Ch 86 Peritoneum Flashcards

Question

aseptic peritonitis

Answer 1

* **Barium (chemical)** * **Bile peritonitis (chemical)** * **Uroperitoneum (chemical)** (bile and urine produce little inflammation unless infected with bacteria) * **Peritoneal foreign body / Mechanical** (retained surgical sponge gossypiboma, <15um particles are cleared. larger result in granuloma or localized abscess) survey abdominal radiographs and sonography enabled detection of retained surgical sponges in six of seven dogs (86%) in one study ***Starch granulomatous** peritonitis (surgical glove powder, dx by iodine staining or polarized light microscopic examination of peritoneal fluid. Tx corticosteroids) * **Sclerosing encapsulating peritonitis**

Answer 2

- chronic form where abdominal organs become encased in thick, “cocoon-like” layers of collagenous connective tissue. - Peritoneal fluid large numbers of RBCs, macrophages with erythrophagia, mixed inflammatory cells, reactive mesothelial cells, and fibroblasts - etiologic agents and pathogenesis not apparent - Successful combined surgical and medical treatment > was unresponsive to corticosteroid treatment alone but was successfully treated with aggressive surgery and the addition of tamoxifen. - abdominal radiographs reveal hypersegmented, gas-filled intestines gathered in the central abdomen = considered a characteristic sign

Answer 3

- most common source = leakage from GIT (60% of dogs and 47% of cats - STUDY: 46% had undergone abdominal surgery within 14 days before - causes include GIT surgery dehiscence, FB, neoplastic, nsaid perforation, GDV, necrosis - pancreas may be the source of bacterial peritonitis (abscess rupture) and - pancreatitis may occur as a result of peritonitis - pyometra - Biliary effusion > commonly the result of traumatic disruption of the biliary tract/gall bladder - Bile is a known adjuvant and will likely progress to septic bile peritonitis. - Postoperative peritonitis appears to be the most lethal form - Penetrating wounds associated with gunshots, foreign body and bite wounds - major complication of peritoneal dialysis

Answer 4

- preoperative septic peritonitis, - hypoproteinemia, - hypoalbuminemia - intraoperative hypotension - presence of a foreign body (risk or protective depending on the study)

Answer 5

- The severity of peritonitis is related to the site of leakage along GIT - Increased bacterial load and increased proportion of anaerobic bacteria > considered responsible for the increased mortality rate associated with large bowel - stomach and proximal small intestine contain low numbers and no anaerobes. - colon has very dense bacterial concentration, with obligate anaerobes in excess of aerobes by approximately 1000:1. - Virulence enhancement factors = substances that enhance bacterial growth, bile salts, gastric mucin, hemoglobin, and barium - Septic peritonitis is most commonly polymicrobial. - Early mortality commonly caused by Gram-negative aerobic - bowel perforation, two species predominate: E. coli and Bacteroides fragilis - α-Hemolysin (exotoxin) of E. coli postulated to play a key role in facilitating pathogenicity

Answer 6

E.Coli Bacteroides fragilis

Answer 7

- Clinical signs quite variable. - Peritoneal effusion consistent finding (difficult to detect on palpation if small volume) - Most are systemically ill. Anorexia, vomiting, depression, general malaise, and other nonspecific signs of illness - Cats more commonly hypothermic - SIRS initially injected mucous membranes, tachycardia, and fever > progresses to hypovolemia and shock - Lack of bowel sounds on abdominal auscultation

Answer 8

RADs - loss of serosal contrast = free fluid - Free peritoneal gas may indicate GIT disruption, gas-producing organism, or penetrating injury - pneumoperitoneum > present in 20% of dogs 10 days after surgery - Positive contrast studies may be indicated, Iodinated water-soluble only ultrasound - free air and small quantities of free peritoneal fluid. - may ID abnormal organs - guided FNA CT - diagnosis of intraabdominal abscess, penetrating injuries (in humans) Bloodwork - CBC, biochem, total protein and albumin, urea nitrogen, electrolytes, glucose, serum lactate, and blood gas abdominal centesis - single most useful diagnostic test - Cytological evaluation was reported to be 71% sensitive in 1 study.

