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Small Animal Surgical Diseases > Peritonitis > Flashcards

Peritonitis Flashcards

1
Q

What is the MOST common classification of peritonitis?

A

Secondary generalized septic peritonitis

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2
Q

What is the MOST common etiology for peritonitis?
a. GI tract
b. urogenital
c. hepatobiliary system
d. penetrating foreign bodies

A

a. GI tract

followed by urogenital

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3
Q

Peritonitis occurs as a result of an initial injury which leads to inflammation, vascular permeability, and fluid leakage.
What causes the mast cells degranulation and cytokine release that leads to further inflammation and and leakage and can cause severe changes such as hypovolemia, fibrin, shock, SIRS and DIC?

A

the immune reaction to the fluid that leaked.

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4
Q

What are some things in the history that may make you more suspicious that peritonitis is occurring when you are seeing appropriate clinical signs?

A

Recent abdominal surgery or FB (dehiscence)
being on steroids/NSAIDs (ulcers)
any trauma (HBC, BDLD)
or being intact (pyo)

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5
Q

The following are non-specific clinical signs you may see for WHAT surgical disease?
- abdominal pain
- fluid wave
- abdominal distension
- fever
- anorexia
- vomiting & diarrhea
- lethargy

A

peritonitis

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6
Q

A patient presents to your ER clinic as a referral from a local GP. This patient is tachycardic, has pale MM, and is severely dehydrated. You take the blood pressure and it reads 30. What is likely occuring in this patient?

A

shock! most likely hypovolemic shock.

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7
Q

What diagnostics can you run to diagnose peritonitis?

A
  • CBC/Chem with electrolytes
  • PT/PTT
  • Abdominocentesis (cytology, culture, and lactate)*
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8
Q

A patient presents to you and is having non-specific signs associated with peritonitis. You run a CBC/Chem/Electrolytes on this patient. The results show what for the following categories:
- WBCs:
- RBCs:
- Protein:
- Glucose:
- Electrolytes:
- Kidney values:
- Liver values:

A
  • WBCs: marked toxic neutrophilia
  • RBCs: anemia
  • Protein: hypoproteinemia
  • Glucose: hyper or hypoglycemia
  • Electrolytes: low Na, Cl, K
  • Kidney values: azotemia
  • Liver values: enzyme elevation
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9
Q

A patient presents to you and is having non-specific signs associated with peritonitis. You run a PT/PTT on this patient. The results show what?

A

If in DIC, then times will be prolonged. This has a poorer prognosis and should be corrected with an albumin transfusion.

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10
Q

A patient presents to you and is having non-specific signs associated with peritonitis. You perform abdominocentesis on this patient to look at a cytology of the fluid. What could you possibly see?

A
  • degenerative neutrophils
  • intracellular bacteria
  • vegetative material
  • bile
  • neoplastic cells
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11
Q

What is characteristic of peritonitis on abdominal radiographs?

A

loss of serosal detail
gas behind the diaphragm

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12
Q

T/F: the prognosis of peritonitis depends on the inciting cause

A

true

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13
Q

What are the 7 negative prognostic factors for peritonitis?

A
  1. refractory hypotension
  2. cardiovascular collapse
  3. respiratory distress
  4. disseminated intravascular coagulation
  5. plasma lactate > 2.5 mmol/L
  6. ionized hypocalcemia
  7. multiple organ dysfunction syndrome
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14
Q

In general, how do you approach treating a patient with peritonitis?

A
  1. stabilize them
  2. administer appropriate antibiotics
  3. control and fix the problem via exploratory laparotomy
  4. lavage & drain abdominal cavity
  5. consider placing a feeding tube
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15
Q

What pre-operative drugs should you not use in peritonitis cases?

A

NSAIDs to spare the GI tract and the kidneys

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16
Q

How do you treat a patient in shock to stabilize them? (they have high HR, low BP)

A

Do 1/4 shock bolus over 15 minutes
check their BP again and repeat until corrected the inciting cause.

17
Q

What are the BEST broad spectrum antibiotics to use in cases of peritonitis?

A

Cefoxitin
Ampicillin sublactam

18
Q

T/F: usually your first choice antibiotic to empirically treat peritonitis is the correct antibiotic choice.

A

true

19
Q

Describe how your prep site should look for a surgery to correct the inciting cause of peritonitis.

A

From sternum to pelvis and WIDE

20
Q

Describe the small intestine closure for SI enterotomy

A

full thickness (through serosa, submucosa, and mucosa)
single layer
good apposition – ensuring that submucosa is apposed to submucosa and no mucosa is blocking it, or else it will not heal.

21
Q

If you are correcting a SI perforation and you notice that the tissue is necrotic. You scratch the serosa and it does not bleed. What should you do?

A

resection and anastamosis.

22
Q

If you are correcting a SI perforation and you notice that the tissue is relatively healthy and the perforation is small, what should you do?

A

freshen the edges a bit and then close without tension.

23
Q

When performing an resection and anastamosis, where should you made your resection cuts and why?

A

closer to the vasculature for better healing.

24
Q

Your patient has peritonitis due to pyometra. How do you treat this?

A

remove the uterus
lavage and suction

25
Q

Your patient has peritonitis from a suspected bladder rupturebecause you collected urine from the abdomen. Upon opening the patient up, you realize that the bladder is intact. What could be the other source of the peritonitis?

A

ruptured ureter or urethral tear.

26
Q

What should you use to lavage an abdomen during a surgery to correct peritonitis?

A

3-15 liters of WARM saline. Do not add anything to this saline.
Rinse the abdomen until the fluid is clear and make sure to suction it all out.

27
Q

How do you choose between primary closure vs drainage options in cases of peritonitis?

A

if your abdomen flushed out well and the peritoneum was mildly inflammed, then you should consider primary closure.

If the abdomen had extensive fibrin tags, debris, necrosis, or severe inflammation, then you may consider placing a drain.

28
Q

You’ve just completed a surgery on a dog to correct the SI perforation that caused peritonitis. Describe the elements of this patients aftercare.

A
  • aggressive fluids
  • correct electrolyte imabalances
  • antbiotics
  • plasma or blood transfusion (if needed)
  • oxygen therapy

Small Animal Surgical Diseases (20 decks)

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