Endotoxaemia, peritonitis & adhesions Flashcards Preview

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Flashcards in Endotoxaemia, peritonitis & adhesions Deck (24)
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1
Q

what is the pathogenesis of endotoxaemia

A
  1. Endotoxins released from G - bacteria - rapid bacterila replication and death
  2. Endotoxins absorbed across gut barrier - facilitated - facilitated by damaged gut barrier function
  3. Endotoxins free in the blood stream - liver extraction (mononuclear phagocytes)
  4. Endotoxins binds to inflammatory cells
  5. activates inflammatory cells to produce inflammatory mediators
  6. inflammatory mediators scereted by inflammatory cells
2
Q

what is the pathophysiological consequence of endotoxins in the bloodstream

A

Inflammation

3
Q

Systemic inflammatory respond syndrome (SIRS)

A

a general systemic inflammatory process independent of cause
Sepsis = systemic inflammatory response to bacterial infection

4
Q

multiple organ dysfunction syndrome

A

insufficient of 2 or more organ system e.g azotaemia, early laminitis

5
Q

Multiple organ failure syndrome

A

Failure of 2 or more organ systems e.g AKI, DIC, laminitis

6
Q

what are the causes of endotoxamia

A

Endotoxin molecules releases -as a by product of G- bacterial growth
Source of gram negative bacteria - localised function of infection
Translocation - entry of engenous batceria/products from GIT to systemic circulation

7
Q

what is the structural component of the outer layer of gram negative bacteria and what is its significance

A

LIpopolysaccharide (LPS) - permeability barrier - integral for survival and resistance to host defence mechanisms
Heat STABLE - In contrast to secreted exotocins

8
Q

what is the significance of LPs and endotoxaemia

A

Aute gastrointestinal injury will increase the permeability to LPS

9
Q

GIT permeability to LPS will be increased by;

A

GIt rupture
local ischaemia; strangulating lipoma
inflammation: anterior enteritis
systemic acidosis

10
Q

what is the pathophysiology of endotoxaemia

A
  1. endotoxins enters vascular system
  2. endotoxin contacts blood
  3. margination, activation & extravasation of neutrophils
  4. host pathology begins
  5. organ dysfunction develops
  6. Compensatory anti-inflammatory response syndrome
11
Q

On a hemogram what is a pathogneumonic sign of endotoxaemia

A

LEUKOPENIA due to neutropenia most specific indicator
+/- band neutrophils
Toxic changes: less condensed chromatin & cytoplasmic basophilia (blue) due to retention of ribosomal RNA

12
Q

what results on a biochem panel will be see with a horse suffering from endotoxaemia

A

hypocalcaemia as direct/indirect effect
hypoglycaemia in foals; hyperglycaemia in adults
coagulopathy ==> DIC

13
Q

what is the underlying principle of the txm of endotoxemia

A

Prevention by recognising & monitoring those patients at risk and treating the underlying source of LPS

14
Q

what drug can be used to inhibit LPS release into circulation, it is an antimicrobial therapy and you need to be aware that these kill bacteria and may increase the endotoxin activity initially

A

Ceftifur sodium

15
Q

what drug is used to scavenge LPS- it binds to lipid A of LPS and is nephrotoxic

A

Polymixin B

16
Q

what drug; blocks the production of pro inflammatory mediators via blocking the activation of NF- KB mediators of intracellular signalling cascage after LPS binding to mononuclear phagocytes: inhibition of cellular activity by LPS

A

Ethyl pyruvate

17
Q

what drugs can be use do inhibit the inflammatory mediators sysnthesis

A
NSAIDS - flunixin 
pentoxifylline 
corticosteroids 
antioxidants
Lignocaine
18
Q

where does the peritoneum lie

A

in the abdominal cavity (parietal peritoneum) & covers viscera (visceral peritoneum)

19
Q

what is the function of the peritoneal fluid

A

allows sliding of viscera; microvilli trap water and serous exudates
Production of peritoneal fluid: contain cells & cellular mediators that have roles in peritoneal healing
Fluid resorption and diffusion

20
Q

what is the definition of peritonitis

A

inflammation of the mesothelial lining of the peritoneum

21
Q

what are the CS associated with peritonitis

A

Colic; low grade and recurrent

associated with inflammation +/- sepsis +/- cardiorespiratory dysfunction

22
Q

what are some the findings on a haemorgam that help with the diagnosis

A

Inflammtion (fibrinogen)

hyper to hyper proteinaemia (protein loss in the abdominal cavity vs gammopathy)

23
Q

what other diagnostic tools can help diagnose peritonitis

A

abdominocentesis and fluid analysis

24
Q

How do you treat peritonitis

A
identification of aetiology - surgical exploration 
antimicrobial therapy 
fluid therapy 
peritoneal lavage 
analgesics, Anti-inflammatory 
adhesion management