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Surgery > E2- Peritonitis > Flashcards

E2- Peritonitis Flashcards

1
Q

Perinoneal circulation: focal contaimation can do what?

A

QUICKLY inoculate entire peritoneum

caudal to cranial flow

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2
Q

***Primary classification of peritonitis****

A

spontaneous inflam in the absence of intraperitoneal source

corona virus→ FIP (cats)

hematogenous/lymphogenous bact spread, transmural bacterial migration from GI tract, or bact spread from oviducts

Gram + organisms more common and usually MONOBACTERIAL

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3
Q

***Secondary classification of peritonitis****

A

consequence of an underlying primary dz process

bowel leakage/translocation, urine/bile/blood extravasation, neoplastic invasion, pancreatitis

Gram - organisms more common and usually POLYMICROBIAL

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4
Q

_____ peritonitis- infectious etiologies present (usually bacterial)

A

septic

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5
Q

Why is it important to differentirate b/t primary Vs secondary peritonitis?

A

Surgery is NOT routinely indicated for primary but is requisite for secondary

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6
Q

Septic peritonitis from GI origin causes

A

cause= 38-75% of cases

mecahnical perforation (FB), trauma, ruptured neoplasia, vascular disruption leading to ischemia/necrosis (GDV), surgical dehiscence after R&A, drug induced

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7
Q

Septic peritonitis from GI origin: location of perforation dictates ____

A

bacterial demographics

aboral = higher total bacterial counts, increased anaerobes, increased mortality

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8
Q

Septic peritonitis from GI origin: two main offenders from the bowel?

A

E. Coli (57-74% of cases) = alpha hemolysin endotoxin

Bacteroides fragilus (anaerobic)- enhances lethal potential of E. Coli

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9
Q

Septic peritonitis from **hepatobiliary** causes

A

Ruptured gall bladder mucocele

necrotizing cholecystitis

abscess (+/- tumor)

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10
Q

Serptic peritonitis from **Urogenital** causes

A

pyometra

prostatic abscess

ovarian cyst

pyelonephritis/renal abscess

retained testicle

ruptured bladder

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11
Q

Other causes of septic peritonitis?

A

pancreatic

splenic

penetrating trauma- bite wounds

lymph node

iatrogenic

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12
Q

Peritonitis pathophysiology: local manifestations

A
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13
Q

Peritonitis Pathophysiology: Systemic manifestations

A

trickle down effect

***have a good understanding of this***

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14
Q

What are the terminal effects of peritonitis?

A

DIC- disseminated intravascular coagulation

SIRS- systemic inflam response syndrome

MODS- multiple organ dysfunction syndrome

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15
Q

Clinical signs of peritonitis

A

variable- depend on etiology, duration, signalment and severity

classic= painful, vomit, fever, distended abdomen +/- shock (acute abdomen)

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16
Q

Two phases of shock in peritonitis?

A
  • Hyperdynamic
    • vasomotor dysfunction, cytokine-induced peripheral vasodilation, tachycardia, hyperemic (brick red) MM’s w/ rapid CRT, bounding pulses and hyperthermia
  • Hypodynamic
    • decreased contractility and CO = pale MM w/ CRT >2sec, weak peripheral pulses, hypothermic, increased RR,HR, dehydration, dull mentation
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17
Q

Septic peritonitis in cats

A

NO pain on abdominal palpation

relative BRADYCARDIA = <140bpm

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18
Q

Diagnostic imaging of peritonitis

A

Abdominal US- pneumoperitoneum and ID pathology

Radiographs- pneumoperitoneum and loss of serosal detail

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19
Q

How long can residual free air remain after abdominal surgery?

A

up to 30 days

20
Q

Preferred diagnostic technique for peritonitis in people?

A

CT imaging

differentiating surgical vs non surgical

21
Q

What is the GOLD standard dx for peritonitis?

A

CYTOLOGY

US guided- aFAST (focused assessment w/ sonography for trauma)

blind 4 quadrent abdominocentesis

diagnostic peritoneal lavage (DPL)

22
Q

What is seen on cytology that is diagnostic for peritonitis?

