Kapitel 86 – Peritoneum and retroperitoneum

Question 1

What are the natural openings of the caudal abdomen and what do they contain?

Answer 1

Inguinal canal: containing the external pudenal vessels, genitofemoral vessels, genitofemoral nerve and the spermatic cord in males.

Vascular lacunae: femoral artery and vein, lymphatic vessels and the saphenous nerve.

Question 2

What are the boarders of the epiploic foramen and why it this foramen of surgical significance?

Answer 2

a. bounded dorsally by the caudal vena cava and ventrally by the portal vein

b. Bleeding from the liver can be temporarily arrested by placing a finger through the epiploic foramen just cranial to the pylorus and curling the finger ventrally to occlude the hepatic artery and portal vein.

Question 3

What are the three portion of the greater omentum?

Answer 3

a. Bursal portions (most important portion)
b. The splenic portion - extends to the hilus of the spleen to form the gastrosplenic ligament
c. Veil portion – containing the left limb of the pancreas (smallest portion)

Question 4

What does parts of the lesser omentum give rise to?

Answer 4

The hepatoduodenal ligament and hepatogastric ligament.

Question 5

What organs and structures are considered retroperitoneal?

Answer 5

a. Kidneys
b. Ureters for most of their length
c. Adrenal glands
d. The aorta
e. Caudal vena cava
f. Lumbar lymph nodes

Question 6

What is the normal colloid pressure of peritoneal fluid?

Answer 6

28 mmhg

Question 7

What is the normal intra-abdominal pressure?

Answer 7

2-7,5 cm H2O

Question 8

What organ dysfunctions are described in acute abdominal compartment syndrome?

Answer 8

a. acute pulmonary failure secondary to compressive atelectasis and impaired gas exchange
b. increased intrathoracic pressure leading to increased pleural and pericardial pressures
c. decreased venous return to the heart
d. acute renal failure with marked oliguria
e. intestinal ischemia with resultant bacterial translocation
f. hepatic ischemia resulting in increased liver enzyme levels
g. increased intracranial pressure leading to decreased cerebral perfusion and neuronal injury
h. venous thrombosis and thromboembolism
i. abdominal wall ischemia or necrosis

Question 9

When should surgical decompression be considered in abdominal compartment syndrome?

Answer 9

When intraabdominal pressure nears 30 cm H2O, particularly in oliguric animals

Question 10

What is associated with adhesion formation in the abdominal cavity?

Answer 10

a. Ischemia
b. Endotoxemia
c. Intestinal manipulation
d. Bowel distension
e. Desiccation of serosal surfaces.

Question 11

How can you minimize/prevent adhesion?

Answer 11

a. Prevent of tissue drying
b. Gentle tissue handling
c. thorough hemostasis
d. precise suture placement
e. complete removal of blood clots and foreign debris
f. thorough lavage

Question 12

The severity of clinical signs of peritonitis is proportional to the degree of elevation of proinflammatory cytokines. Which ones in particular?

Answer 12

TNF-α, IL-8, and IL-6

Question 13

A number of intraperitoneal substances are known adjuvants in peritonitis. These substances either worsen the local and systemic inflammatory response or worsen the prognosis in bacterial peritonitis. Which are those substance?

Answer 13

a. gastric mucin
b. bile salts
c. hemoglobin
d. barium

Question 14

was is the mortality rate of dogs with septic peritonitis?

Answer 14

55% in dogs with at least one failed organ system and 94% in those with concurrent hypotension needing vasopressor therapy.

Question 15

How is peritonitis classified? Which one is most common in small animals?

Answer 15

a. primary or secondary
b. acute or chronic
c. localized or generalized
d. septic or aseptic

–> Acute generalized secondary septic peritonitis

Question 16

Give an example of primary peritonitis in small animals

Answer 16

Feline coronavirus infection resulting in feline infectious peritonitis

Question 17

What is the mortality rate in digs that developed intestinal anastomotic leakage?

Answer 17

85 % despite aggressive treatment

Question 18

What are the two most common bacterial isolates in peritonitis secondary to bowel perforation?

Answer 18

E. coli and Bacteroides fragilis.

Question 19

What volume of fluid can be detected on physical examination by ballottement?

Answer 19

A peritoneal fluid volume of 10 ml/kg BW

Question 20

Are cats with septic peritonitis usually

Answer 20

Hypothermic

Question 21

During abdominal auscultation, what is a persistent sign of peritonitis?

Answer 21

Lack of bowel sounds due to reflex intestinal ileus.

Question 22

Which is the single most useful test for peritonitis?

Answer 22

Abdominocentesis

Question 23

What are early radiological signs of peritonitis?

Answer 23

patchy, flaky, or mottled appearance of the abdominal organs and blurred borders between bowel loops and abdominal organs

Question 24

what minimum blood test are recommended when suspecting peritonitis?

Answer 24

a. Complete blood count
b. total protein and albumin
c. urea nitrogen
d. electrolytes
e. glucose
f. serum lactate
g. blood gas analysis

Question 25

What are the 3 different methods abdominocentesis?

Answer 25

a. Single tap - 1-3 cm caudal to the umbilicus
b. Four-quarter tap
c. Diagnostic peritoneal lavage – 20-22 ml/kg of sterile saline in injected, the animal is gently rolled from side to side for up to 10 min then the fluid is sampled.

Question 26

What is the recommended volume of surgical lavage in septic peritonitis?

Answer 26

200-300 ml/kg or until the returning fluid is clear

Question 27

What is the indications for open peritoneal drainage?

Answer 27

a. Severe systemic manifestations of peritonitis
b. ineffective drainage with conventional procedures
c. extensive suppuration or necrosis of the deep layers of the abdominal incision

Question 28

During open peritoneal drainage, what is the criteria for final closure of the abdomen?

Answer 28

a. Gross improvement in color and clarity of drainage fluid
b. Progressively decreasing volume of drainage fluid measured by weight of bandages
c. Decrease or absence of cellular toxicity on cytologic examination of drainage fluid, and absence of bacteria on cytology

Question 29

What are known most common complications of open peritoneal dranage?

Answer 29

a. Nosocomial (hospital-acquired infection) peritoneal infection
b. Hypoproteinemia
c. Hypoalbuminemia
d. anemia.

Question 30

List potential causes of hemoperitoneum. What is the most common diagnosed non-traumatic cause?

Answer 30

a. blunt or penetrating abdominal trauma
b. iatrogenic surgical or diagnostic trauma
c. neoplasia
d. coagulopathies
e. splenic torsion,
f. liver lobe torsion
g. ruptured abdominal viscera.

 The most common diagnosis in acute nontraumatic hemoperitoneum in dogs is malignant neoplasia

Question 31

Which is the most common retroperitoneal neoplasia in domestic animals?

Answer 31

Lipoma