Answer 9

1. difference in peripheral blood **glucose** and peritoneal fluid glucose (BG:FG) with blood Glu >20mg/dL higher diagnostic 2. difference in peripheral plasma **lactate** and peritoneal fluid lactate concentrations (PL:FL), with >2 mmol/L difference diagnostic - both are reported to be 100% sensitive and 100% specific for diagnosing septic peritonitis

Answer 10

- single tap should be performed on the ventral midline 1 to 3 cm caudal to the umbilicus - positive in 80% of animals with a 10 mL/kg effusion volume - accuracy: 43% for needle vs 82.9% for catheter vs 94.6% for lavage - Diagnostic peritoneal lavage involves intraperitoneal infusion of 20 to 22 mL/kg of a warmed, sterile isotonic saline solution - examined grossly, cytologically, biochemically, and microbiologically - peritoneal effusions: ascites vs aseptic(surgical) vs septic vs uro/bile vs chylo - aerobic and anaerobic culture and sensitivity testing - False negative results in local peritonitis

Answer 11

- complicated by normal response of peritoneum to surgical insult. - Experimentally, total leukocyte counts 1 to 3 days after surgery ranged 500 to 10,500 cells/µL, nondegenerate neutrophils predominate. Dogs with induced peritnitis > Bacteria were seen consistently within neutrophils and free. - No absolute cell count or differential count can reliably distinguish between a “normal” postsurgical response and postoperative infection. septic peritonitis - Bacteria within neutrophils and free - Cytology of abdominal fluid is <87% accurate in companion animals - [Glucose]: should be used as supportive, not definitive, evidence of septic peritonitis; interpret with fluid analysis, cytology and clinical findings - blood-to-fluid lactate difference 2.0 mmol/L > NOT relaible in CATS other peritonitis - Peritoneal [creatinine] > serum = uroperitoneum, as is peritoneal fluid [potassium] > serum - Peritoneal [bilirubin] > 2x serum = free intraperitoneal bile

Answer 12

- resuscitation is aimed at restoration of perfusion and hydration while preventing volume overload. - consider both crystalloids LRS and Hypertonic saline (7.5% NaCl) solution - Both fluid and protein exude from the plasma into the peritoneal cavity - oncotic support via FFP - urine output at least 1 to 2 mL/kg/h to avoid fluid overload and pulmonary edema. - Alterations of IVFT based on results of serum electrolyte and blood gas - Aggressive resuscitation may exacerbate the pathological changes to the microcirculation - There may be a role for CCS in some cases of septic shock (critical illness-related corticosteroid insufficiency)

Answer 13

- initiated as soon as peritoneal fluid samples obtained for C&S - survival benefit of early and appropriate antimicrobial administration documented in humans - **Bactericidal drugs** effective against both Gram-positive and Gram-negative aerobes and anaerobes - cephalosporin or ampicillin plus an aminoglycoside are most commonly recommended - Prospective clinical trials comparing efficacy of various antibiotic regimens are lacking - controversy in human medicine if C&S justified  often didn’t result in change of antibiotics  prospective randomized trial comparing triple-drug therapy with single-agent showed no significant differences between treatment groups - trend in humans: “less is best,” with single-drug therapy of short duration. - Cats that received appropriate empirical antimicrobial therapy were more likely to survive.

Answer 14

aimed at: - elimination of the source of contamination or infection, - reduction of the bacterial load, - removal of foreign material and inflammatory cells/mediators - prevention of persistent or recurrence 1. debride 2. lavage 3. serosal patching 4. omentalisation 5. closure/drainage

Answer 15

- lavage with copious amounts of warm, sterile, physiologic saline - reducing the bacterial load, eliminating blood clots and debris, and reducing inflammatory cells/ mediators. - conflicting experimental evidence for efficacy: >> No evidence that lavage reduces mortality or septic complication rates in humans receiving appropriate systemic antibiotic - no definitive effect of peritoneal lavage was seen for the population as a whole. Kalafut 2018: Comparison of Initial and Postlavage Bacterial Culture Results of Septic Peritonitis in Dogs and Cats JAAHA - pilot study, the number of dogs with decreased postlavage concentration of bacteria was not statistically significant, and the study was unable to show whether lavage had an overall effect on survival - no benefit for ab's in lavage fluid

Answer 16

- hypokalemia, - hypoproteinemia, - subcutaneous edema, - progressive decrease in packed cell volume. - Nosocomial infection

