Surgical Complications/Peritonitis Flashcards
What organs are retroperitoneal?
kidneys
ureters (for most of their length)
adrenal glands
aorta
caudal vena cava
lumbar lymph nodes
How do small particles (<10um) move from the peritoneal fluid into the systemic circulation? Which small particles?
diaphragmatic lymph→ mediastinal l.n.→thoracic duct→systemic circulation
RBC, bacteria, & neoplastic cells
What are the two types of peritonitis?
- aseptic:
- endogenous chemical contamination of the peritoneum (sterile bile, urine, lymph, or pancreatic enzymes)
- Exogenous chemical contamination (talc or irritating lavage solutions and mechanical irritation from manipulation of organs during sx)
- Septic: associated with infection
What are the two types of septic peritonitis?
- Primary: spontaneous inflammation of peritoneum
- Secondary: associated with intra-abdominal leakage of bacteria into the peritoneum or disruption of the body wall resulting in the introduction of external bacteria. Rupture,
perforation, or leakage of bacteria from the gastrointestinal tract is the most common cause in small animals.
Which part of the immune system does the peritoneum depend on mainly for absorbing and localizing infections?
innate
What blocks fluid reabsorption in peritoneal inflammation?
fibrin (occludes peritoneal drainage)
Components of normal peritoneal fluid?
relatively acellular
(some macrophages, mesothelial cells, lymphocytes)
Can peritoneal fluid clot? Why?
no, does not contain fibrinogen
What is the pathogenesis of septic peritonitis?
Why is there an influx of protein rich fluid?
How does peritoneal contamination injury result in death?
multiple organ dysfxn
- kidney
- pancreas
- liver
What are the beneficial actions of the omentum?
- isolate and seal the source of contamination by formation of an omental adhesion in response to fibrinous exudate
- absorb bacteria and other particulate matter
- rich blood supply to the lesion, high absorptive capacity, and pronounced angiogenic activity to further assist resolution.
What are the SIRS criteria for dogs?
What are the SIRS criteria for cats?
Clinical signs of septic peritonitis?
Differentiate the expected abdominocentesis results for a septic vs. aseptic abdomen vs. ascites vs. uroperitoneum vs. chyloperitoneum?
When performing an abdominocentesis, what is the best location to insert the needle?
caudal to the umbilicus ~1cm in
What would be the different indications if intracellular vs. extracellular bacteria were present in the peritoneal fluid?
intracellular: septic peritonitis
extracellular: perforated bowel w/ collection needle
What would be diagnostic for uroabdomen in the peritoneal fluid?
peritoneal fluid creatinine in excess of serum creatinine
peritoneal fluid potassium in excess of serum potassium.
What would be dx for bile in peritoneal fluid?
peritoneal fluid bilirubin >2x serum bilirubin
golden-green granular pigment
or a basophilic mutinous material is the predominant
cytologic finding
What is the recommended abx tx for septic peritonitis?
third generation cephalosporin & metronidazole (anaerobes)
What is the general flow for peritonitis DX & TX?
Why does peritonitis pre-dispose anastomoses to dehis?
peritonitis causes strong proteolytic activity that degrades collagen and extracellular matrix and may predispose intestinal anastomoses and enterotomies to dehiscence.
What are the different SX techniques than can be used with a septic peritonitis?
debridement
lavage
serosal patching
omental wrapping
drainage: open vs. closed
What type of drain is used for a closed drainage?
Jackson-Pratt drain
