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What are the anatomical segments of the peritoneum?
- parietal peritoneum- mesothelial cells covering abdominal cavity
- visceral peritoneum- mesothelial cells covering abdominal organs
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What are the potentials spaces within the abdomen?
- peritoneal cavity- b/w visceral and parietal peritoneum
- retroperitoneal space- peritoneum on only one surface
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What are the retroperitoneal organs? (6)
- kidneys
- ureters
- adrenal glands
- aorta
- caudal vena cava
- lumbar lymph nodes
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Normal peritoneum is a(n) _________ membrane, which has...
bidirectional; free exchange b/w peritoneal fluid and plasma.
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Describe normal peritoneal fluid.
- small amount for lubrication- no fibrinogen and no clotting
- cell count <300/mm3- mostly macrophages, mesothelial cells, lymphocytes
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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
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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
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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
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What are the classifications of peritonitis? (4)
- Primary or Secondary
- Acute or Chronic
- Septic or Aspetic
- Localized or Generalized
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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
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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
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What are some endogenous chemicals that cause aseptic peritonitis? (4)
- bile
- urine
- pancreatic enzyme (pancreatitis)
- gastric fluid
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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
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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
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What are clinical signs of peritonitis? (7)
- attitude- quiet to recumbent
- decreased appetite
- vomiting
- abdominal distention
- pain
- +/- PU/PD
- +/- draining tracts
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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
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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
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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?
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What are specific surgical treatments for hepatobiliary peritonitis?
- gallbladder rupture- remove gall bladder, assess bile duct
- liver abscess- liver lobectomy
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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
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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
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What is a major mainstay of treatment of peritonitis?
- LAVAGE LAVAGE LAVAGE
- 200-300mL/kg of lavage fluid
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Describe post-op care after peritonitis. (6)
- fluids
- antibiotics
- nutrition- prefer enteral feeding
- PAIN MANAGEMENT- NOT STEROIDS OR NSAIDS
- antiemetics
- prokinetics if ileus
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What factors increase the risk of adhesions after peritonitis surgery? (5)
- endotoxemia
- intestinal manipulation
- bowel distention
- desiccation
- FB contamination
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