Peritonitis - Pathophysiology, Signs and Diagnosis

Question 1

What is septic peritonitis characterised by?

Answer 1

inflammation of the peritoneum secondary to bacterial contamination.

Question 2

What % of septic peritonitis has GIT as the source in dogs?

Answer 2

75%

Question 3

T or F:
Septic peritonitis is usually polymicrobial?

Answer 3

True

Question 4

What is the mortality rate of septic peritonitis?

Answer 4

37-85%

Question 5

What is the most useful diagnostic test of septic peritonitis?

Answer 5

Abdominocentesis

Question 6

What % of septic peritonitis has GIT as the source in cats?

Answer 6

47%

Question 7

When does enteric dehisence occur in GI surgery post operatively?

Answer 7

3-9 days

Question 8

What increases risk of ingesta leaking and therefore a decreased survival in patients? (3)

Answer 8

Undergoing a greater number of enteric procedures;
Following trauma;
In the presence of preoperative septic peritonitis, low preoperative serum albumin and plasma protein concentrations, and intra-operative hypotension.

Question 9

What should be used to biopsy large intestine?

Answer 9

Endoscope

Question 10

Why should full thickness biopsies of large intestines be avoided?

Answer 10

The increased bacterial load and higher proportion of anaerobic bacteria present in the distal gastrointestinal tract are responsible for increased mortality associated with large intestinal perforation, which can approach 100%.

Question 11

Other than 2ry to GI surgery, what are other causes of GI related septic peritonitis? (8)

Answer 11

Perforation secondary to gastric dilatation volvulus
Foreign bodies
Ulcers
Trauma
Intussusception
Neoplasia
Iatrogenic injury
Leakage of feeding tubes.

Question 12

What are other causes/systems which can result in septic peritonitis?

Answer 12

Urogenital Tract
Hepatobiliary system
Perforated abscess
Peritoneal dialysis

Question 13

What % of septic peritonitis is due to urogenital system?

Answer 13

21.4%

Question 14

What is the main urogenital cause of septic peritonitis?

Answer 14

Pyometra

Question 15

What % of septic peritonitis is due to hepatobiliary system?

Answer 15

9.5%

Question 16

What is the main bacteria responsible for septic peritonitis 2ry to hepatobiliary system?

Answer 16

Clostridium sp

Question 17

What are the main abscesses which can perforate causing septic peritonitis?

Answer 17

Sublumbar abscess (2ry to migrating FB)
Prostatic
Pancreatic

Question 18

What is the normal predominate bacteria in septic peritonitis?

Answer 18

E. Coli

Question 19

Which bacteria type is early mortality related to?

Answer 19

Gram negative aerobic organisms.

Question 20

Why do gram negative aerobic organisms have a high mortality rate?

Answer 20

High level of endotoxin (which are absorbed into circulation)

Question 21

What are the effects of endotoxins in the body (4)

Answer 21

Toxic to mammalian cells;
Decrease intraperitoneal pH;
Lyse intraperitoneal erythrocytes;
Decreased viable peritoneal leucocytes.

Question 22

Clinical signs of septic peritonitis:
Affecting the abdomen? (3)

Answer 22

Abdominal enlargement (poss 2ry tachypnoea due to compression, pleural effusion and pain)
Abdo pain
Lack of bowel sounds (ileus)

Question 23

Clinical signs of septic peritonitis:
Gastrointestinal (4)

Answer 23

Anorexia, V+, D+
Icterus (2ry to liver)

Question 24

Other general sings? (2)

Answer 24

Deydration +/- hypovolaemia
PUPD

Question 25

What is the demeanour of a septic peritonitis patient? (3)

Answer 25

Depressed Malaise Collapse

Question 26

In the early stages of SIRS/sepsis, what is the effect on: 1.Pulse? 2.CRT? 3.HR? 4.Temp? 5.MM?

Answer 26

1. Hyerdynamic 2. Fast 3. Tachycardia 4. Pyrexic 5. Injected

Question 27

What is the effect as hypovolaemia and vasoldilation progress in sepsis: 1.HR? 2.Pulse? 3.CRT? 4.Temp? 5. MM?

