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Surgery of Abdomen and Thorax Cavitities > Peritonitis - Pathophysiology, Signs and Diagnosis > Flashcards

Peritonitis - Pathophysiology, Signs and Diagnosis Flashcards

1
Q

What is septic peritonitis characterised by?

A

inflammation of the peritoneum secondary to bacterial contamination.

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2
Q

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

A

75%

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3
Q

T or F:
Septic peritonitis is usually polymicrobial?

A

True

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4
Q

What is the mortality rate of septic peritonitis?

A

37-85%

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5
Q

What is the most useful diagnostic test of septic peritonitis?

A

Abdominocentesis

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6
Q

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

A

47%

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7
Q

When does enteric dehisence occur in GI surgery post operatively?

A

3-9 days

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8
Q

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

A

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.

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9
Q

What should be used to biopsy large intestine?

A

Endoscope

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10
Q

Why should full thickness biopsies of large intestines be avoided?

A

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%.

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11
Q

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

A

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

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12
Q

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

A

Urogenital Tract
Hepatobiliary system
Perforated abscess
Peritoneal dialysis

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13
Q

What % of septic peritonitis is due to urogenital system?

A

21.4%

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14
Q

What is the main urogenital cause of septic peritonitis?

A

Pyometra

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15
Q

What % of septic peritonitis is due to hepatobiliary system?

A

9.5%

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16
Q

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

A

Clostridium sp

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17
Q

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

A

Sublumbar abscess (2ry to migrating FB)
Prostatic
Pancreatic

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18
Q

What is the normal predominate bacteria in septic peritonitis?

A

E. Coli

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19
Q

Which bacteria type is early mortality related to?

A

Gram negative aerobic organisms.

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20
Q

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

A

High level of endotoxin (which are absorbed into circulation)

21
Q

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

A

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

22
Q

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

A

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

23
Q

Clinical signs of septic peritonitis:
Gastrointestinal (4)

A

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

24
Q

Other general sings? (2)

A

Deydration +/- hypovolaemia
PUPD

25
Q

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

A

Depressed
Malaise
Collapse

26
Q

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

A
  1. Hyerdynamic
  2. Fast
  3. Tachycardia
  4. Pyrexic
  5. Injected
27
Q

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

A
  1. Severe tachycardia
  2. Weak
  3. Prolonged
  4. Hypothermia
  5. Pale
28
Q

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

A

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

29
Q

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

A

Vaginal/preputial discharge
Py/haematuria

30
Q

How can septic peritonitis effect HLs?

A

Abnormal gait

31
Q

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

A

Hyper or hypothermic
Cats more commonly hypothermic

32
Q

What abdo radiographic changes are seen in septic peritonitis?

A
  • Loss of serosal detail (abdo fluid)
  • Abdo gas
33
Q

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

A

Young animal
Thin animal

34
Q

What are the causes of gas on abdo xrays?

A

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

35
Q

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

A

3 thoracic chest x rays

36
Q

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

A

3.3

37
Q

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

A

Disseminated intravascular coagulation

38
Q

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

A

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.

39
Q

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

A

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.

40
Q

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

A

82.9%

41
Q

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

A

Peritoneal lavage

42
Q

Why is chemical analysis of abdo fluid of minimal use?

A

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

43
Q

What greatly increases the success of culture of abdo fluid?

A

Inoculation of blood culture bottles.

44
Q

Gross appearance of septic peritonitis abdominocentesis? (6)

A

Clear

Serosanguineous

Turbid

Purulent

Green (bile)

Food/faeces

45
Q

Cytology of septic peritonitis abdominocentesis? (3)

A

Toxic and degenerate neutrophils

Intracellular bacteria

Vegetable material

46
Q

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

A

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

47
Q

What fluid analysis suggests uroabdomen?

A

Peritoneal fluid creatinine concentration higher than that in the serum

48
Q

What fluid analysis suggests intraperitoneal bile?

A

Peritoneal fluid bilirubin concentration higher than that in the serum

49
Q

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

A

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*

Surgery of Abdomen and Thorax Cavitities (10 decks)

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