SAOP3- Peritonitis

  1. What are the anatomical segments of the peritoneum?
    • parietal peritoneum- mesothelial cells covering abdominal cavity
    • visceral peritoneum- mesothelial cells covering abdominal organs
  2. What are the potentials spaces within the abdomen?
    • peritoneal cavity- b/w visceral and parietal peritoneum
    • retroperitoneal space- peritoneum on only one surface
  3. What are the retroperitoneal organs? (6)
    • kidneys
    • ureters
    • adrenal glands
    • aorta
    • caudal vena cava
    • lumbar lymph nodes
  4. Normal peritoneum is a(n) _________ membrane, which has...
    bidirectional; free exchange b/w peritoneal fluid and plasma.
  5. Describe normal peritoneal fluid.
    • small amount for lubrication- no fibrinogen and no clotting
    • cell count <300/mm3- mostly macrophages, mesothelial cells, lymphocytes
  6. Describe localization of peritoneal contamination.
    • [All help wall off contamination, but lead to other issues as well]
    • omentum has rich blood and lymphatic supple
    • ileus
    • reflex rigidity- diaphragm- impedes resp motion, reduced intraperitoneal circulation, decreases lymphatic clearance 
    • profound inflammatory reaction
  7. What are some systemic results of an inflammatory reaction of the peritoneal cavity? (8)
    • fluid loss
    • hypovolemia (dumping fluid and protein into the abdomen)
    • hypoproteinemia
    • respiratory acidosis
    • decreased CO
    • hypotension
    • tissue hypoxia
    • metabolic acidosis
  8. What are the very severe end results of bacterial peritonitis, ileus, increased abdominal pressures, and impaired biles flow?
    bacteremia, bacterial translocation, endotoxemia--> PTE, DIC, SIRS, MODS
  9. What are the classifications of peritonitis? (4)
    • Primary or Secondary
    • Acute or Chronic
    • Septic or Aspetic
    • Localized or Generalized
  10. Describe primary/ spontaneous peritonitis. (4)
    • rare
    • d/t imparied immune system or ascites
    • usually a mono-bacterial infection
    • FIP is most common cause in cats
  11. What are 5 causes of aseptic (sterile) secondary peritonitis?
    • chemical (endogenous or exogenous)- bile, urine, pancreatitis, gastric fluid, antibiotics, antiseptics, barium, enema solution, enteral nutrition
    • peritoneal FB
    • starch granulomatous peritonitis
    • mechanical peritonitis
    • sclerosing encapsulating peritonitis
  12. What are some endogenous chemicals that cause aseptic peritonitis? (4)
    • bile
    • urine
    • pancreatic enzyme (pancreatitis)
    • gastric fluid
  13. Describe septic peritonitis. (3)
    • most commonly caused by the GI tract [usually dehiscence from GI sx] (colon is the worst- Bacteriodes fragilis and E. coli)
    • bacterial type and counts
    • enhanced by bile salts, gastric mucin, hemoglobin, barium
  14. What are causes of secondary septic peritonitis? (5)
    • GI perforation (most common)- perforating or penetrating FB, GDV, perforating ulcers, neoplasia, dehiscence of surgery site, ischemic necrosis
    • genitourinary tract- septic uroabdomen, ruptured pyometra, ruptured prostatic abscess
    • hepatobiliary tract- liver abscess, gallbladder rupture
    • pancreatitis
    • lymph node abscess
  15. What are clinical signs of peritonitis? (7)
    • attitude- quiet to recumbent
    • decreased appetite
    • vomiting
    • abdominal distention
    • pain
    • +/- PU/PD
    • +/- draining tracts
  16. Describe belly tap findings with peritonitis.
    • Transudate: cells 300-1500, protein <2.5
    • Modified transudate: cells 1000-7000, protein 2.5-7.5
    • Exudate: cells >5000, protein >3
    • Fluid glucose more than 20mg/dL less than blood glucose--> indicative of bacteria consuming glucose--> SEPTIC
  17. Describe some pre-operative treatments for septic peritonitis. (2)
    • fluid resuscitation- restore perfusion and hydration and account for ongoing losses, correct acid-base
    • antimicrobials- empirical broad spectrum, save abdominal fluid for C&S
  18. Describe general surgical treatment for septic peritonitis. (3)
    • identify and localize primary problem
    • wide celiotomy- flush and lavage abdomen, address primary cause an eliminate source of contamination
    • wound management- drain, wound closure?
  19. What are specific surgical treatments for hepatobiliary peritonitis?
    • gallbladder rupture- remove gall bladder, assess bile duct
    • liver abscess- liver lobectomy
  20. What are specific surgical treatments for henitourinary peritonitis?
    • ruptured bladder- debride, repair
    • kidney or ureter damage- repair vs remove
    • ruptured pyometra- OHE
    • prostatic abscess- debride and marsupialize
  21. What are specific surgical treatments for GI peritonitis?
    • stomach leakage- resect and close
    • duodenal leakage- debride and close (not easily removed...must repair)
    • jejunal or ileal leakage- R&A
    • colonic leakage- R&A
    • Augmentation- serosal or omental patch
  22. What is a major mainstay of treatment of peritonitis?
    • 200-300mL/kg of lavage fluid
  23. Describe post-op care after peritonitis. (6)
    • fluids
    • antibiotics
    • nutrition- prefer enteral feeding
    • antiemetics
    • prokinetics if ileus
  24. What factors increase the risk of adhesions after peritonitis surgery? (5)
    • endotoxemia
    • intestinal manipulation
    • bowel distention
    • desiccation
    • FB contamination
Card Set
SAOP3- Peritonitis
vetmed SAOP3