Peritonitis, Haemoabdomen, Uroabdomen

Question 1

what measurement of glucose in abdominal free fluid is supportive of septic fluid

Answer 1

1mmol/l less than blood

Question 2

what measurement of lactate in abdominal free fluid is supportive of septic fluid

Answer 2

2mmol/l more than blood

Question 3

Describe how to treat peritonitis

Answer 3

source control key - this depends on the source
stabilise patient
antibiotic if septic - escalate vs de-escalate

Question 4

describe the escalate approach to peritonitis

Answer 4

start with no antibiotics (or a single antibiotic e.g. amoxy clav) and wait for C+S results or patient deterioration before adding others in.

Question 5

describe the de-escalate approach to peritonitis treatment

Answer 5

Start with double or triple combination antibiotics (e.g. amoxy-clav, metronidazole and marbofloxacin) and then reduce depending on C+S results

Question 6

Describe how to diagnose haemoabdomen

Answer 6

POCUS
free fluid –> tap –> PCV on fluid
Blood PCV and compare

Question 7

if PCV of free fluid and blood same what does this mean

Answer 7

haemoabdomen
ACUTE

Question 8

if PCV of free fluid higher than blood what does this mean

Answer 8

semi acute bleed (some compensation of volume has occured)

Question 9

if PCV of free fluid lower than blood what does this mean

Answer 9

chronic bleed e.g. cancer

Question 10

describe how to treat a neoplastic bleed

Answer 10

If response to fluid bolus is poor -> transfusion
- Auto-transfusion vs whole blood vs pRBC + Plasma (do a met check before auto-transfusion)

definitive treatment- surgery +/- chemo

Question 11

Describe how to treat blunt trauma causing haemoabdomen

Answer 11

WAIT
Tranexamic Acid – anti-fibrinolytic; maintains clot stability
Repeat transfusions.

Question 12

Describe how to treat penetrating injury that causes a haemoabdomen

Answer 12

Operate – stabilise and cut, don’t wait!
Consider a staged approach – pack it and close
Tranexamic Acid – anti-fibrinolytic; maintains clot stability

Question 13

describe how to treat coagulopathy caused by rat poison that causes haemoabdomen

Answer 13

auto-transfusion
fresh frozen plasma with vitamin K

Question 14

describe the clinical signs seen with uroabdomen

Answer 14

abdo pain
reduced mentation
Inappropriately low heart rate- due to potassium- Very important

Question 15

what history makes you think uroabdomen

Answer 15

Urinary signs (stranguria/dysuria)
Previous surgery (cystotomy)
Trauma (RTA)

Question 16

describe how to treat bradycardia caused by uroabdomen

Answer 16

calcium gluonate- slow IV - to protect cardiac action potential

Question 17

describe what you see in fluid if uroabdomen

Answer 17

Creatinine >2x blood value
Potassium >1.4x blood (dogs) >1.9x blood (cats)

Question 18

at what point can hyperkalaemia be life threatening

Answer 18

> 8.0mmol/l – risk of atrial standstill

But this is just a number- can occur at lower

Question 19

describe how to buy time when treating a uroabdomen

Answer 19

place urinary catherter- 2-3 days this can buy you

Question 20

Describe how to fix hyperkalaemia in cases of uroabdomen

Answer 20

give hartmans because it is alkalinising
give glucose - but beware need to make sure doesn’t go hyperglycaemic
Insulin
Beta agonists- last resort

Question 21

Describe how Hartmanns help treat hyperkalaemia

Answer 21

because it is alkalinising- the amount of K+ in hartmans is not much alkalising has better effect
contains lactate which gets metabolised into bicarb which forces the K+ back into cells