Lecture 17 2/18/25 Flashcards
What are the potential etiologies of peritonitis?
-dehiscence of surgery sites
-blunt or penetrating trauma
-visceral rupture from obstruction or inflammation
-GI perforation from concurrent NSAIDs and steroids
-abscess leakage
-pyometra leakage
What are the clinical signs in patients with peritonitis?
-lethargy
-anorexia
-vomiting
-dehydration
-abdominal pain
-abdominal distention
What are the signs that peritonitis has progressed to sepsis and/or shock?
-tachycardia
-weak pulses
-pyrexia or hypothermia
-pale or bright red mucous membranes
-prolonged capillary refill time
What are the laboratory findings in peritonitis cases?
-hypoglycemia or hyperglycemia
-decreased albumin
-increased ALT, AST, ALP
-left shift or toxic WBCs
-prolonged coagulation and/or thrombocytopenia
-hyperlactemia
-ionized hypocalcemia (cats)
-increased BUN, creatinine, K+ (urine leakage)
-hyperbilirubinemia (bile leakage)
What are the findings on radiographs in peritonitis patients?
-regional or generalized loss of visceral/serosal margination
-free gas in the abdomen IF animal has not had recent surgery
-regional or generalized, moderately dilated, adynamic small intestine
Why should an animal be placed in lateral recumbency for 2 to 5 minutes prior to horizontal beam x-rays?
to allow for the gas bubbles to rise and be better visualized on x-ray
What are the findings on abdominal fluid cytology in patients with peritonitis?
-bacteria or organic debris
-toxic or degenerate neutrophils
-increased WBCs
What are the findings on abdominal fluid chemistry in patients with peritonitis?
-fluid glucose at least 20 mg/dl less than peripheral plasma
-abdominal fluid lactate > or = 4.2 mmol/mL or abdominal fluid:blood lactate ratio > 2 mmol/mL
-bilirubin > 2x peripheral plasma in bile leak cases
-creatinine > or = 2x serum and potassium > or = 1.4 serum in urine leak cases
What are the treatment steps in peritonitis patients?
-fluids: crystalloids, concentrated albumin
-analgesics
-IV broad spectrum antibiotics
-vasopressors and inotropes for non-responsive hypotension
-blood products as needed
-medications for GI signs
-emergency surgery in most cases
What are the characteristics of antibiotic use in peritonitis patients?
-outcome is improved if appropriate antibiotics are given soon after presentation
-continue post-op antibiotics based on culture results and severity of condition
Which antibiotics are used in peritonitis cases?
one of the following:
-ampicillin-sulbactam
-ampicillin
combined with one of the following:
-enrofloxacin
-amikacin
-gentamicin
What are the steps to surgical treatment of peritonitis?
-exploratory laparotomy
-collect culture, sensitivity, and gram stain samples
-address source of peritonitis
-use omentum as physiologic drain for abscesses
-patch visceral repairs with omentum or serosa
-lavage out gross contamination and suction out all fluid
-place NG or GJ tube
-provide post-op abdominal drainage as needed
What are the steps to surgically managing an abscess involved in peritonitis?
-open and drain the abscess
-collect samples for culture and biopsy
-suture omentum into the cavity
What are the indications for abdominal drainage?
-residual fibrin tags and debris
-severe, generalized inflammation
-questionable blood supply
-causative lesion that cannot be fully repaired/corrected
-planned second looks
-monitoring of colonic perforation
What are the methods for abdominal drainage?
-continuous suction drains
-negative pressure wound therapy
-open peritoneal drainage
What are the steps to placing a jackson-pratt drain?
-place drain(s) evenly spaced throughout abdominal cavity
-place a purse string suture
-place a finger trap suture using surgeon’s throws
-take an extra bite and tie a knot
-cover all drain exit sites with bandaging
-label drains and catheters
What are the characteristics of drain management/care?
-fluid production should gradually decrease over a matter of days
-must account for drain and urinary catheter losses when determining fluid administration/intake
-complications uncommon
-lack of fluid production indicates clogging or kinking
-removal occurs when fluid character improves; should be based on abdominocentesis
What are the characteristics of vacuum-assisted closure?
-for severe peritonitis
-ineffective if sponge or tube becomes clogged
-kept in place for 1 to 4 days with canister changes as needed
-bandage change if loss of negative pressure
-complications include protein/fluid loss and nosocomial infection
What are the characteristics of open peritoneal drainage?
-sometimes used in cases of extensive peritonitis, peritonitis in which source cannot be controlled with just one surgery, or abdominal compartment syndrome
-external rectus sheath is loosely apposed
-closure done 3 to 5 days later
-bandage changes done every 12 hours using sterile technique under sterile sedation
-complications include hypoproteinemia, anemia, evisceration, and nosocomial infection
What are the components of post-op monitoring and care?
-fluids
-colloids
-oxygen
-analgesics
-antibiotics
-blood pressure
-urine output
-body weight
-blood work
-incisional care
-nutritional support
What is the prognosis of peritonitis?
-mortality rates around 50%
-increases risk of intestinal dehiscence
What are the indicator of poorer prognosis in peritonitis cases?
-pre-op hypotension or hypoalbuminemia
-persistent hyperlactemia in dogs
-persistent ionized hypocalcemia in cats
-delayed diagnosis
-non-responsive hypotension
-multiple organ dysfunction
-DIC
-septic bile peritonitis
