Peritonitis Flashcards
What is peritonitis
Inflammation of the peritoneum and/or peritoneal cavity. The peritoneum is a serous membrane with a parietal and visceral layer, < 1ml/kg peritoneal fluid and is semi permeable.
Briefly describe primary peritonitis
This is also know as spontaneous bacterial peritonitis because there is no identifiable source and the route of infection is hematogenous or bacterial translocation. This is not surgical and typically caused by gram positive bacteria
Secondary Peritonitis can be caused by __ leakage of bacteria, infection or __ and __ causes such as neoplasia or surgical FB’s
Secondary Peritonitis can be caused by intra-abdominal leakage of bacteria, infection or abscess and non infectious causes such as neoplasia or surgical FB’s
Tertiary Peritonitis
Severe persistent or recurrent infection after secondary peritonitis
Sclerosing encapsulating peritonitis can be treated by trying to remove __ and resecting and anastomosing __ but has __ treatment success
Sclerosing encapsulating peritonitis can be treated by trying to remove adhesions and resecting and anastomosing intestines but has poor treatment success
The etiology of peritonitis is typically of __ origin
The etiology of peritonitis is typically of GI origin
Briefly describe the pathophysiology of peritonitis
Irritant -> vascular dilation -> increased capillary permeability -> phagocytosis
The omentum and mesentery is there to wall off and increase blood flow and lymphatics so when this fails = systemic inflammatory response
History and clinical signs of a dog with peritonitis
Fever, anorexia, vomiting, diarrhea, lethargy, abdominal pain, abdominal dissension (fluid wave) , prayer position in dogs
What might a physical exam of a dog with peritonitis look like?
There will be evidence of perfusion impairment that presents as dehydration, dull mental ion, mucous membrane color, weak PQ and/or blood pressure. There may also be indicators of SIRS/sepsis.
When diagnosing peritonitis, what should you look for on rads or AUS and what would you see?
Expect to see pneuomperitoneum for up to 18-21 days
Bloodwork for a patient with peritonitis
marked leukocytosis (toxic neutrophils), anemia, hypoproteinemia, electrolyte imbalances, acid-base abnormalities, pre- renal azotemia
__ is the most helpful diagnostic for peritonitis
Abdominocentesis
Briefly describe normal peritoneal fluid
- <1ml/kg non-clotting, clear, yellow fluid (straw colored)
- transudate should be <3000 nucleated cells/ul, 50% macrophages, 50% lymphocytes, <2.5 g/dL protein
Transudate
<2.5g/dL protein
<1500 NC/ul
Modified transudate
2.5-7.5 g/dL protein
1000-7000 NC/uL
Exudate
> 3 g/dL protein
7000 NC/uL
Uroabdomen
Transudate or modified transudate
Abdominal creatinine > serum 2x
Abdominal potassium > serum 1.4x
Bile peritonitis
Modified transudate or exudate
Bile staining +/- phagocytized bile pigements
Abdomen bilirubin > serum 2x
Septic abdomen
Intracellular bacteria
Abdominal fluid glucose > serum (1.1mmol/L)
Treatment goals for peritonitis
DILUTION IS THE SOLUTION TO POLLUTION
-Correction of fluid and electrolyte imbalances
- stop the source of sepsis with exploratory laparotomy and copious lavage
- appropriate antimicrobial therapy
- drainage
Medical management of peritonitis
- fluid replacement
- correct electrolytes and glucose imbalances
- antibiotics
- nutritional support (increased metabolic demand, protein loss, directly benefit to enterocytes and GIT, decreases bacterial translocation)
Antibiotics for peritonitis currently include __ and __
Antibiotics for peritonitis currently include unasyn (amoxicillin) and cefoxitin
Surgical management of peritonitis is done by a __ in which your goal is to stop the source of contamination. What common procedures would you perform during this?
Surgical management of peritonitis is done by a exploratory laparotomy in which your goal is to stop the source of contamination. Common procedures include debridement, drainage of abscess, resection and anastomosis
What is the holding layer of the GI tract
Submucosa