A

degenerative neutrophils w/ intracellular bacteria***

23
Q

How accurate is cytology?

A

only 57-87% accurate****

24
Q

In dogs with septic effusion, peritoneal fluid glucose concentration will ALWAYS be _____ than the blood glucose concentration

A

LOWER

25
Q

In dogs, Glucose is _____ points lower in belly fluid than blood

A

20 points

bc glucose is used up by bacteria and phagocytic cells

26
Q

In dogs, Lactate is ____ points higher in belly fluid than blood

A

2 points

anaerobic metabolism and lactic acid production by bacteria in peritoneum

27
Q

How does glucose sensitivity compare to cats vs dogs

A

cats only 86% sensitive, dogs 100% sensitive

so we rely more on lactate for cats

28
Q

Diagnosis of fluid analysis for peritonitis: uroperitoneum

A

Urogenital source- peritoneal fluid creatinine conc > serum creatinine conc = dx for uroperitoneum

29
Q

Diagnosis of fluid analysis for peritonitis: Bile peritonitis

A

peritoneal fluid bilirubin conc ****>2.5X*** serum bilirubin conc is 100% dx for bile peritonitis in dogs and cats

30
Q

Treatment of peritonitis

A

provide hemdynamic support: fluids, blood products, antibiotics, analgesia

emergency surgery!!!

  • reduce amount of contamination
  • prevent further contamination by controlling source
  • provide postop abdominal drainage
31
Q

Antimicrobial selection for peritonitis

A

increased rate of bact resistance with ampicillin, cefazolin, fluoroquinolones

lower rates of resistance with aminoglycosides and 3rd gen cephalosporins

combo therapy to start: FOUR QUADRANT:

  • iv ampicillin/aminoglycoside/metro, careful w/ P that have poor perfusion = can lead to acute renal failure
  • iv ampicillin/baytril/metro -classic “go to” choice
32
Q

For peritonitis surgery- you must repair or remove the ____

A

inciting cause= intestinal resection and anastomosis, cholecystectomy, liver lobectomy, partial cystectomy, nephrectomy

33
Q

What is important in peritonitis surgery?

A

LAVAGE w/ warm isotonic saline

suction

34
Q

Do NOT overlook the need for ____ with peritonitis sx

A

PO enteral nutrition- these animal need feeding tubes!!

35
Q

PO ___ critical with peritonitis sx

A

drainage

36
Q

____ closure- if source of infection has been isolated and completely controlled in peritoneal sx

A

primary

37
Q

Two types of open peritoneal drainage

A

gravity dependent- dressing packed w/in open incision

vacuum assisted closure

38
Q

Two types of closed peritoneal drainage

A

passive- multi luminal, penrose or column disk catheters

**active**- closed suction (jackson pratt)- requires external vacuum to create neg pressure w/in cavity

39
Q

Pros of open peritoneal drainage

A

most effecient way to drain

limits anaerobic bacterial growth

40
Q

Cons of open peritoneal drainage

A

labor intensive bandage management

risk of nosocomial contamination

anemia, hypoproteinemia and electrolyte imbalances

2nd sx procedure to close abdomen

41
Q

Pros of closed peritoneal drainage

A

lower risk of nosocomial bact contamination

decrease potential for evisceration

less intensive PO bandage care

no additional sx to close abd

42
Q

Cons of closed peritoneal drainage

A

occlusion (omentum/clots)

ascending bacterial contamination

43
Q

Open Vs Closed peritoneal drainage: which one is significantly better?

A

NO SIGNIFICANT difference

44
Q

Open Vs Closed peritoneal drainage: which requires more intensive care?

A

OPEN

blood, plasma, enteral nutrition

45
Q

Open Vs Closed peritoneal drainage: which one requires a longer hospital stay?

A

6 days- open

3.5 days closed

46
Q

Cav’s choice for abdominal drainage?

A

closed suction- Jackson pratt

Surgery (15 decks)

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