Answer 27

1. Severe tachycardia 2. Weak 3. Prolonged 4. Hypothermia 5. Pale

Question 28

What is the effect of septic peritonitis on WBC? (3)

Answer 28

Can be high or low. Increased band neutrophils (>5%) Toxic changes

Question 29

What effect can septic peritonitis have on the genitourinary tract? (2)

Answer 29

Vaginal/preputial discharge Py/haematuria

Question 30

How can septic peritonitis effect HLs?

Answer 30

Abnormal gait

Question 31

What is the temp of septic peritonitis patients (dogs and cats)?

Answer 31

Hyper or hypothermic Cats more commonly hypothermic

Question 32

What abdo radiographic changes are seen in septic peritonitis?

Answer 32

- Loss of serosal detail (abdo fluid) - Abdo gas

Question 33

Where might loss of serosal detail be normal abdo x ray finding?

Answer 33

Young animal Thin animal

Question 34

What are the causes of gas on abdo xrays?

Answer 34

Septic peritonitis (2ry to gas producing bacteria) FB Post GI surgery Penetrating abdo trauma

Question 35

If concerns are that septic peritonitis are due to neoplasia, what should be performed before proceeding?

Answer 35

3 thoracic chest x rays

Question 36

Double (bi-cavity) septic effusions (e.g. pleural and peritoneal) are associated with what fold increase in chance of death?

Answer 36

3.3

Question 37

What is Double (bi-cavity) septic effusions (e.g. pleural and peritoneal) a sequela to?

Answer 37

Disseminated intravascular coagulation

Question 38

Are contrast studies often needed for septic peritonitis diagnosis? Why?

Answer 38

No Barium should always be avoided because leakage into the peritoneum is associated with increased mortality. Alternative imaging modalities such as ultrasonography or CT (where available) can also be used.

Question 39

What makes U/S extremely useful in the diagnosis of septic peritonitis? (3)

Answer 39

detection of small volumes of free abdominal fluid which can be aspirated. The underlying cause of the peritoneal effusions can also be determined, as can the presence/absence of pancreatitis.

Question 40

What is the accuracy of U/S guided fluid analysis?

Answer 40

82.9%

Question 41

What can increase the diagnostic accuracy of septic peritonitis diagnosis to 94.6%(but is rarely used due to U/S guided?

Answer 41

Peritoneal lavage

Question 42

Why is chemical analysis of abdo fluid of minimal use?

Answer 42

blood-to- peritoneal fluid lactate and glucose concentrations in normal dogs 4 days after exploratory laparotomy mirror those of patients with septic peritonitis.

Question 43

What greatly increases the success of culture of abdo fluid?

Answer 43

Inoculation of blood culture bottles.

Question 44

Gross appearance of septic peritonitis abdominocentesis? (6)

Answer 44

Clear Serosanguineous Turbid Purulent Green (bile) Food/faeces

Question 45

Cytology of septic peritonitis abdominocentesis? (3)

Answer 45

Toxic and degenerate neutrophils Intracellular bacteria Vegetable material

Question 46

Septic peritonitis fluid analysis: 1. Total protein? 2. Nucleated cell 3. pH?

Answer 46

Total protein > 3 g/μl Nucleated cell count > 5000/ μl (can't differentiate between a normal postoperative response and septic peritonitis) Peritoneal fluid pH < 7.35

Question 47

What fluid analysis suggests uroabdomen?

Answer 47

Peritoneal fluid creatinine concentration higher than that in the serum

Question 48

What fluid analysis suggests intraperitoneal bile?

Answer 48

Peritoneal fluid bilirubin concentration higher than that in the serum

Question 49

How can glucose and lactate be used to diagnose septic peritonitis using abdo fluid? (3)

Answer 49

Blood-to-peritoneal fluid glucose difference > 1.12 mmol/l* Peritoneal fluid glucose concentration < 2.75 mmol/l* Peritoneal fluid lactate concentration >2 mmol/l higher than in the blood*