Digestion & Metabolism 2: Peritonitis

Question 1

PATHOPHYSIOLOGY of PERITONITIS (4)

end with PERFUSION

Answer 1

1. when the ENTIRE peritoneal cavity is INFLAMED, the CAPILLARIES LEAK both FLUID & ALBUMIN
2. this leakage causes DECREASED VASCULAR VOLUME
3. decreased volume causes DECREASED VENOUS RETURN TO THE HEART
4. overall, DECREASED PERFUSION

Question 2

in DOGS & CATS peritonitis is almost ALWAYS…

Answer 2

DIFFUSE

Question 3

when animals are SEPTIC, they’ll often VASOCONSTRICT/VASODILATE

Answer 3

VASODILATE

Question 4

how is the RAA system activated by HYPOVOLEMIA (4)

Answer 4

1. CAROTID & AORTIC BODY have STRETCH RECEPTORS that DETECT HYPOVOLEMIA
2. hypovolemia causes ADRENALS to RELEASE GCCs
3. GCCs –> TACHYCARDIA & VASOCONSTRICTION
4. RAA system ACTIVATED to RETAIN Na & WATER by KIDNEYS

Question 5

do you need INFECTION for SEPSIS?

what ELSE can cause sepsis?

Answer 5

NO, infection isn’t necessary for sepsis –> SEPSIS IS WIDESPREAD INFLAMMATION

release of substances from DAMAGED TISSUE can interact with MACROPHAGES & LYMPHOCYTES and cause release of INFLAMMATORY MEDIATORS

Question 6

how does SMOOTH MUSCLE DILATE? (3)

Answer 6

1. RELEASE of ATRIAL NATRIURETIC PEPTIDE via cGMP
2. cGMP clips PHOSPHATE off of MYOSIN
3. VASODILATION

Question 7

vasodilation & HYPERpolarization? (3)

Answer 7

1. if we have LOSS OF ENERGY in a cell or LACTATE HIGH, then K CHANNELS OPEN
2. causes HYPERPOLARIZATION OF MEMBRANE & Ca channels STAY SHUT
3. causes VASODILATION

Question 8

the SIGNS for peritonitis OVERALL are…

can include what 4 specific signs?

if we SUSPECT peritonitis, what DIAGNOSTIC should we do?

Answer 8

NOT SPECIFIC

4 signs?
1. ANOREXIA
2. VOMITING
3. DEPRESSION
4. FEVER

we should do ABDOMINAL RADS

Question 9

what is this in ABDOMINAL RAD? (arrow)

when would it be normal?

if NOT normal, what should we do next?

Answer 9

FREE GAS POCKET

normal = if it’s recently had ABDOMINAL SX

if NOT normal, then NEEDS FULL ABDOMINAL EXPLORATORY SX

Question 10

what structure can we CLEARLY see in this THORACIC RAD?

what does good detail of this structure indicate? (2)

Answer 10

we can CLEARLY SEE DIAPHRAGM

GOOD DETAIL of this structure indicates…
1. AIR present on BOTH SIDES
2. PPERITONITIS

Question 11

what is a FOUR-QUADRANT tap?

Answer 11

allows us to use a needle to try and ASPIRATE FLUID FROM THE ABDOMEN

Question 12

BACTERIA IN ____ FLUID is NOT diagnostic for PERITONITIS, but BACTERIA ____IS & indicates going to ____

Answer 12

EXTRACELLULAR, INTRACELLULARLY, SURGERY

Question 13

PERITONEAL FLUID GLUCOSE should be WHAT if peritonitis?

PERITONEAL FLUID LACTATE should be ____ mmol/L ____ than BLOOD

which method is 100% SENSITIVE & SPECIFIC for PERITONITIS DIAGNOSIS in dogs?

what happens once SURGERY is performed?

Answer 13

PERITONEAL FLUID GLUCOSE >20 mg/dL LOWER than BLOOD GLUCOSE

PERITONEAL FLUID LACTATE should be 2 mmol/L HIGHER than BLOOD

PERITONEAL FLUID LACTATE 100% SENSITIVE & SPECIFIC FOR PERITONITIS

once Sx performed, NONE OF THESE NUMBERS/FINDINGS ARE HELPFUL!

Question 14

2 INITIAL medical managements for PERITONITIS in ER?

Answer 14

1. AGGRESSIVE STABILIZATION & MONITORING
2. ADMINISTER IV CRYSTALLOIDS & COLLOIDS

Question 15

UROPERITONEUM is ALWAYS considered a ____ ____

might see ____

Answer 15

MEDICAL EMERGENCY

might see ARRHYTHMIAS

Question 16

HYPERKALEMIA causes ____cardia

the closure of WHAT channel is responsible for this?

normally, K excreted via..

Answer 16

HYPERKALEMIA –> BRADYCARDIA

closure of SODIUM CHANNELS due to HYPERPOLARIZATION causes bradycardia

normally, K excreted via KIDNEYS

Question 17

CALCIUM CHLORIDE compared to CALCIUM GLUCONATE?

Answer 17

CALCIUM CHLORIDE has 3X as much CALCIUM as in CALCIUM GLUCONATE

Question 18

if PERITONITIS is present, then we should assume there’s a ____ ____ ____ & requires what 2 treatments?

give 2 specific medications

Answer 18

SECONDARY BACTERIAL INFECTION

1. CULTURE DURING Sx
2. BROAD-SPECTRUM ANTIBIOTICS
   –> CEPHALOSPORIN or
   –> CLINDAMYCIN for G+

Question 19

if a dog comes in with SEPTIC PERITONITIS, the most IMPORTANT thing you can do is… (2)

what are 2 common causes?

Answer 19

1. STABILIZE ANIMAL
2. REMOVE INCITING CAUSE

cause = GI LEAKAGE either from…
1. FB
2. ANASTOMOSIS/RESECTION gone wrong

Question 20

if a dog comes in with GI LEAKAGE, we can perform a ___ ____, which is performed via…

does this work better than OMENTAL WRAPPING?

Answer 20

SEROSAL PATCH

take a couple LOOPS OF BOWEL and SUTURE THEM TOGETHER

DOES NOT work better than omental wrapping

Question 21

PERITONEAL LAVAGE…

what should the SOLUTION be made of?

after lavaging, need to make sure we…

Answer 21

solution = LARGE VOLUMES of WARM, BALANCED ELECTROLYTE SOLUTION

after lavaging, ASPIRATE ALL THE FLUID because if not, can EXACERBATE PERITONITIS/cause BACTEREMIA

Question 22

describe the MMs in two terms

usually a result of WHAT 3 clinical signs?

what 2 diseases could it indicate?

Answer 22

MMs?
1. INJECTED
2. VERY PINK

result of…
1. VASODILATION
2. ASPIRATION
3. REGURGITATION

could indicate…
1. PNEUMONIA
2. DIC

Question 23

DOGS GIVEN ___ DURING Sx for ____ PERITONITIS had ____ SURVIVAL

Answer 23

LIDOCAINE, SEPTIC, BETTER