Digestion & Metabolism 2: LA Peritoneal Dz Flashcards
clinical signs of peritoneal can be WHAT?
what are 3 common clinical signs?
VARIABLE, can look very different always
3 common?
1. GENERALIZED DULLNESS
2. GENERALIZED DEPRESSION
3. SECONDARY ILEUS
4 diagnostics for PERITONEAL dz?
which one is MOST IMPORTANT for diagnosis?
- PE/HISTORY
- HEMATOLOGY for signs of INFECTION, INFLAMMATION
- US of ABDOMEN for PERITONEAL FLUID
- ABDOMINOCENTESIS & SAMPLING –> MOST IMPORTANT FOR DIAGNOSIS OF PERITONEAL DZ
ABDOMINOCENTESIS..
what COLOR & CELL COUNT is normal?
what cells can NORMALLY be found in here? (2)
normal?
COLOR = CLEAR YELLOW
CELL COUNT = <5,000 cells/uL
a FEW LEUKOCYTES & MESOTHELIAL CELLS can be found
describe abdominal fluid color
NORMAL PERITONEAL FLUID, CLEAR YELLOW
what do MESOTHELIAL CELLS do?
what if we see A LOT of them upon ABDOMINOCENTESIS?
they MAKE UP THE PERITONEAL LINING
if TOO MANY = REACTIVE, potential inflammation
are PLANT MATERIAL, NEUTROPHILS or LYMPHOCYTES normal in peritoneal fluid?
NO
Dx what kind of peritonitis this is & what we can see!
SEPTIC PERITONITIS
can see EXTRA- and INTRACELLULAR BACTERIA
Dx what kind of peritonitis this is & what we can see!
SEPTIC PERITONITIS with REACTIVE MESOTHELIAL CELLS & WBCs
Dx what kind of peritonitis this is & what we can see in TOP & BOTTOM box?
this is ENTEROCENTESIS (from GI)
in TOP = PROTOZOA, indicates LEAKAGE FROM LI/COLON
in BOTTOM = MIXED BACTERIA
found in PERITONEAL FLUID, what is this? is it normal?
PLANT MATERIAL & NO
Dx what kind of peritonitis this is & what we can see! (see 2 things)
do we see any bacteria?
PANCREATITIS or BILE PERITONITIS
we can see…
1. can see REACTIVE but NON-DEGENERATE NEUTROPHILS & MACROPHAGES
2. LIPID VACUOLES consistent with FAT NECROSIS or CHYLE
NO BACTERIA
what is the MOST COMMON DISEASE OF THE PERITONEAL CAVITY IN LA?
BACTERIAL PERITONITIS
BACTERIAL PERITONITIS…
PRIMARY = ?
SECONDARY usually from…
& what do we see on CULTURE?
how is DIAGNOSIS CONFIRMED? does this rule out peritonitis?
PRIMARY = IDIOPATHIC
SECONDARY = CONTAMINATION OF PERITONEAL CAVITY FROM ANOTHER SOURCE (GI, REPRODUCTIVE, URINARY TRACT)
on culture, can see 1 or 2 PREDOMINATING bacteria
diagnosis CONFIRMED = >20,000 cells/uL, but DOES NOT RULE OUT PERITONITIS IF NOT
PRIMARY peritonitis occurs mainly in what 2 species?
HORSES & ALPACAS
PRIMARY peritonitis…
occurs in WHAT 2 SPECIES?
caused by WHAT organism in horses?
present with what 4 clinical signs?
see WHAT on US?
see WHAT on cytology?
what 3 CBC findings?
tx?
HORSES & ALPACAS
caused by ACTINOBACILLUS EQUUILLI most commonly
present with..
1. FEVER
2. ANOREXIA
3. DULL MENTATION
4. MILD COLIC
see INCREASED PERITONEAL FLUID ON US
3 CBC?
1. LEUKOCYTOSIS
2. HYPERFIBRINOGENEMIA
3. ELEVATED TS
tx = ANTIMICROBIALS
PRIMARY peritonitis…
occurs in WHAT 2 SPECIES?
caused by WHAT organism in ALPACAS?
prognosis?
HORSES & ALPACAS
in ALPACAS, caused by STREP. ZOOEPIDEMICUS (GRAM POSITIVE COCCI)
prognosis is GOOD with ANTIMICROBIALS
what is the MOST COMMON FORM OF PERITONITIS?
chronicity of this condition?
