Peritonitis Flashcards

1
Q

Hansen, JVECC, 2019:
Gastrostomy tube usage in septic peritonitis
Survival rate?
75% of the cases developed septic peritonitis from what source?
Complication rate?
What % had G-tube-related complications?

A

Hansen, JVECC, 2019:
75% survival rate
75% had a gastrointestinal source of septic peritonitis
50% complication rate
33% had G-tube-related complications

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2
Q

Rodriguez, Vet Surg 2018
What did this study find in regards to the biomechanical properties of the feline ventral abdominal wall?

A

-The POU region achieved lower loads to failure.
- Load to failure was greater in males compared with females.
-No difference was detected between full-thickness
and fascia-only closure OR between Vicryl and PDS closure
-Failure most commonly occurred by tearing of suture through tissues.
-Tissue failure with suture line loosening occurred mainly in the 5 x 5-mmSBSI group.
- Thickness of linea alba decreased from cr to cd

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3
Q

Rossanesse, JSAP 2019
What congenital condition may be predisposed in Cavalier King Charles Spaniels? And what did this study find?

A

Congenital pleuroperitoneal diaphragmatic hernia (rare) caused by a defect in the dorsolateral diaphragm (L crus).
The hernia configuration was consistent in all cases
Defects of the L crus of the diaphragm –> herniation of the stomach into thorax w/ possible tension gastrothorax

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4
Q

Matiasovic, JSAP 2018
What was found with thoracic/abdominal wall impalement in 54 dogs?

A

Impalement w/ wooden objects (n=34),
Thoracic cavity was most commonly penetrated (n=37).
CT: sensitive and specific to ID wooden material in 64% and 88% of 11 cases.
Thoracotomy was performed in 56%, celiotomy in 20% and FB or its fragments were retrieved during Sx in 37% of cases.
Complications occurred in 19 dogs (35%): 68% were minor and 32% major.
Survival rate for thoracotomy cases was 93% (n=30).
Overall long-term survival was 90%.

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5
Q

Morgan, Vet Surg 2020
What was found in this retrospective study of 128 dogs with PPDH diagnosed?

A

91 dogs tx w/ sx and 37 dogs conservatively
Dogs treated surgically were younger, more likely to be sexually intact, more likely to have C/S from PPDH & more likely to have other congenital abnormalities compared with dogs treated conservatively.
97% of ST dogs were discharged from hospitals.
Intraoperative and postop complications
were reported in 22% and 41% of dogs; Most complications were low grade (75% and 83%)
Followup was available in 87 dogs, at a median of 1062 days.
Hernia recurrence was not reported.
The deaths of 9 dogs (five ST, four CT) could be attributed to PPDH
Long median survival times were observed
in both the ST and CT groups (8.2 and 5 years).

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6
Q

Spillebeen, Vet Surg 2017
What was found in regards to treatment of septic peritonitis?

A

Negative pressure abdominal drainage vs. passive
Overall survival was 81%.
Tx costs, Ax and operating time, drainage time, survival, and postop complications were similar between techniques.
Loss of total plasma protein and decreased inflammation-related factors in abdominal fluid at time of closure were noted in all patients.
Neutrophilic inflammation was greater in abdominal wall samples after NPAD.
POAD patients showed discomfort during bandage changes and had frequent leakage of abdominal fluid outside of the bandage.
NPAD resulted in less abdominal fluid leakage, and evidence of superior healing on histological evaluation of abdominal tissues.

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7
Q

Hatch, JAVMA 2018
What was the incidence of chyloabdomen in cats and dogs? Differences?

A

Incidence was 2.0 cases/100,000 admissions for cats and 2.8 cases/100,000 admissions for dogs.
Mean age at dx of chyloabdomen in cats was 11.3 years, compared with 6.9 years in dogs.
The most common c/s in dogs and cats combined were lethargy (39/51 [76%]) and anorexia (37/51 [73%]), but fewer (23/53 [43%]) had abdominal distention.
Chylothorax was a common comorbidity (25/53 [47%]), with malignant neoplasia being the most common underlying diagnosis (24/53 [45%]).
MST from diagnosis of chyloabdomen was 31 days overall (25 d for cats; 73 d for dogs), 8 days for patients with malignant neoplasia (carcinoma), and 73 days for patients without neoplasia.

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8
Q

Marshall, JVECC 2019
What was found in this septic peritonitis study?

A

The likelihood of an aerobic organism to have multidrug resistance post-lavage was a third of that pre-lavage
-39 of 40 dogs (97.5%) received appropriate empiric antimicrobial therapy based on pre- and post-lavage culture results, of which 5 (12.8%) did not survive to discharge.
Most frequent isolates detected included Escherichia coli, Clostridium perfringens, and Enterococcus faecalis.
The same organism based on species was isolated in pre- and post-lavage cultures in 32 dogs, accounting for
59 anaerobic and aerobic isolates. There was a new bacterial isolate detected in 20 dogs, accounting
for 46 isolates and an overall total decrease of 14 isolates between pre- and post-lavage culture
-Overall survival rates (87.5%) were higher than previously reported in the literature for septic peritonitis (20-85%)

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9
Q

Scotti, JVECC 2019
-What was found in cats with septic peritonitis (SP)?