Answer 17

200-300ml/kg or until the fluid is returning clear

Answer 18

- Peritonitis is associated with an increased risk for suture line disruption and leakage. - - Strong proteolytic activity in peritonitis degrades collagen and extracellular matrix and may predispose intestinal anastomoses and enterotomies to dehiscence - Serosal patching of anastomoses and areas of potential leakage from hollow viscera is recommended for patients with peritonitis - Its effectiveness is controversial, however - Use of a serosal patch did not protect dogs from either postoperative septic peritonitis or failure to survive in a more recent study. - efficacy of fibrin sealant has not been evaluated

Answer 19

Strong proteolytic activity in peritonitis degrades collagen and extracellular matrix which may predispose to dehiscense

Answer 20

- mechanically seal small leaks. - Omental angiogenesis, growth factors, immunocompetent cells, and inflammatory cells may contribute to improved anastomotic healing - although direct evidence of its efficacy in this application is lacking. - A few studies on benefits of omentalising anastomosis performed in the 70’s and in non-peritonitis conditions. - wrapping omentum 360 degrees around intestine > may cause obstruction

Answer 21

Primary closure Open peritoneal drainage Closed peritoneal drainage

Answer 22

- patient selection for closure versus open not apparent. - Randomized, prospective clinical trials comparing closure, open and closed drainage are lacking. Small numbers and lack of patient homogeneity in retrospective studies comparing treatments makes interpretation of results difficult - No significant difference in outcome between animals treated with closed-suction drains vs primary closure (44 dogs) - mortality 46% in 28 dogs without abdominal drainage - Retrospective with no diff in survival between groups Open peritoneal drainage versus primary closure

Answer 23

- Open peritoneal drainage was introduced in human patients to try improve outcome beneficial effects: - increased removal of bacteria, foreign material, and inflammatory mediators (experimental study in horses) - decreased abdominal adhesion - ease of inspection of the peritoneal cavity, - unfavorable environment for anaerobic bacteria technique - Variations whether daily debridement and lavage, the type and frequency of bandaging, the timing of closure - The linea alba, subcutaneous tissue, and skin of the cranial two-thirds of the wound are left open. - covered with a sterile bandage. - Tack omentum to prevent occlusion. - bandage is changed aseptically once daily or more to prevent strike-through +/- under GA with lavage. timing of closure: - gross improvement in color and clarity of drainage fluid, - progressively decreasing volume of drainage fluid (weight of bandages) - decrease or absence of cellular toxicity - absence of bacteria on cytology

Answer 24

1. Nosocomial infection 2. hypoproteinemia, 3. hypoalbuminemia 4. anemia

Answer 25

- Superiority of open peritoneal drainage over closed lacks controlled clinical trials. Has been shown to have no advantage over closed treatments in a prospective trial. - Randomized prospective clinical trial. Overall survival was 81%. negative pressure therapy is an effective alternative to open dtainage. Clinical outcomes, including survival were comparable between techniques. Spillebeen 2017 Advantages - decreased frequency of bandage changes - continuous removal of fluid - collection and storage of effusate - nosocomial infection and hypoproteinemia remain challenges (same as open) disadvantages - occlusion of the vacuum by omentum or viscera - formation of enterocutaneous fistula - ascending infection

Answer 26

- Most drainage methods suffer from ineffective drainage of the entire peritoneal cavity (therefore place multiple) - Acquired bacterial infection is a potential complication of all methods of peritoneal cavity drainage - Jackson-Pratt (retrospec 20 dogs): drain duration of 6 days, hypoproteinemia and anaemia in most, 85% survived to discharge - mortality rate 30% comparable to open abdominal drainage Mueller 2001: Use of closed-suction drains advanatges - decreased risk for nosocomial infection, - decreased potential for evisceration, - decreased intensity of postoperative bandage care, - no need for a second procedure. disadvanatges - Occlusion by omentum is a common - hypoprotienaemia + aneamia still occurs Criteria for removal: - largely rely on the clinical judgment of the attending clinician. - blood-to–peritoneal drain fluid glucose or lactate not a reliable

Answer 27

1. whether or not to provide drainage and the method remains controversial and at discretion of the surgeon. 2. Two described effective methods are active drains and open abdomen. 3. There are insufficient data for comparison of vacuum-assisted peritoneal drainage to open or closed peritoneal drainage or primary closure without drainage

Answer 28

- Animals with septic peritonitis are often critically ill and require intensive supportive care - Opiod analgesia and lignocaine - Cardiovascular support (dopamine or dobutamine) to maintain CO or MAP - Continuation of fluid therapy (tailored to individual: UO, CVP, eletrolytes, glucose) - Epidural local anesthesia is contraindicated in patients with septic peritonitis because of decreased survival times

