Peritonitis Flashcards
What is the difference between primary and secondary peritonitis?
Primary- inciting cause not found (ex: FIP)
Secondary - trauma, translocation of bacteria, dehiscence, abdominal rupture
What is the most common type of peritonitis seen in vet med?
Secondary generalized septic peritonitis
What body system are the majority of cases of peritonitis related to?
GI tract (36-73% of cases)
Describe the pathogenesis of peritonitis
Injury leads to inflammation which leads to fluid leakage out of vasculature. Immune reaction (mast cell degranulation, cytokine release) causes more leakage and inflammation which then leads to hypovolemia/ ambuminemia and fibrin. If severe can lead to shock, SIRS, DIC
What is the common signalment for peritonitis?
There’s not one
-if young animal, foreign body more likely
What are some of the common things noted on history in peritonitis cases?
Recent abdominal surgery or foreign body, chronic steroid or NSAID use (can cause ulcers), trauma, intact (pyometra)
What are the main clinical signs associated with peritonitis?
Vague- abdominal pain/fluid distention or wave, fever, anorexia, vomiting, diarrhea, lethargy
If in hypovolemic shock, what might you see on physical?
Tachycardia, pale MM, delayed CRT, hypotension, severe dehydration, arrythmias, SIRS
What diagnostics should you always perform in peritonitis cases?
CBC/chem
-PT/PTT (if times prolonged, think DIC and consider albumin transfusion)
-abdominocentesis (cytology/culture, lactate)
What changes do you often see on CBC/chem in peritonitis cases?
Marked neutrophilia with toxic changes, anemia/hypoproteinemia, hypo/hyperglycemia, electrolyte abnormalities (low sodium and chloride if vomiting, low potassium if anorexic), azotemia, liver enzyme elevations
What are some signs of peritonitis on Abdominal rads?
loss of serosal detail, ground glass, gas behind diaphragm
What does the prognosis in peritonitis cases depend on?
Inciting cause
What are some negative prognostic indicators in peritonitis cases?
Refractory hypotension, cardiovascular collapse, respiratory distress, DIC, lactate >2.5, ionized hypocalcemia, MODS
What are the main surgical steps in a peritonitis case?
Exploratory laparotomy
- stabilize, administer appropriate antibiotics, control/fix problem, drain the abdominal cavity, consider placing drain or leaving open, consider feeding tubes
What drugs are most important pre-op in these cases?
Analgesics- opioids
-shock bolus fluids (1/4 at a time with blood pressure rechecks in between)
What is a good first line antibiotic choice in these patients?
Cefoxitin, ampicillin sulbactam (unasyn)
- can culture, but often does not affect treatment
Describe the prep for these cases prior to surgery?
Clip HUGE margin, sternum to pubis and very wide
-be sure you have crazy amounts of warm sterile saline available and suction
What should you be sure to look at during explore?
Gross observation, run GI tract, kidneys/bladder, pancreas/gall bladder, follow omentum
Describe some general principles for GI surgery
Pack off area you are focusing on, remove foreign bodies, close, and always lavage
What is the bandaid of the abdomen?
The omentum!
When performing enterotomy, how should you close?
Single layer, full thickness, can do simple interrupted or continuous pattern
What is important to remember when doing Resection and anastomosis?
Preserve blood supply as much as possible by cutting closer to main branches, need to close mesentery to prevent bowel entrapment
What are the options for closure after abdominal surgery?
Primary closure with (2-3 at least) or without drain, or open closure
-if abdomen flushes out well and not too much inflammation, can do without drain
What are the indications for leaving cavity open?
Excessive fibrin, debris, necrosis, inflammation
