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Surgery > Septic Abdomen Diagnosis Treatment and Prognosis > Flashcards

Septic Abdomen Diagnosis Treatment and Prognosis Flashcards

1
Q

6 perfusion parameters

A
  1. Mucus membranes
  2. Mentation
  3. CRT
  4. Extremity temperature
  5. Pulse
    • listen and feel
  6. Blood pressure
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2
Q

Closed drains and effusive wounds

A
  • If very effusive, drains may cause hypoproteinemia
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3
Q

Monitoring post-op septic patient with drains

A
  • blood pressure
  • drain protection
  • serial cytology
  • electrolytes
  • hematocrit
  • total protein
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4
Q

Causes of perforation

A
  • Foreign body
  • Tumor
    • gastrinoma
    • adenocarcinoma
    • lymphoma
    • leiomyoma
  • Intussusception
  • Volvulus/Torsion
  • Abscess
  • Granulomas
  • Trauma
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5
Q

Clinical presentation sepsis

A
  • Vomiting
  • Anorexia
  • Depression
  • Abdominal pain
  • Coma

*non-specific

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6
Q

Pathophysiology of of peritonitis

A
  • In abdomen
    • Accumulation of gas
    • Accumulation of liquid
    • bacterial proliferation
    • circulation to the mucosa and submucosa deteriorates
    • bacterial migration into peritoneal cavity and into blood stream
    • loss of albumin
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7
Q

Consequences of peritonitis prior to surgery

A
  • Collagen synthesis is affected
    • necessary for wound strength
    • helps cover small defects
  • Studies in rats have shown a resulting decrease in collagen and wound strength
  • Elevation in TNF-alpha
    • results decreased collagen synthesis and TGF-beta
  • Collagen destruction by collagenases
    • in human matrix metalproteinase-8
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8
Q

Exam

A
  • Abdominal pain
  • Dehydration
  • Potentially palpate object if foreign body is present
  • Look underneath tongue if linear foreign body suspected
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9
Q

Diagnosis of obstruction

A
  • History
  • Rads
    • barium (not if perf suspected)
    • Plication SI
    • Intraluminal gas bubbles
    • failure of movement 8 huors
    • intestinal diameter > 2 times L5 vertebral body
    • definitive detection in 52% patients
  • Ultrasound
    • Definitive detection 96% patients
    • Jejunal serosa-to-serosa diameter greater than 1.5 cm
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10
Q

Diagnosis of Perforation

A
  • Pneumoperitoneum
  • Abdominal effusion
  • Lactate
  • Glucose
  • Cytology
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11
Q

Diagnosis of Peritonitis

Glucose

A
  • Difference of blood-to-fluid of > 20mg/dL
    • 100% specific (100% specific in cats)
    • 100% sensitive (86% sensitive in cats)
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12
Q

Diagnosis of Peritonitis

Lactate

A
  • Difference of blood-to-fluid of < -2.0 mmol/L
    • 100% specific
    • 100% sensitive
    • Not reliable in cats
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13
Q

Diagnosis of Peritonitis

Cytology

A
  • More than 13,000 nucleated cells
    • dogs 85% sensitive, 100% specific
    • cats 100% sensitive, 100% specific
  • Toxic neutrophils
  • Intracellular bacteria
  • about 57-87% precise
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14
Q

Diagnosis of Peritonitis

Culture

A
  • Would be ideal
  • takes 3-5 days
  • always do culture for treatment
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15
Q

Preoperative management of peritonitis

A
  • Ideally correct metabolic abnormalities
  • Stabilize patient
    • crystalloids, colloids, blood products
    • medications to stabilize blood pressure
      • after stabilizing blood pres w/ dopamine/dobutamine
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16
Q

Surgical Treatment

A
  • Gastrotomy
  • Enterotomy
  • Resection and anastomosis
  • Bilroth I
    • pylorectomy with gastroduodenostomy
  • Bilroth II
    • pylorectomy with gastrojejunostomy
17
Q

Confirming viability of intestines

A
  • Mural texture
  • Intestinal color
    • blue/black is bad
  • Peristalsis
  • Arterial pulsation
  • Bleeding at incision
18
Q

Surgical Technique

A
  • Systemic inspection of digestive tract
  • decide what is best for patient
  • Don’t pull on linear foreign body
    • unless it moves easily
    • can cause a mesenteric tear
  • Aerobic and anaerobic culture
  • Lavage, lavage, lavage
19
Q

Mesenteric rent

A
  • make sure to close all rents
    • can strangulate intestines if trapped
20
Q

Common pathogens in peritonitis

A
  • E. Coli
  • Enterococcus
  • Staphylococcus auareus coagulase-positive
21
Q

Postoperative care

A
  • Hydration state
  • Electrolyte abnormalities
  • Albumin
  • Antiemetics
  • Antacids
  • Lactic acid
  • Antibiotics
  • Nutrition
22
Q

Causes for failure of repair

A
  • Albumin less than 2.5 g/dL
  • Peritonitis prior to surgery
23
Q

Retrospective study numbers dogs and cats

A
  • 91% with simple obstruction survived
  • 80% with a linear foreign body survived
  • 63% of obstruction occurred in jejunum
  • Presence of linear foreign body and a longer duration of symptoms associated with a higher probability of death
  • No difference between partial and complete obstruction
24
Q

Conclusion

A
  • Many causes for sepsis and perforation
  • Albumin and systolic pressure is important
  • Type of surgical management does not matter (open v closed)
  • Aggressive supportive care VERY important

Surgery (11 decks)

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