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Surgery of Abdomen and Thorax Cavitities > Peritonitis - Treatment > Flashcards

Peritonitis - Treatment Flashcards

1
Q

What types of shock are the septic peritonitis patients facing?

A

Hypovolaemic
Distributive

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2
Q

What is the main risk in septic patients?

A

Anaesthetic!
Stabilise patient as much as possible

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3
Q

What should be provided to patients with increased RR?

A

Oxygen!

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4
Q

What may be the cause for increased RR/effort?

A

Ascites
Pulmonary Dx
Pleural effusion

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5
Q

How should the patient be prepared for surgery if severe ascites?

A

Tilted table to prevent resp compression

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6
Q

What type of antibiotic is indicated?

A

Bactericidal - effective against +ve and -ve

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7
Q

What are good empirical antibiotic choices?

A

2nd gen cephalosporin
metronidazole (10mg/kg IV q12hr)
Clavulanic amoxicillin (20mg/kg IV q6hr)

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8
Q

How many patients currently receive appropriate empirical ABx?

A

52.6%

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9
Q

When has it been found poor ABx choices have been made for sx? (2)

A

Previous ABx administered
Recent abdo surgery performed

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10
Q

Which ABx should be avoided - why?

A

FLUOROQUINOLONES
Increase resistance and less than 52% of isolated in peritonitis are sens

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11
Q

What period of time should ABx be used for?

A

5-7 days

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12
Q

When should ABx be used for a prolonged course of 2-3 weeks? (2)

A

S. Auereus present
Pancreatic necrosis

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13
Q

What are the pre-op goals? (7)

A
  • Client education/informed consent
  • understanding viscera involved
  • Smooth rapid induction of anaesthesia
  • Understanding co-morbidities
  • Aseptic prep
  • Understand anatomy
  • Stabilise cardiovasc/resp
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14
Q

What are the surgical goals? (5)

A
  • Reduce bacteria load, foreign material and inflamm mediators
  • elimination of contam/infection
  • prevent leak
  • halstead principles
  • provision of post op nutrition support (feeding tube if needed)
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15
Q

What are post operative goals? (2)

A
  • Thorough post op evaluation
  • monitor for complications
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16
Q

What incision will be made?

A

Xiphoid to pubis

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17
Q

What campaign have WHO released to reduce surgeon error?

A

“Safe surgery saves lives”

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18
Q

How do you extend incision in male dog?

A

Continue incision paramedian to one side of prepuce
Preputial muscle and vessels identified and reflect laterally to expose linea alba.

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19
Q

What must be placed on wound edges of incision?

A

Moist lab swabs

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20
Q

What happens to falciform fat on entry?

A

Removed to improve visualisation (dithermy or suturing of cranial vasc)

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21
Q

What can be dissected to visualise oesophagus as it enters cardia?

A

Triagnular lig

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22
Q

General approach to ex lap

A

Liver
Oesophagus
Diaphragm
Pylorus
Duodenum
Pancreas
Portal vein
hepatic artery
Gall Bladder
R adrenal gland and kidney
Greater omenturm
Spleen
L kidney and adrenal gland
Small intestine
Mesenteric LN
Colon
Rectum (gentle traction on descend colon)
Sublumb LN
Bladder - + ureter
Vas deferens in male
Prostate
Internal surface of abdo wall
LAVAGE, SWAB COUNT, SUCTION

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23
Q

How do you visualise R adrenal gland?

A

Cut Nephroheptaic ligaement

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24
Q

How to identify ileum?

A

Antimesenteric vessel

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25
Q

What are basic essential requrements for septic peritonitis surgery? (4)

A

Retractors
Suction
Diathermy
Body temp saline/hartmanns

26
Q

Should we lap surgery septic peritonitis?

A

No

27
Q

What should we do with any excised tissue?

A

Histo
C+S

28
Q

Canine jejunum leak test (10cm site):
1. Volume in digital occlusion
2. Volume in Doyen occlusion
3. acheive what pressure?