Answer 29

Early enteral or parenteral nutritional support is recommended: - directly beneficial to enterocytes and decreases bacterial translocation - associated with significantly shorter length of hospitalization - Massive protein exudation into peritoneal fluid is expected - Protein-energy malnutrition leads to impaired immunocompetence, depletion of energy stores, weakness, delayed wound healing, and organ failure - Feeding tube placement: Nasogastric or nasoenteric feeding tubes, O-tube - Gastrostomy and jejunostomy > risk in septic environment (Elmenhorst 2020: G-tube associated with a low complication rate) - open surgical jejunostomy has the highest reported complication rates of 17.5% - 42% in small animals - ileus, Gastric distention predisposes to vomiting or regurgitation

Answer 30

Transfusion of whole blood or blood components or synthetic colloid often used - Albumin supplementation in severe hypoalbuminemia ( canine-specific, potenitally no survuval benefit even if given) - Human serum albumin > adverse reactions suggestive of type III hypersensitivity, significant morbidity and mortality) - Fresh frozen plasma (FFP) may be given to provide albumin and oncotic support - hydroxyethyl starches (HES): dont improve albumin and associated with risk of AKI

Answer 31

There was strong evidence for an association between sepsis severity category and survival, with 8% mortality in the “abdominal infection” group, 55% mortality in the “severe sepsis” group, and 94% mortality in the “septic shock” group

Answer 32

Despite advances in diagnosis and critical care management in patients with septic peritonitis, mortality rates remain stubbornly high in animals and humans. There was no significant difference in survival in a retrospective study comparing two different time periods in a single institution (1988-1993 vs. 1999-2003).

Answer 33

comparison of survival rates among published results of retrospective studies is difficult. Inclusion criteria vary between publications: - include dogs and cats, despite differences between these species - grouping various causes, various microbial pathogens, various treatments makes meaningful comparisons of techniques and treatments impossible.

Answer 34

**50% and 85%** - regardless of treatment method (open, drain, closed etc) - must be interpreted with caution because large RCCT are lacking - Nonsurvivors typically succumb to complications related to dysfunction organ systems in the immediate postoperative period

Answer 35

* Refractory hypotension * Elevated ALT, GGT * Plasma lactate over 2.5mmol/L or inability to normalise * Ionised hypocalcaemia * Multiorgan dysfunction

Answer 36

- Rate of recurrence was 10% - 3/7 (42.9%) survival after re-op - Time until surgery didn’t - age, needing vasopressors, lactate - Dogs with GI sepsis - contradictory in literature: presence of a foreign body - Septic peritonitis is a known risk factor for dehiscence of enterectomy sites - MODS: renal, cardiovascular, hepatic and coagulation (PT or PTT is prolonged or the platelet count is 100,000/µL or less)

Answer 37

No association was detected between anastomotic technique and IRA dehiscence in dogs without septic peritonitis (stapled 4.2%, hand-sewn 8.1%); however, stapled anastomoses were less likely to dehisce in dogs with peritonitis (stapled 9.7%, hand-sewn 28.9%). Risk factors for dehiscence included previoius SP and hand-sewn technique

Answer 38

- overall similar to dogs but soem difference between species: absence of signs of pain during abdominal palpation, relative bradycardia, spontaneous peritonitis more common - SP secondary to gastrointestinal leakage still most common etiology - overall **survival rate was 66%** (2019)

Answer 39

prognostic indicators in cats - overall survival 58/83 (69.9%) - risk factors for mortality: higher blood glucose on presentation, not receiving empirical antibiotics on admission

Answer 40

- The presence of an abdominal mass or having dehiscence of a previous gastrointestinal surgery did not confer a worse prognosis. - Intraoperative hypotension was associated with non-survival. Cats that survived beyond 1 day postoperatively had an improved likelihood of survival (87.5%)

Answer 41

- bite wounds, gunshot wounds, knife wounds - Intensive resuscitation and supportive care + early surgical exploration of the abdomen is often required - damage to abdominal viscera was confirmed in 70% by surgery or necropsy - diagnostic peritoneal lavage led to accurate diagnosis in 90% (blood, grossly dark bloody or opaque lavage fluid, white blood cell (WBC) count above 500/mm3, bacteria) - assessment of the integrity of the urinary system may be required b4 sx - Bacterial contamination may be from: GIT tract, skin contaminants, or oral flora - cosider imaging to determine (u/s, CT) Indications for surgical exploration: - persistent hemorrhage, - positive diagnostic peritoneal lavage - abscessation or necrosis - herniation

