Peritonitis - Karnik

Created by tdschraeder 

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What is the definition of an "acute abdomen?"

sudden onset of abd. discomfort or pain

Explain the pathophysiology of the pain response associated w/acute abd. & peritonitis

Stimulation of type A (fast, sharp nociceptive response) & C nerve fibers (dull/slow pain) (capsules of abd. viscera, parietal peritoneum, mesentery)
Stretch, tension, shear, & chemical irritants such as inflammatory mediators activate type A & C fibers, causing a painful response (visceral vs. somatic)

Describe the pathophysiology of septic peritonitis

peritoneal defenses
Inflammatory response - systemic manifestations
omentum
ileus
reflex rigidity

What are the ddx's for acute abd.?

varied, affecting GIT, hepatobiliary, pancreatic, splenic, urogenital, peritoneal & other misc. systems.

What is the most common system affected in septic peritonitis?

GIT

What is involved w/medical mgmt & stabilization of a pt. w/an acute abd.?

fluid replacement: 90ml/kg, crystalloids & colloids
correct: electrolyte status
hypoglycemia
Abx - broad spec.

What are the adv./disadv. of medical mgmt alone versus sx mgmt for septic peritonitis.

Adv. of sx: decreased abdominal adhesion formation
ease of peritoneal inspection
Disadv. of sx: hypproteinemia
intensive monitoring

What are the diagnostic tests th/can be performed for septic peritonitis?

cytology of peritoneal fl.
abd. fl. lactate conc.
glucose measurement (peritoneal vs. peripheral blood)

Which diagnostic test for septic peritonitis will lead to a more definitive dx?

peritoneal fl. glucose
a difference of glucose >20mg/Dl in peritoneal vs. peripheral blood is 100% sensitive & specific in dogs but 92% in cats

Explain how an abd. exploratory can be both diagnostic & therapeutic.

the following can be performed during exploratory celiotomy: find & stop source of contam.
debridement
serosal patching
omentalization

What types of closure can be performed on pts w/septic peritonitis?

can be done w/or w/o drainage
primary closure w/o drainage acceptable

What is open peritoneal drainage?

performed by placing loose simple continuous monofilament suture closure of the linea alba, leaving a 1-6 cm gap betw. the wound edges.
The falciform is excised & the omentum should be tacked in place to prevent it f/migrating to the open abd. incision.
Closure of the caudal 3rd of the linea alba & overlying SQ tissues & skin is recommended

When is open peritoneal drainage indicated?

In cases of generalized septic peritonitis in wh/intraop. lavage alone may not be sufficient to thoroughly cleanse the peritoneal surfaces or when cont'd septic inflamm. processes of the peritoneum are anticipated.

What are some complications of open peritoneal drainage?

evisceration of abd. contents
adherence of abd. viscera to the bandage
inadequate drainage of peritoneal fl.
formation of intestinal fistulae
hypoptroteinemia

Describe PO mgmt of septic peritonitis.

nutritional support
appropriate antibiotic therapy (C & S)
plasma transfusion
blood transfusion/nasal oxygen
pain mgmt
aggressive fluid therapy
correct electrolyte imbalances

What is one of the most important components of PO mgmt of septic peritonitis?

copious lavage

What is the overall prognosis for pts. w/septic peritonitis?

poor

What is the potential mortality rate of pts. w/septic peritonitis?

33-48%

What are the factors associated w/a poor prognosis following septic peritonitis? (aka: risk factors regarding mortality)

refractory hypotension - intra-op
pre-op septic peritonitis
low pre-op serum albumin

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