Digestion & Metabolism 2: Peritonitis Flashcards
PATHOPHYSIOLOGY of PERITONITIS (4)
end with PERFUSION
- when the ENTIRE peritoneal cavity is INFLAMED, the CAPILLARIES LEAK both FLUID & ALBUMIN
- this leakage causes DECREASED VASCULAR VOLUME
- decreased volume causes DECREASED VENOUS RETURN TO THE HEART
- overall, DECREASED PERFUSION
in DOGS & CATS peritonitis is almost ALWAYS…
DIFFUSE
when animals are SEPTIC, they’ll often VASOCONSTRICT/VASODILATE
VASODILATE
how is the RAA system activated by HYPOVOLEMIA (4)
- CAROTID & AORTIC BODY have STRETCH RECEPTORS that DETECT HYPOVOLEMIA
- hypovolemia causes ADRENALS to RELEASE GCCs
- GCCs –> TACHYCARDIA & VASOCONSTRICTION
- RAA system ACTIVATED to RETAIN Na & WATER by KIDNEYS
do you need INFECTION for SEPSIS?
what ELSE can cause sepsis?
NO, infection isn’t necessary for sepsis –> SEPSIS IS WIDESPREAD INFLAMMATION
release of substances from DAMAGED TISSUE can interact with MACROPHAGES & LYMPHOCYTES and cause release of INFLAMMATORY MEDIATORS
how does SMOOTH MUSCLE DILATE? (3)
- RELEASE of ATRIAL NATRIURETIC PEPTIDE via cGMP
- cGMP clips PHOSPHATE off of MYOSIN
- VASODILATION
vasodilation & HYPERpolarization? (3)
- if we have LOSS OF ENERGY in a cell or LACTATE HIGH, then K CHANNELS OPEN
- causes HYPERPOLARIZATION OF MEMBRANE & Ca channels STAY SHUT
- causes VASODILATION
the SIGNS for peritonitis OVERALL are…
can include what 4 specific signs?
if we SUSPECT peritonitis, what DIAGNOSTIC should we do?
NOT SPECIFIC
4 signs?
1. ANOREXIA
2. VOMITING
3. DEPRESSION
4. FEVER
we should do ABDOMINAL RADS
what is this in ABDOMINAL RAD? (arrow)
when would it be normal?
if NOT normal, what should we do next?
FREE GAS POCKET
normal = if it’s recently had ABDOMINAL SX
if NOT normal, then NEEDS FULL ABDOMINAL EXPLORATORY SX
what structure can we CLEARLY see in this THORACIC RAD?
what does good detail of this structure indicate? (2)
we can CLEARLY SEE DIAPHRAGM
GOOD DETAIL of this structure indicates…
1. AIR present on BOTH SIDES
2. PPERITONITIS
what is a FOUR-QUADRANT tap?
allows us to use a needle to try and ASPIRATE FLUID FROM THE ABDOMEN
BACTERIA IN ____ FLUID is NOT diagnostic for PERITONITIS, but BACTERIA ____IS & indicates going to ____
EXTRACELLULAR, INTRACELLULARLY, SURGERY
PERITONEAL FLUID GLUCOSE should be WHAT if peritonitis?
PERITONEAL FLUID LACTATE should be ____ mmol/L ____ than BLOOD
which method is 100% SENSITIVE & SPECIFIC for PERITONITIS DIAGNOSIS in dogs?
what happens once SURGERY is performed?
PERITONEAL FLUID GLUCOSE >20 mg/dL LOWER than BLOOD GLUCOSE
PERITONEAL FLUID LACTATE should be 2 mmol/L HIGHER than BLOOD
PERITONEAL FLUID LACTATE 100% SENSITIVE & SPECIFIC FOR PERITONITIS
once Sx performed, NONE OF THESE NUMBERS/FINDINGS ARE HELPFUL!
2 INITIAL medical managements for PERITONITIS in ER?
- AGGRESSIVE STABILIZATION & MONITORING
- ADMINISTER IV CRYSTALLOIDS & COLLOIDS
UROPERITONEUM is ALWAYS considered a ____ ____
might see ____
MEDICAL EMERGENCY
might see ARRHYTHMIAS
HYPERKALEMIA causes ____cardia
the closure of WHAT channel is responsible for this?
normally, K excreted via..
HYPERKALEMIA –> BRADYCARDIA
closure of SODIUM CHANNELS due to HYPERPOLARIZATION causes bradycardia
normally, K excreted via KIDNEYS
CALCIUM CHLORIDE compared to CALCIUM GLUCONATE?
CALCIUM CHLORIDE has 3X as much CALCIUM as in CALCIUM GLUCONATE
if PERITONITIS is present, then we should assume there’s a ____ ____ ____ & requires what 2 treatments?
give 2 specific medications
SECONDARY BACTERIAL INFECTION
- CULTURE DURING Sx
- BROAD-SPECTRUM ANTIBIOTICS
–> CEPHALOSPORIN or
–> CLINDAMYCIN for G+
if a dog comes in with SEPTIC PERITONITIS, the most IMPORTANT thing you can do is… (2)
what are 2 common causes?
- STABILIZE ANIMAL
- REMOVE INCITING CAUSE
cause = GI LEAKAGE either from…
1. FB
2. ANASTOMOSIS/RESECTION gone wrong
if a dog comes in with GI LEAKAGE, we can perform a ___ ____, which is performed via…
does this work better than OMENTAL WRAPPING?
SEROSAL PATCH
take a couple LOOPS OF BOWEL and SUTURE THEM TOGETHER
DOES NOT work better than omental wrapping
PERITONEAL LAVAGE…
what should the SOLUTION be made of?
after lavaging, need to make sure we…
solution = LARGE VOLUMES of WARM, BALANCED ELECTROLYTE SOLUTION
after lavaging, ASPIRATE ALL THE FLUID because if not, can EXACERBATE PERITONITIS/cause BACTEREMIA
describe the MMs in two terms
usually a result of WHAT 3 clinical signs?
what 2 diseases could it indicate?
MMs?
1. INJECTED
2. VERY PINK
result of…
1. VASODILATION
2. ASPIRATION
3. REGURGITATION
could indicate…
1. PNEUMONIA
2. DIC
DOGS GIVEN ___ DURING Sx for ____ PERITONITIS had ____ SURVIVAL
LIDOCAINE, SEPTIC, BETTER
