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Tobias ECVS > Ch 86 - Peritoneum and Retroperitoneum > Flashcards

Ch 86 - Peritoneum and Retroperitoneum Flashcards

1
Q

What is the Cullens sign?

A

A characteristic ring of SQ haemorrhage around the umbilicus often seen with haemoperitoneum or peritonitis by direct extension from the abdominal cavity to the SQ

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2
Q

What lines the pelvic and peritoneal cavities?

A

Transversalis fascia and mesothelial cells (peritoneum)

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3
Q

What are omental milky spots?

A

A source of neutrophils, macrophages and lymphocytes, an important part of the peritoneal defense mechanism

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4
Q

How would you classify peritoneal fluid as normal, transudate, modified transudate and exudate based on cell count and protein concentration?

A
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5
Q

What is the predominant cell type in normal peritoneal fluid?

A

Macrophage

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6
Q

What rate of fluid absorption is the peritoneal cavity capable of?

A

3-8% BW per hour

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7
Q

What is normal intraabdominal pressure in dogs?

A

2-7.5 cmH2O

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8
Q

What is required for adhesion formation?

A

Fibrinous exudate (from surgical manipulation or many diseases) and vascular damage/ischaemia

In the absense of ischaemia, fibrin undergoes fibrinolysis. When accompanied by vascular damage, fibrin is infiltrated by fibroblasts while produce collagen and form firm adhesions

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9
Q

In addition to ischaemia, what else increases the liklihood of adhesion formation?

A
  • Endotoxaemia
  • Intestinal manipulation
  • Bowel distention
  • Dessication of serosal surfaces
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10
Q

List some methods of reducing the liklihood of adhesion formation

A
  • Prevention of dessication
  • Gentle tissue handling
  • Meticulous haemostasis
  • Precise suture placement
  • Complete removal of blood clots anf foreign debris
  • Thorough lavage
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11
Q

List some methods of peritoneal defense

A
  • Release of complement (C3a, C5a) which stimulates neutrophil chemotaxis and degranulation of basophils and mast cells
  • Diaphragmatic lymphatics
  • Resident leucocytes and macrophages
  • Abscess formation
  • Resident natural killer cells
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12
Q

What is the major proinflammatory mediator produced by mesothelial cells?
What stimulates its production?

A
  • IL-8
  • Stimulated by TNFa and IL-1B from macrophages
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13
Q

What is the main anti-inflammatory mediator in septic peritionitis?

A

IL-10

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14
Q

SIRS is proportional to the degree of elevation of what proinflammatory cytokines?

A
  • IL-1B
  • TNFa
  • IL-6
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15
Q

What substances are know adjuvants in septic peritonitis??
(Intraperitoneal substances which enhance bacterial growth)

A
  • Gastric mucin polysaccharide
  • Bile salts
  • Haemoglobin
  • Barium
  • Peritoneal fluid volume
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16
Q

What are some broad functions of the omentum?

A
  • Isolate and seal
  • Absorbs bacteria and other particulate matter
  • Rich blood supply
  • Pronounced angiogenic activity
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17
Q

What is the cause of ileus secondary to septic peritonitis?

A
  • Sympathoadrenergic reflex inhibition which completely blocks myenteric cholinergic neurons
18
Q

What are the broad classifications of peritonitis?

A
  • Primary or secondary
  • Acute or chronic
  • Localised or generalised
  • Septic or aseptic
19
Q

List some causes of aseptic and septic secondary peritonitis

A
20
Q

What is sclerosing encapsulating peritonitis?
What is the recommened treatment?

A

A chronic form of peritonitis in which abdominal organs become encased in thick cocoon-like layers of collagenous connective tissue

Surgical exploration and biopsy and corticosteroids

21
Q

List risk factors for post-op dehiscense and septic peritonitis

A
  • Pre-op septic peritonitis
  • Hypoalbuminaemia
  • Hypoproteinaemia
  • Intraop hypotension
22
Q

What is highly correlated with survival in bile periotonitis

A

Presense of bacteria

23
Q

What is early and late mortality in septic peritonitis most associated with?

A
  • Early mortality - Gram negative aerobic organisms associated with high circulating concentrations of endotoxin, particularly E.Coli
  • Late mortality: Presense of anaerobic organisms
24
Q

What are the two most common bacteria isolated with bowel perforation?

A
  • E.Coli
  • Bacteroides fragilis
25
Q

What volume of intraperitoneal fluid can be detected by ballottement?

A

10ml/kg

26
Q

How much fluid is instilled for diagnostic peritoneal lavage?

A

20-22ml/kg warmed sterile isotonic saline

27
Q

What are some reasonable empirical ABx options?

A

Bactericidal drugs effective against gram positive and gram negative aerobes and anaerobes

28
Q

What is the minimal amount of lavage fluid recommended?

A

200-300ml/kg or until the fluid is returning clear

29
Q

What is the reasoning behind serosal patching in septic peritonitis?

A

Strong proteolytic activity in peritonitis degrades collagen and extracellular matrix which may predispose to dehiscense

30
Q

List broad options of coeliotomy closure after treatment of septic peritonitis?

A
  • Primary closure
  • Open peritoneal drainage
  • Closed peritoneal drainage
31
Q

What is considered a conditionally essential amino acid during catabolic illness?

A

Glutamine

32
Q

What intraop drug has been significantly associated with a greater short term survival?

A

Lidocaine

33
Q

List some negative prognostic indicators of septic peritonitis

A
  • Refractory hypotension
  • Elevated ALT, GGT
  • Plasma lactate over 2.5mmol/L or inability to normalise
  • Ionised hypocalcaemia
  • Multiorgan dysfunction
34
Q

What is the most common bacteris isolated from dog and cate bite wounds?

A

Pasteurella multocida

35
Q

What are the most common bacteria isolated from gun shot wounds?

A
  • Staphylococcus spp
  • Clostridium spp
36
Q

What is the most common organism isolated from intraabdominal abscesses?

A

Bacteroides fragilis

37
Q

What was the mortality rate of traumatic haemoperitoneum cases which required a blood transfusion?

A

Mortality 27%

38
Q

What is the most common primary retroperitoneal tumour?

A

Lipoma

39
Q

What are the most common causes of retroperitonitis?

A
  • FB migration
  • Ovarian pedicle granuloma
40
Q

What is a mesothelioma?
To what exposure is it often seen in relation to?

A

Neoplasms arising from the mesothelial lining of the coeliomic cavities (peritoneal, pleural, pericardial)
- Often seen in relation to asbestos exposure

Tobias ECVS (110 decks)

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