Answer 42

Pasteurella multocida

Answer 43

Staphylococcus spp Clostridium spp

Answer 44

- secondary to trauma to the urinary system. - The presence of urine in the peritoneal cavity has severe metabolic consequences but is not usually associated with bacterial peritonitis. - abdominocentesis fluid creatinine or potassium concentrations exceed serum values. - ratios for creatinine and potassium were greater than 2 : 1 and 1.4:1, respectively. Sx - If the urine is infected, early definitive repair or diversion is recommended to decrease risk for diffuse peritonitis.

Answer 45

- comparison of peritoneal fluid cholesterol and triglyceride concentrations with serum - not appear to induce an inflammatory response - spontaneous pleural and peritoneal chyle most often associated with neoplasia and carry a grave prognosis - may be secondary to lymphanic rupture, thoracic duct ligation

Answer 46

- associated with organs or lymph nodes, peritoneal or retroperitoneal foreign bodies - requires the presence of neutrophils and, frequently, anaerobic bacteria - Anaerobic organisms secrete large amounts of succinic acid, which inhibits neutrophil function in vitro - neutrophils effector - protected from normal peritoneal defense mechanisms, and fibrinous exudate prevents penetration of antibiotics. - mineralization or air density, may be apparent with abscesses on rads - Surgical treatment of intraperitoneal abscesses is usually required to remove the abscess, omentalize the abscess cavity, or establish drainage.

Answer 47

Bacteroides fragilis

Answer 48

causes: - Abdominal surgery (most common) - from ruptured abdominal viscus, - infection with gas-forming organisms - penetrative injury - abdominal drain site - leakage of gas through distended stomach - iatrogenic - duration of pneumoperitoneum experimentally: 9-25 days

Answer 49

Common causes: trauma, iatrogenic trauma, neoplasia, coagulopathies, splenic torsion - acute nontraumatic hemoperitoneum in dogs is malignant neoplasia diagnosis - accuracy of needle abdominocentesis is 50% to 62%. - Blood in contact with peritoneal surface >45 minutes does not clot - Blood by abdominocentesis that clots is suggestive of inadvertent splenic or vascular penetration - PCV peritoneal : peripheral PCV, serial measurements - RBC counts in excess of 100,000/mm3 in diagnostic peritoneal lavage (humans) - patient's overall hemodynamic status Tx - Autotransfusion and abdominal binding (trauma)

Answer 50

Mortality 27%

Answer 51

- Primary retroperitoneal diseases include retroperitonitis, pneumoretroperitoneum, nonneoplastic space-occupying lesions, and neoplasia - lipoma, fibrosarcoma, lymphosarcoma, myxoma, pheochromocytoma, paraganglioma, osteosarcoma, leiomyosarcoma and Metastatic - Primary disease of the kidneys, ureters, adrenal glands - retroperitonitis occurs most commonly secondary to foreign body migration and ovarian pedicle granuloma after ovariohysterectomy. imaging - poor definition of the borders of the left kidney and retroperitoneal swelling. - CT and magnetic resonance imaging (MRI) are useful diagnostic tools in suspected retroperitoneal disease. sx -particular attention paid to the location of the ureters during granuloma resection

Answer 52

- Chronic sinus tracts commonly secondary to foreign bodies. - fistulae defined as abnormal connections between epithelial-lined structures (not sinus) - lumbar, paralumbar, or flank are often associated with peritoneal or retroperitoneal foreign bodies - dx: ultrasound, CT or positive-contrast Sinography - sinography: 87% sensitive and 100% specific - Radiographic: tissue swelling, periosteal reactions on adjacent bone, gas densities and possible foreign bodie - back pain secondary to lumbar plant foreign bodies > proposed that plant parts were inhaled and then migrated along the diaphragmatic crus -

Answer 53

FB migration Ovarian pedicle granuloma

Answer 54

Neoplasms arising from the mesothelial lining of the coeliomic cavities (peritoneal, pleural, pericardial) - Often seen in relation to asbestos exposure

