Endotoxaemia, peritonitis & adhesions

Question 1

what is the pathogenesis of endotoxaemia

Answer 1

1. Endotoxins released from G - bacteria - rapid bacterila replication and death
2. Endotoxins absorbed across gut barrier - facilitated - facilitated by damaged gut barrier function
3. Endotoxins free in the blood stream - liver extraction (mononuclear phagocytes)
4. Endotoxins binds to inflammatory cells
5. activates inflammatory cells to produce inflammatory mediators
6. inflammatory mediators scereted by inflammatory cells

Question 2

what is the pathophysiological consequence of endotoxins in the bloodstream

Answer 2

Inflammation

Question 3

Systemic inflammatory respond syndrome (SIRS)

Answer 3

a general systemic inflammatory process independent of cause
Sepsis = systemic inflammatory response to bacterial infection

Question 4

multiple organ dysfunction syndrome

Answer 4

insufficient of 2 or more organ system e.g azotaemia, early laminitis

Question 5

Multiple organ failure syndrome

Answer 5

Failure of 2 or more organ systems e.g AKI, DIC, laminitis

Question 6

what are the causes of endotoxamia

Answer 6

Endotoxin molecules releases -as a by product of G- bacterial growth
Source of gram negative bacteria - localised function of infection
Translocation - entry of engenous batceria/products from GIT to systemic circulation

Question 7

what is the structural component of the outer layer of gram negative bacteria and what is its significance

Answer 7

LIpopolysaccharide (LPS) - permeability barrier - integral for survival and resistance to host defence mechanisms
Heat STABLE - In contrast to secreted exotocins

Question 8

what is the significance of LPs and endotoxaemia

Answer 8

Aute gastrointestinal injury will increase the permeability to LPS

Question 9

GIT permeability to LPS will be increased by;

Answer 9

GIt rupture
local ischaemia; strangulating lipoma
inflammation: anterior enteritis
systemic acidosis

Question 10

what is the pathophysiology of endotoxaemia

Answer 10

1. endotoxins enters vascular system
2. endotoxin contacts blood
3. margination, activation & extravasation of neutrophils
4. host pathology begins
5. organ dysfunction develops
6. Compensatory anti-inflammatory response syndrome

Question 11

On a hemogram what is a pathogneumonic sign of endotoxaemia

Answer 11

LEUKOPENIA due to neutropenia most specific indicator
+/- band neutrophils
Toxic changes: less condensed chromatin & cytoplasmic basophilia (blue) due to retention of ribosomal RNA

Question 12

what results on a biochem panel will be see with a horse suffering from endotoxaemia

Answer 12

hypocalcaemia as direct/indirect effect
hypoglycaemia in foals; hyperglycaemia in adults
coagulopathy ==> DIC

Question 13

what is the underlying principle of the txm of endotoxemia

Answer 13

Prevention by recognising & monitoring those patients at risk and treating the underlying source of LPS

Question 14

what drug can be used to inhibit LPS release into circulation, it is an antimicrobial therapy and you need to be aware that these kill bacteria and may increase the endotoxin activity initially

Answer 14

Ceftifur sodium

Question 15

what drug is used to scavenge LPS- it binds to lipid A of LPS and is nephrotoxic

Answer 15

Polymixin B

Question 16

what drug; blocks the production of pro inflammatory mediators via blocking the activation of NF- KB mediators of intracellular signalling cascage after LPS binding to mononuclear phagocytes: inhibition of cellular activity by LPS

Answer 16

Ethyl pyruvate

Question 17

what drugs can be use do inhibit the inflammatory mediators sysnthesis

Answer 17

NSAIDS - flunixin 
pentoxifylline 
corticosteroids 
antioxidants
Lignocaine

Question 18

where does the peritoneum lie

Answer 18

in the abdominal cavity (parietal peritoneum) & covers viscera (visceral peritoneum)

Question 19

what is the function of the peritoneal fluid

Answer 19

allows sliding of viscera; microvilli trap water and serous exudates
Production of peritoneal fluid: contain cells & cellular mediators that have roles in peritoneal healing
Fluid resorption and diffusion

Question 20

what is the definition of peritonitis

Answer 20

inflammation of the mesothelial lining of the peritoneum

Question 21

what are the CS associated with peritonitis

Answer 21

Colic; low grade and recurrent

associated with inflammation +/- sepsis +/- cardiorespiratory dysfunction

Question 22

what are some the findings on a haemorgam that help with the diagnosis

Answer 22

Inflammtion (fibrinogen)

hyper to hyper proteinaemia (protein loss in the abdominal cavity vs gammopathy)

Question 23

what other diagnostic tools can help diagnose peritonitis

Answer 23

abdominocentesis and fluid analysis

Question 24

How do you treat peritonitis

Answer 24

identification of aetiology - surgical exploration 
antimicrobial therapy 
fluid therapy 
peritoneal lavage 
analgesics, Anti-inflammatory 
adhesion management