SECONDARY PERITONITIS
often ACUTE
SECONDARY peritonitis…
= usually as a result of WHAT?
causes WHAT 2 SEVERE clinical signs?
what OTHER clinical sign can we see & from what dz?
range of when this becomes FATAL? intervention?
fatality depends on…
= usually as a result of ACUTE, SEVERE RUPTURE OF GI TRACT
causes SEVERE INFLAMMATION & ENDOTOXEMIA
can also see INJECTED MMs from ENDOTOXEMIA
becomes fatal within 4-24 HOURS WITH OR WITHOUT INTERVENTION
fatality depends on HOW BIG THE LEAKAGE IS
4 COMMON GI SOURCES of SECONDARY PERITONITIS in HORSES
- GASTRIC IMPACTION or STRANGULATING LESION
- CECAL IMPACTION causing RUPTURE
- LARGE COLON RUPTURE due to SEVERE COLITIS or MULTIPLE ENTEROLITHS
- SMALL COLON RUPTURE
4 COMMON GI SOURCES of SECONDARY PERITONITIS in RUMINANTS
- RUMEN (from sx)
- RETICULUM (hardware dz)
- ABOMASAL ULCERATION/C3 ULCERATION
- STRANGULATION
ACUTE GI RUPTURE has WHAT sort of prognosis?
what 2 conditions must be met to attempt intervention?
prognosis = GRAVE TO FATAL
2 conditions…
1. SOURCE OF CONTAMINATION CAN BE ADDRESSED
2. contamination can be METICULOUSLY DEBRIDED/LAVAGED
CHRONIC SECONDARY PERITONITIS…
= usually presents how?
can be associated with what 4 conditions?
what is the MOST IMPORTANT part of TREATING THIS? what 3 ways can we achieve this?
= usually presents as a SLOW LEAK where INFLAMMATION/INFECTION occurs
can be associated with…
1. GI ISCHEMIA, NECROSIS & TRANSLOCATION
2. METASTATIC ABSCESSATION
3. TRAUMA via PENETRATION OF ABDOMINAL CAVITY
4. UMBILICAL REMNANT ABSCESS
we need to FIND THE SOURCE!! we can do that by..
1. HEMATOLOGY
2. COMPREHENSIVE ABDOMINAL US
3. EXPLORATORY Sx
SEPTIC PERITONITIS should be treated via…
what approach should be used for EQUIDS/PIGS?
what approach should be used for RUMINANTS/CAMELIDS/PIGS?
what MUST BE DONE during procedure? (2)
SURGICAL EXPLORATION!
equids/pigs = VENTRAL MIDLINE under GA
ruminants/camelids/pigs = RIGHT FLANK under GA
we MUST DO A THOROUGH ABDOMINAL LAVAGE and ASPIRATE ALL THE FLUID LEFT THERE
4 TREATMENTS for SEPTIC PERITONITIS
hint: support (2), antibiotics, pain
- CARDIOVASCULAR support via FLUIDS, COLLOIDS & VASOPRESSORS
- INCISIONAL SUPPORT w/ BANDAGE to AVOID SURGICAL SITE INFECTIONS
- SYSTEMIC ANTIMICROBIALS
- ANALGESIA/ANTI-INFLAMMATORIES
PROGNOSIS for SEPTIC peritonitis…
overall?
3 specific examples?
OVERALL VARIABLE
3 examples?
1. GROSS GI RUPTURE = grave
2. SECONARY & ABLE TO CONTROL SOURCE = fair to good
3. PRIMARY PERITONITIS = good to excellent
HEMOPERITONEUM…
clinical signs usually related to WHAT 2 PROBLEMS?
fever?
clinical signs usually related to…
1. DECREASED OXYGEN CARRYING CAPACITY
2. HYPOVOLEMIA
NO FEVER!!
why should we assess BOTH PCV and TS when trying to determine if a horse has a HEMORRHAGE?
what other 2 CBC findings can indicate hemorrhage?
because horses have ENORMOUS SPLEENS with HUGE RBC RESERVES that can be stimulated by STRESS/SYMPATHETIC NS
but TS will START TO DECREASE IN HEMORRHAGE
2 others?
1. LACTATE INCREASES with ANAEROBIC METABOLISM (less O2)
2. CREATININE INCREASES/AZOTEMIA due to DECREASED RENAL PERFUSION
what source of abdominal hemorrhage is COMMON IN NEONATES?
UMBILICAL VESSEL HEMORRHAGE and RETRACTION
what source of abdominal hemorrhage is often associated with TRAUMA?
SPLEEN HEMORRHAGE
diagnosis of HEMOPERITONEUM? (five)
+ findings for 2?
- CLINICAL SIGNS
- CBC –> PCV, TS, LACTATE, CREATININE
- US –> see SMOKE-LIKE MARKINGS IN FLUID
- ABDOMINOCENTESIS
- RECTAL exam to help RULE IN OR OUT REPRODUCTIVE or GI DZ
FLUID treatment for HEMOPERITONEUM?
TRANSFUSIONS for HEMOPERITONEUM….
3 other meds?
FLUID tx must be CAUTIOUS given IV to provide CARDIOVASCULAR SUPPORT & NO BOLUSES
TRANSFUSIONS for HEMOPERITONEUM VERY RARELY USED IN LA
3 other meds?
1. ANALGESIA
2. ANTIMICROBIALS depending on WHY they’re bleeding
3. ANTIFIBRINOLYTIC/PRO-COAGULANT AGENTS
