb of the pancreas

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15
Q

what are the boundaries of the lesser omentum

A

lies between the lesser curvature of the stomach and porta hepatis and becomes continuous with the mesoduodenum
some of the lesser omentum will give rise to the hepatoduodenal ligament and the hepatogastric ligament

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16
Q

what are milky spots?

A

aggregations of cells within the omentum which contain neutrophils, macrophages, and lymphocytes

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17
Q

Describe the peritoneum on a microscopic level

A

a single layer of squamous cells of mesothelial origin
covered in microvilli
the squamous cells are supported by connective tissue layer
the peritoneum on the visceral surface of the diaphragm has fenestrations, or stomata, of varying size - 4-16 um in dogs and cats
The stomata and the lymph vessels (called lacunae) aid in clearance of fluid from the cavity

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18
Q

what is the colloid osmotic pressure of normal peritoneal fluid? what is the normal protein concentration? what is the normal number of cells?

A

normal colloid osmotic pressure is 28 mmHg
normal protein is 3 g/dL
normal cells <300

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19
Q

what is the protein and cell count for a transudate

A

protein <2.5 g/dL

cells <1500 cells/uL

20
Q

what is the protein and cell count in a modified transudate

A

protein 2.5-7.5 g/dL

cells 1000-7000 cells/uL

21
Q

what is the protein and cell count for an exudate

A

protein >3 g/dL

cells >5000 cells/uL

22
Q

How quickly does the abdominal lymph system drain

A

The primary route of drainage of particles was through the diaphragmatic lymphatics to the mediastinal lymph node and finally by way of the thoracic duct into the systemic circulation
For small particles less than 10 um, within about 10-90 minutes for a dog and 3 minutes for a cat if injected intraperitoneally

23
Q

What causes lymph to flow from the peritoneal cavity

A

Passive stretching of the diaphragm moves fluid from the cavity to the diaphragmatic lacunae. Diaphragmatic muscle contraction and decreased intrathoracic pressure during exhalation moves fluid through the lymphatics into efferent ducts along a pressure gradient

24
Q

Which side of the body has a higher distribution of lymphatics?

A

the right side - no idea why

25
Q

How quickly can the peritoneal cavity absorb fluid

A

3-8% of body weight per hour

26
Q

what is the normal range for intrabdominal pressure in a dog

A

2.0-7.5 cm H20

mean 4.5 cm H20

27
Q

How do you convert mm Hg to cm H20?

A

multiple mm Hg by 1.36 to get cm H20

28
Q

What does altered abdominal compliance result in?

A

increased intrabdominal pressure

29
Q

At what pressure, in pigs, will abdominal insufflation cause increased HR, increased MAP, increased systemic vascular resistance, decreased cardiac output, decreased mesenteric arterial blood flow, decreased intestinal mucosal blood flow, increased bacterial translocation?

A

greater than 20.4 cm H20

30
Q

what is acute abdominal compartment syndrome

A

a marked increase in intraabdominal pressure and is associated with MODS because of compressive atelectasis with increased peak inspiratory pressure –> impaired gas exchange, increased pleural and pericardial pressures, decreased venous return, intestinal ischemia, renal failure

31
Q

how do you diagnose acute abdominal compartment syndrome

A

high peak inspiratory pressure with oliguria and an apparently tight abdomen
usually the urinary bladder pressure would be greater than 20-25 cm H20

32
Q

What must the environment be for adhesions to form

A

inflammatory cells and fibrin come in and in the absence of ischemia, fibrinolysis occurs
if there is vascular damage though, fibrin is infiltrated by fibroblasts making collagen and then fibrinous adhesions form

33
Q

what is the mainstay of peritoneal fluid’s innate defense system

A

release of C3a and C5a, which will stimulate neutrophil chemotaxis and degranulation of basophils and mast cells

34
Q

What cytokines are dominant in a gram negative peritonitis

A

TNF alpha and IL 6

35
Q

What happens to the peritoneal fibrinolytic system during inflammation

A

the system is inactivated
lack of fibrin clearance leads to fibrin clumps
fibrin clumps will occlude peritoneal stomata and impede clearance of fluid and particles
the fibrin then sequesters microorganisms from normal host defenses

36
Q

how does gastrin mucin polysaccharide act as a peritonitis adjuvant

A

has a heparin like anticomplement effect that inhibits phagocytosis

37
Q

how do bile salts act as a peritonitis adjuvant

A

lowers surface tension and lyses RBCs which release hemoglobin
hemoglobin interferes with phagocytic cell chemotaxis and intracellular killing
may also provide iron to microorganisms
inhibits bacterial clearance from the peritoneal cavity by interfering with lymphatic clearance mechanisms

38
Q

how does peritonitis cause ileus?

A

sympathoadrenergic reflex inhibition

the reflexes completely block myenteric cholinergic neurons

39
Q

what is the role of reflex rigidity in peritonitis

A

diaphragmatic rigidity impedes respiratory movements which then reduces intraperitoneal circulation and decreases the lymphatic clearance of fluid through the diaphragm

40
Q

what is primary peritonitis

A

spontaneous inflammation in the abscence of an evident intraabdominal source of infection or penetrating injury
usually monobacterial and may be called spontaneous bacterial peritonitis
best example would be feline coronavirus causing FIP

41
Q

what is secondary peritonitis

A

secondary generalized septic peritonitis is the most common form of peritonitis in dogs
basically, there is a source for the peritonitis that is clearly evident

42
Q

examples of causes of aseptic peritonitis

A 
chemical (like pancreatitis or barium)
bile (usually aseptic)
uroperitoneum (usually aseptic)
peritoneal FB
starch granulomatous peritonitis 
mechanical peritonitis
sclerosing encapsulating peritonitis
43
Q

examples of causes of septic peritonitis

A 
leakage of GI contents
penetrating abdominal wounds
blunt abdominal trauma
ischemic intestinal injury
pancreatitis
rupture pyometra
uterine torsion
ruptured prostatic abscess
liver abscess or hepatitis
splenic abscess or splenitis
splenic torsion
msenteric lymph node abscess
ruptured gallblader or bile duct with bacterbilia
ruptured bladder with cystitis 
umbilical abscess
surgical contamination 
peritoneal dialysis
44
Q

how would a gosspiboma appear on ultrasound

A

likely would have a hypoechoic mass with an irregular hyperechoic center

45
Q

how can starch induced peritonitis be diagnosed

A

iodine staining or polarized light microscopic exam of peritoneal fluid
treat with steroids

46
Q

what is the most common source of septic peritonitis?

A

intraabdominal bacterial contamination and GI leakage in 60-63% of septic peritonitis cases in dogs and 47% of septic peritonitis cases in cats

Phase 1 (35 decks)

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