Peritonitis - Pathophysiology, Signs and Diagnosis Flashcards
What is septic peritonitis characterised by?
inflammation of the peritoneum secondary to bacterial contamination.
What % of septic peritonitis has GIT as the source in dogs?
75%
T or F:
Septic peritonitis is usually polymicrobial?
True
What is the mortality rate of septic peritonitis?
37-85%
What is the most useful diagnostic test of septic peritonitis?
Abdominocentesis
What % of septic peritonitis has GIT as the source in cats?
47%
When does enteric dehisence occur in GI surgery post operatively?
3-9 days
What increases risk of ingesta leaking and therefore a decreased survival in patients? (3)
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.
What should be used to biopsy large intestine?
Endoscope
Why should full thickness biopsies of large intestines be avoided?
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%.
Other than 2ry to GI surgery, what are other causes of GI related septic peritonitis? (8)
Perforation secondary to gastric dilatation volvulus
Foreign bodies
Ulcers
Trauma
Intussusception
Neoplasia
Iatrogenic injury
Leakage of feeding tubes.
What are other causes/systems which can result in septic peritonitis?
Urogenital Tract
Hepatobiliary system
Perforated abscess
Peritoneal dialysis
What % of septic peritonitis is due to urogenital system?
21.4%
What is the main urogenital cause of septic peritonitis?
Pyometra
What % of septic peritonitis is due to hepatobiliary system?
9.5%
What is the main bacteria responsible for septic peritonitis 2ry to hepatobiliary system?
Clostridium sp
What are the main abscesses which can perforate causing septic peritonitis?
Sublumbar abscess (2ry to migrating FB)
Prostatic
Pancreatic
What is the normal predominate bacteria in septic peritonitis?
E. Coli
Which bacteria type is early mortality related to?
Gram negative aerobic organisms.
Why do gram negative aerobic organisms have a high mortality rate?
High level of endotoxin (which are absorbed into circulation)
What are the effects of endotoxins in the body (4)
Toxic to mammalian cells;
Decrease intraperitoneal pH;
Lyse intraperitoneal erythrocytes;
Decreased viable peritoneal leucocytes.
Clinical signs of septic peritonitis:
Affecting the abdomen? (3)
Abdominal enlargement (poss 2ry tachypnoea due to compression, pleural effusion and pain)
Abdo pain
Lack of bowel sounds (ileus)
Clinical signs of septic peritonitis:
Gastrointestinal (4)
Anorexia, V+, D+
Icterus (2ry to liver)
Other general sings? (2)
Deydration +/- hypovolaemia
PUPD
What is the demeanour of a septic peritonitis patient? (3)
Depressed
Malaise
Collapse
In the early stages of SIRS/sepsis, what is the effect on:
1.Pulse?
2.CRT?
3.HR?
4.Temp?
5.MM?
- Hyerdynamic
- Fast
- Tachycardia
- Pyrexic
- Injected
What is the effect as hypovolaemia and vasoldilation progress in sepsis:
1.HR?
2.Pulse?
3.CRT?
4.Temp?
5. MM?
- Severe tachycardia
- Weak
- Prolonged
- Hypothermia
- Pale
What is the effect of septic peritonitis on WBC? (3)
Can be high or low.
Increased band neutrophils (>5%)
Toxic changes
What effect can septic peritonitis have on the genitourinary tract? (2)
Vaginal/preputial discharge
Py/haematuria
How can septic peritonitis effect HLs?
Abnormal gait
What is the temp of septic peritonitis patients (dogs and cats)?
Hyper or hypothermic
Cats more commonly hypothermic
What abdo radiographic changes are seen in septic peritonitis?
- Loss of serosal detail (abdo fluid)
- Abdo gas
Where might loss of serosal detail be normal abdo x ray finding?
Young animal
Thin animal
What are the causes of gas on abdo xrays?
Septic peritonitis (2ry to gas producing bacteria)
FB
Post GI surgery
Penetrating abdo trauma
If concerns are that septic peritonitis are due to neoplasia, what should be performed before proceeding?
3 thoracic chest x rays
Double (bi-cavity) septic effusions (e.g. pleural and peritoneal) are associated with what fold increase in chance of death?
3.3
What is Double (bi-cavity) septic effusions (e.g. pleural and peritoneal) a sequela to?
Disseminated intravascular coagulation
Are contrast studies often needed for septic peritonitis diagnosis?
Why?
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.
What makes U/S extremely useful in the diagnosis of septic peritonitis? (3)
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.
What is the accuracy of U/S guided fluid analysis?
82.9%
What can increase the diagnostic accuracy of septic peritonitis diagnosis to 94.6%(but is rarely used due to U/S guided?
Peritoneal lavage
Why is chemical analysis of abdo fluid of minimal use?
blood-to- peritoneal fluid lactate and glucose concentrations in normal dogs 4 days after exploratory laparotomy mirror those of patients with septic peritonitis.
What greatly increases the success of culture of abdo fluid?
Inoculation of blood culture bottles.
Gross appearance of septic peritonitis abdominocentesis? (6)
Clear
Serosanguineous
Turbid
Purulent
Green (bile)
Food/faeces
Cytology of septic peritonitis abdominocentesis? (3)
Toxic and degenerate neutrophils
Intracellular bacteria
Vegetable material
Septic peritonitis fluid analysis:
1. Total protein?
2. Nucleated cell
3. pH?
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
What fluid analysis suggests uroabdomen?
Peritoneal fluid creatinine concentration higher than that in the serum
What fluid analysis suggests intraperitoneal bile?
Peritoneal fluid bilirubin concentration higher than that in the serum
How can glucose and lactate be used to diagnose septic peritonitis using abdo fluid? (3)
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*