A
  1. 16.3-19ml
  2. 12.1-14.8ml
  3. 34cm (that of peristalsis)
29
Q

What needle gauge for leak test?

A

23g or 35g

30
Q

What if a leak if found?

A

Simple interrupted with monofil absorb material

31
Q

General leak test vol:
Digitial?
Doyen?

A

20ml
15ml

32
Q

Why is serosal patching prudent?

A

pro-op sepsis –> increase wound dehis

33
Q

Following full thickness organ surgery, what should be done to aid blood supply?

A

Omentalisation

34
Q

How much fluid to lavage post?

A

200-300ml/kg (body temp)

35
Q

What are the acceptable abdo closure methods following septic peritonitis?

A

Primary routine closure
Abdo closure and active suction drain (Jackson Pratt)
Open abdo drain
Vacuum assisted open abdo drainage

36
Q

Where >10% blood loss in anticipated, what should be calculated? (4)

A

Total circulating blood vol
10% blood loss
20% blood loss
30% blood loss

37
Q

What should be done if there if contamin/infect of intra abdo neoplasia?

A

Kit change

38
Q

When is primary routine closure okay?

A

If peritonitis source acceptable, addressed and abdo lavaged. Low residual bacteria

39
Q

Benefit of primary routine closure? (1)

A

Straightforward Post op wound

40
Q

Disadvantages of primary routine closure? (2)

A
  • Inability to repeat lavage or evacuate abdomen
  • Inability to regularly access abdo fluid production
41
Q

What are the survival rates following primary routine abdo closure?

A

54-67%

42
Q

Where is wound failure most likely to happen? How can this be prevented?

A

At the knot - tight square knot needed!

43
Q

How should knots be placed to ensure no increase in hernia developement?

A

Tight and square
At least 5mm of external rectus fascia

44
Q

Which muscle can be reconstructed on abdo closure to void lateral penis deviation?

A

Preputialis muscle

45
Q

Which drains are unacceptable?

A

Passive -penrose.

46
Q

Which drain is used?
How is it placed?

A

Active -Jackson Pratt.
Paramedian adbo incision

47
Q

What are the advantages of placing a drain? (2)

A
  • Monitor abdo fluid production regularly
  • Minimise fluid accumulation
48
Q

Disadvantages of placing a drain? (3)

A
  • poss ascending infections
  • Omentum blocking drain
  • Hypoproteinaemia
49
Q

Drains should be removed when a patient is showing…? (3)

A
  • Clinical improvement
  • No intracellular bacteria on abdo cytology
  • Reduction in abdo fluid production
50
Q

What is the median number of days a drain is removed?

A

6 (2-11) days

51
Q

Should we biochem post op abdo fluid?

A

No - not clinically useful

52
Q

When is open abdominal drain required? (2)

A
  • cannot definitively address source
  • gross contamination/necrotic after
53
Q

Advantages of open abdominal drainage? (3)

A
  • Decreased anaerobic bacteria proliferation
  • minimal fluid accumulation
  • potential for fluid lavage before definite closure
54
Q

Disadvantages of open abdominal drainage? (3)

A

Intensive post op management
Hosp acquired infect
Hypoprotein

55
Q

Survival rates of open abdominal drainage? (referral only)

A

52-89%

56
Q

Which infection associated with GI perforation carries a grave prognosis?

A

Candidal fungal

57
Q

Mortality rate for dogs having more than 1 surgery for septic peritonitis is higher than that reported for single? T or F

A

False

58
Q

What is increase mortality associated with?

A
  • Increase: Lactate, bilirubin, ALP
  • Age
  • Decreased PCV and albulim
  • Hypotension and need for vasopressors
59
Q

Which patients are more likely to develop post op septic peritonitis? (3)

A
  • pre op septic peritonitis
  • hypoalbumin
  • hypoprotein
60
Q

What analgesia (along with opioid) improves survival?

A

Lidocaine CRI

Surgery of Abdomen and Thorax Cavitities (10 decks)

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