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SA DX & TX II > Exam 1 - Peritonitis > Flashcards

Exam 1 - Peritonitis Flashcards

1
Q

what is peritonitis?

A

inflammation of the peritoneum

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2
Q

what is primary peritonitis?

A

spontaneous occurrence with absence of a source of bacterial infection

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3
Q

what is the most common example we see in vet med of primary peritonitis?

A

FIP in cats

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4
Q

what is the most common form of peritonitis in vet med?

A

secondary peritonitis

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5
Q

what are some aseptic causes of secondary peritonitis?

A

bile peritonitis

uroperitoneum

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6
Q

what are some septic causes of secondary peritonitis?

A

leakage of gi contents

reproductive, biliary, urinary, & pancreatic sources with bacteria

penetrating wounds

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7
Q

T/F: ~60% of canine & ~50% of feline cases of septic peritonitis have a gastrointestinal source

A

true

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8
Q

what are the major potential sources of gi septic peritonitis?

A

dehiscence of prior surgical site, foreign body with perforation, ulceration with perforation

others include - necrosis of GDV, neoplasia with perforation, penetrating abdominal injury, necrosis of intussusception site, & dehiscence of gastric/jejunal feeding tube site

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9
Q

when is dehiscence most likely to occur in patients post-op gi surgery? why?

A

3-5 days

lag phase of wound healing - debridement is occurring & collagenases activity is decreased, so strength of intestines depends on sutures

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10
Q

T/F: prophylactic post-op antibiotics will prevent dehiscence in routine post-op gi surgical patients

A

false - won’t decrease it

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11
Q

what are some risk factors associated with dehiscence?

A

delayed enteral nutrition

pre-existing septic peritonitis

hypoalbuminemia (<2-2.5 mg/dL)

linear foreign body

multiple intestinal procedures - multiple enterotomies

administration of blood products

poor surgical technique

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12
Q

where are the most common sites of perforation due to gi ulceration in dogs? what clinical signs are seen?

A

stomach & duodenum

vomiting, hematemesis, & melena

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13
Q

why is the severity of septic peritonitis dependent on the source of infection?

A

a higher bacterial load is seen as you move through the gi tract - stomach & proximal small intestines have low-numbers of acid resistant bacteria while the colon has 1000:1 anaerobes to aerobes

e. coli & bacteroides fragilis are most common

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14
Q

what is SIRS? how does an animal qualify the SIRS criteria?

A

systemic inflammatory response syndrome that is a common sequela to sepsis

must meet 2 or more of the criteria

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15
Q

what is the pathophysiology of SIRS?

A

mediator excess of cytokines/oxygen free radicals cause widespread endothelial injury & dysfunction

leads to vasodilation, increased capillary permeability, tissue edema, & neutrophil entrapment in microcirculation

see multi-organ dysfunction syndrome

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16
Q

what are the sirs criteria that must be met for cats?

A

temp - >103.5 or <100

HR - >225 or <140 bpm

RR - >40

WBC - >19,500 or <5,000

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17
Q

what are the sirs criteria that must be met for dogs?

A

temp - >102.6 or <99

HR - >140

RR - >30

WBC - >19,000 or <6,000

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18
Q

what are some common clinical signs associated with peritonitis?

A

lethargy, weakness, vomiting/regurgitation, inappetence, increased respiratory effort, & abdominal distension

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19
Q

what makes up the hyperdynamic response that is initially seen in patients with peritonitis? what about the hypodynamic response seen after?

A

hyperdynamic - fever, red/injected mucus membranes, tachycardia, & bounding pulses

hypodynamic - hypothermia, hypotension, & pale mucus membranes

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20
Q

T/F: bradycardia is more common in cats with peritonitis instead of tachycardia

A

true

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21
Q

what initial diagnostic labwork should be done for a peritonitis patient?

A

PCV/TS, electrolytes, lactate, blood glucose, & BUN/creatinine

CBC/chem, & coagulation panel

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22
Q

what is typically seen on abdominal radiographs in a patient with peritonitis? is this used to definitely diagnose peritonitis?

A

decreased serosal detail, free peritoneal gas

nope

23
Q

when should you consider doing thoracic rads for a patient with peritonitis?

A

neoplasia is high on the differential list

suspicion for possible aspiration based on history/physical exam

avoid VD view

24
Q

this radiograph was taken of a patient with peritonitis - what is seen?

A

free peritoneal gas

25
Q

why should an abdominal ultrasound be done for a patient with peritonitis?

A

assess for free abdominal fluid

26
Q

what is the most useful diagnostic test for septic peritonitis?

A

abdominocentesis!!!! put fluid in an EDTA tube & culture it

27
Q

what does the gross appearance of peritoneal fluid look like in a patient with peritonitis?

A

serosanguinous, bloody, purulent - all possible

28
Q

what does the cytology of peritoneal fluid look like in a patient with peritonitis?