Answer 55

- Mesotheliomas clinically produce malignant effusions - dx: histopathologic examination of mesothelial biopsy specimens is required - Tx: palliative (repeat drainage) - doxorubicin and intrathoracic cisplatin survived 300 days

Answer 56

PDX 2-0 and 3-0 can be used without reservation for the closure of ventral midline coeliotomy in cats. Although there was no statistically significant difference between PDX 2-0, 3-0 and 4-0, PDX 4-0 showed a higher probability for suture breakage

Answer 57

A thick and diffuse fibrous capsule around the intestine was detected and removed surgically, and biopsies were taken from the affected organs confirming the SEP. Case 1 recovered well, was discharged some days after surgery and was clinically unremarkable for the next 2 years. Case 2 showed unsatisfactory improvement

Answer 58

- The most frequent site of rupture was the CBD in dogs and the cystic duct in cats (also gallbladder and hepatic duct) - common surgeries were cholecystoduodenostomy and CBD repair in dogs and cholecystectomy - One dog that underwent cholecystectomy experienced recurrent bile peritonitis - Short-term survival following surgical treatment of traumatic bile peritonitis was excellent and recurrence appears uncommon Measurement of peritoneal bilirubin should be considered

Answer 59

100 client-owned dogs The overall agreement between abdominal CT scan and exploratory laparotomy in all cases was 97% Abdominal CT scan read by a board-certified diplomate is a sensitive presurgical diagnostic tool for surgical abdominal disease in the dog. 3% of patients in which the surgical plan changed intraoperatively, as new lesions were identified in surgery.

Answer 60

overall survival rate was 75.9% (n = 44/58). no association between anatomical location of leakage (GIT tract, billary), microorganism species and survival although further studies are warranted

Answer 61

QOL scores were significantly higher with surgery versus those with palliative care (P = .007). Median survival time (MST) was 213 days with surgery and 39 days with palliative care (P = .049). Survival benefit of surgery was lost when considering only dogs with malignant histopathology (MST, 81 days; P = .305). > underscores the importance of timely preoperative staging Owners were more likely to be satisfied when they chose surgery owners (26%) second-guessed or were unsure of their decision

Answer 62

77 dogs that underwent abdominal surgery for septic peritonitis 31 dogs (40.3%) had AKI diagnosed (23.4%) dogs presented with AKI, (16.9%) dogs developed AKI postoperatively a significant risk factor for survival to discharge

Answer 63

Differences were identified between AUS and surgical or necropsy findings for 51 of 94 (54%) dogs. Splenic masses were most commonly identified as the cause of hemoabdomen. Sensitivity of AUS was 87.4%, 37.3%, and 31.3% for masses in the spleen, liver, and mesentery, the utility of AUS to detect grossly identifiable lesions in dogs with nontraumatic hemoabdomen was limited

Answer 64

detection of migrating FB in subcutaneous and underlying soft tissue structures. Retrospective study. Sample population: Forty-one dogs. relative sensitivity of preop-US 88% and and preop-CT/MRI was 57.1% The success rate for FB removal was higher in with intra-op us (89.5%) vs none (59.1%; Clinical resolution occurred in 90.2% of dogs for a median duration of follow-up of 4.2 years Intraoperative US should be used in combination with preop-US to increase the likelihood of migrating FB surgical removal in dogs In our study, 39% of the dogs were presented to a clinician after one or more surgical treatment had already been attempted No preop-DI technique is able to identify all migrating FB The reported sensitivity of preop-CT ranges between 19% and 75%.

Answer 65

Culture samples were collected from the peritoneal surface pre- and postlavage from dogs and cats treated surgically for septic peritonitis Microbial growth occurred in at least one culture in 88.6% of patients. There was no significant difference in bacterial isolates or susceptibility profiles pre- versus postlavage. Positive culture pre- or postlavage and appropriate antimicrobial selection did not significantly affect survival. no definitive effect of peritoneal lavage was seen for the population as a whole Limitations of this study include a small sample size, lack of standardization of surgical technique among surgeons, and lack of standardization of antimicrobial protocols Based on these findings, we recommend obtaining cultures both pre- and postperitoneal lavage, to ensure that all organisms are identified. | lavage solution used was not standardized

Answer 66

Lack of specifically scheduled time for surgery, few theatre staff and lack of sponge counting and documentation may have contributed to the 17 retained surgical sponge cases reported.

Ch 86 Peritoneum Flashcards

(98 cards)