A

58 survived to discharge (69.9%)
The most common etiology was secondary SP due to GI perforation (49.4%), followed by primary SP (22.3%).
Mean blood glucose concentration was significantly different between survivors and nonsurvivors
Cats that received appropriate empirical antibiotic
therapy were 4.4 times more likely to survive than cats that did not receive appropriate antibiotics

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10
Q

Davis
Preop septic peritonitis and anastomotic technique on dehiscence of enterotomy
VetSurg 2018

A

Dehiscence rate 11%
~w/o septic peritonitis 7%
~w/ septic peritonitis 21%

In septic peritonitis dehiscence
~stapled 8%
~Hand-sewn 29%

Risk factors for dehiscence
~septic peritonitis
~Hand‐sewn

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11
Q

Rodriguez
Feline Ventral abdominal wall
VetSurg 2018

A

Post umbilical region is biomechanically weak

Load to failure
Males > Female

Failure:
tearing of suture through tissues

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12
Q

Cudney
Diagnostic utility of AUS for hemoabdomen- nontraumatic
JAVMA 2021

A

Difference in AUS & Sx/Necropsy 54%

Sensitivity of AUS
~Spleen 87%
~Liver 37%
~Mesentery 31%

0 of 6 dogs with peritoneal diffuse nodular metastasis had lesions detected by AUS.

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13
Q

Hatch
Incidence of chyloabdomen
JAVMA 2018

A

MST 31d
~w/ neoplasia 8d
~w/o neoplasia 73d

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14
Q

Fink
Risk factors for recurrent 2ndary septic peritonitis
JVECC 2020

A
10% developed recurrent 2ndary septic peritonitis
~lower alb prior to 1st surgery
~higher PCV
~GI origin
additional risk in GI origin
~w/ GI FB

Relaporatomy survival 43%

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15
Q

Scotti
Prognostic in Cats with septic peritonitis
JVECC 2019

A

Survival to discharge 70%

Causes
~GI perforation 50%
~Primary septic peritonitis 22%

Appropriate abs 4.4 x more likely to survive

Higher BG = poorer prognosis
(126 vs 164)

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16
Q

Gardner JVECC 2022

At what pressure is decompression recommended?

A

20 mm Hg

17
Q

Fleming, Vet Surg 2018
What’s the significance of spontaneous hemorrhage discussed in this paper?

A

Splenic hemorrhage was diagnosed in 43.2% of small dogs and 61.3% of large dogs.
Small dogs had lower prevalence of splenic hemorrhage and higher prevalence of hemorrhage from liver or from another location such as retroperitoneal mass, kidney, or adrenal vs large dogs.
Hemangiosarcoma was associated with splenic hemorrhage and occurred more frequently in large vs small dogs

18
Q

Anderson JSAP 2021

Overall survival rate in feline septic peritonitis?

What finding was associated with non survival?

Survival to what day post op was associated with improved likelihood for survival?

All patients that survived to what day PO survived to discharge?

A

Overall survival rate in feline septic peritonitis?
66%

What finding was associated with non-survival?
Intra-op hypotension

Survival to what day post op was associated with improved likelihood for survival?
1d

All patients that survived to what day PO survived to discharge?
6d

19
Q

Hatch et al JAVMA 2018 What differences were identified in dogs vs cats with chyloabdomen?

A
  1. Cats older at the time of diagnosis
  2. Cats more likely to have increased abdominal TP and cholesterol
  3. MST longer in dogs, but not statistically different
20
Q

What did Hatch et al JAVMA 2018 conclude about chyloabdomen in dogs and cats?

A

outcome depends on underlying cause (worse for neoplasia Chylothorax present in 47% of cases

21
Q

According to Davis et al VetSurg 2018 is preoperative septic peritonitis a risk factors for dehiscence following R and A?

A

yes

These patients 3.8 times more likely to dehisce

22
Q

Davis et al VetSurg 2018 Does type of enterostomy technique influence likelihood of dehisence with preoperative septic peritonitis?

A

Yes

Staples anastomosis less likely to dehisce in the presence of preoperative septic peritonitis

23
Q

Marshall et al JVECC 2019 What differences were identified between pre- and post-lavage bacterial cultures from dogs with septic peritonitis?

A

Positive culture - 92% pre, 87% post Antibacterial resistance - 57% pre, 67% post
Multi drug resistance - 33% pre, 14% post

24
Q

Fink et al JVECC 2020 What blood work values were associated with recurrence of septic peritonitis?

A

Low albumin prior to 1st surgery Increased PCV prior to 1st surgery

25
Q

Fink et al JVECC 2020 What risk factors were identified for development of recurrent septic peritonitis?

A
  1. Sepsis of GI origin, especially GIFB
  2. Hypoalbuminemia
  3. Increased PCV
26
Q

Scotti et al JVECC 2019

What factors were associated with survival for cats with septic peritonitis?

A

Blood glucose

Appropirate empirical antibiotic therapy