A

toxic & degenerative neutrophils with INTRACELLULAR BACTERIA +/- vegetable material

29
Q

______ is required for source control in animals with septic peritonitis

A

surgery

30
Q

T/F: peritonitis has a 30-50% mortality rate in small animal patients

A

true

31
Q

what are some poor prognostic indicators of peritonitis?

A

refractory hypotension, elevated lactate without response to resuscitation, respiratory distress, cardiovascular collapse, DIC, & MODS

32
Q

with a gi source causing septic peritonitis, what should you look out for? why?

A

recurrent sepsis (dehiscence of your surgical site)

increases mortality rate to 60%

33
Q

what does your glucose & lactate measurements off of peritoneal fluid look like in a patient with septic peritonitis?

A

glucose - fluid glucose <50mg/dL, >20mg/dL peripheral whole blood: fluid difference, or plasma:fluid difference of >38mg/dl may be more sensitive

lactate - fluid lactate >2.5 mmol/dL (dogs, blood: fluid difference of -2.0mmol/L (dogs

34
Q

what must be done prior to pursuing surgery in an animal with septic peritonitis?

A

stabilize!!! goal directed resuscitation with close monitoring of the BP, HR, temperature, SpO2, lactate, & BG

35
Q

if your patient with septic peritonitis has hypoalbuminemia, what fluids should be considered?

A

plasma or a colloid for shock doses of fluid

36
Q

T/F: blood pressure support may be indicated in patients with septic peritonitis

A

true - pressors may be necessary - norepinephrine often considered 1st in septic patients

37
Q

what antibiotics are often used for treating septic peritonitis?

A

broad spectrum - ampicillin/sulbactam + enrofloxacin

ampicillin/sulbactam alone

3rd generation cephalosporin

38
Q

T/F: in patients with septic peritonitis, empirical selection of antibiotics is not associated with survival but timing is

A

true - IV ASAP, ideally within 1 hour of diagnosing

39
Q

what is the #1 requirement for treating septic peritonitis?

A

surgery

40
Q

what are the goals of surgery in a patient with septic peritonitis?

A

full abdominal explore

source control

lavage

+/- drainage

41
Q

why should you anticipate complicated anesthesia in patients with septic peritonitis? how do you minimize these risks?

A

vasodilation occurs from sepsis, so they are more sensitive to the hypotensive side effects of drugs

minimize time under anesthesia - prep as much as possible before induction

MAC sparing, multi-modal protocol is critical - may even consider TIVA with no gas inhalant

42
Q

what is the most common procedure performed in patients with septic peritonitis when the gi tract is identified as the source? when is this not possible? what is done instead?

A

R&A

perforated duodenal ulcers - debride & close the gi in this situation reinforcing the closure with omentum or serosal patch

43
Q

T/F: multiple studies suggest that GI staplers perform better than hand sutured anastomosis sites

A

true - decreased risk of dehiscence when the transverse staple line is oversewn

44
Q

how do you want to lavage the abdomen of a patient with septic peritonitis?

A

minimum of 200-300ml/kg recommended using warm sterile saline (want what you’re suctioning back to be clear)

aim to reduce bacterial load, debris, & inflammatory cells - DO NOT ADD ABX TO IT, not necessary & may induce chemical peritonitis

obtain a closing culture (both aerobic & anaerobic)

45
Q

T/F: it is okay to place a penrose drain in the abdominal cavity

A

false - VERY BAD DO NOT DO THIS

46
Q

T/F: there is a lot of debate on drainage techniques for patients with septic peritonitis

A

true - JP drain is safest in absence of advanced ICU/training

47
Q

why should a penrose drain never be placed in the abdominal cavity of a dog with septic peritonitis?

A

not appropriate for abdominal drainage

cannot be used in the abdominal cavity (they become quickly walled off and allow ingress of bacteria) or the thoracic cavity (they allow air to pass into the thorax!!!)

48
Q

what is a JP drain? when should you consider using it for a patient with septic peritonitis?

A

active, closed suction drain with fenestrations & one-way valve where you can monitor fluid volume & character closely

consider when there is severe contamination in the abdomen you can’t adequately remove/lavage

49
Q

why should you use caution with interpretation of chemistry/cytology of drain fluids in post op septic peritonitis patients?

A

over-interpretation is common - not a reliable as a sole predictor of dehiscence

50
Q

in post-op septic peritonitis patients, how much fluid was collected in the drains daily? what lab abnormalities were commonly seen in these animals?

A

47 +/- 25 ml/kg/day

hypoproteinemia in 90% of animals

anemia in 80% of animals

51
Q

what monitoring should be done in post-op septic peritonitis patients 24/7?

A

continuous ECG, blood pressure, PCV/TS, albumin, lactate, glucose, & cbc chem every few days

52
Q

T/F: early enteral nutrition is important in patients with septic peritonitis

A

true - consider placing a feeding tube at the time of surgery

53
Q

T/F: you need to keep up with fluid losses through the JP drain if you placed one in a patient with septic peritonitis

A

true

SA DX & TX II (62 decks)

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