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77 Cards in this Set
- Front
- Back
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what are the nine regions the abdomen can be divided into?
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the right and left hypochondriac regions
the epigastric or xyphoid region the umbilical region the right and left lateral regions (including the flanks and paralumbar fossae) the right and left inguinal regions, the pubic region. |
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what area is important in allowing passage of thoracic dz into abd and vice versa.
what passes thru this area? |
Paired slitlike openings dorsal to the diaphragm and ventral to the psoas muscles separate the pleural and peritoneal cavities only by a thin layer of fused endothoracic and transversalis fascia.
The sympathetic trunk and splanchnic nerves also enter the abdominal cavity in this area. |
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describe the portions of the omentum:
1.bursal portion 2. The splenic portion of the greater omentum extends to the hilus of the spleen to form the gastrosplenic ligament. 3.The smallest portion of the greater omentum is the veil portion containing the left limb of the pancreas. |
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what is the omental bursa?
what is the epiploic foramen? |
The omental bursa is a potential space between these layers.
The omental bursa is a closed sac except for its large opening, the epiploic foramen, bounded dorsally by the caudal vena cava and ventrally by the portal vein.97 |
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what is the surgical significance of the epiploic foramen?
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Bleeding from the liver can be temporarily arrested by placing a finger through the epiploic foramen just cranial to the pylorus and curling the finger ventrally to occlude the hepatic artery and portal vein.
Migration of loops of small intestine through the epiploic foramen is rare but may result in intestinal strangulation |
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where is the lesser omentum located?
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It lies between the lesser curvature of the stomach and porta hepatis, becoming continuous with the mesoduodenum.
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what are milky spots?
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aggregations of cells that are a source of neutrophils, macrophages, and lymphocytes and are important components of peritoneal defense mechanisms
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what organs are retroperitoneal?
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The kidneys,
ureters for most of their length, adrenal glands The aorta, caudal vena cava, lumbar lymph nodes are also retroperitoneal. |
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what is the peritoneum?
what types of cells does it contain? |
serous membrane composed of a single layer of squamous cells of mesothelial origin.
The cell surface is covered with microvilli The mesothelial cells are supported by a connective tissue stromal layer composed of elastic and collagen fibers, macrophages, lymphocytes, mast cells, glycosaminoglycans, and adipose cells |
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what are stomata?
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the peritoneum of the visceral surface of the diaphragm has fenestrations of the basement membrane, the stomata, of variable size
Mesothelial cell processes regulate stomata size, increasing the size in peritonitis. In dogs and cats, these fenestrations are considered large, generally in the 4- to 16-µm diameter range or larger. These fenestrations and special lymphatic collecting vessels, the lacunae, are important in clearance of fluid and particles from the peritoneal cavity.--drain to the sternal lymph nodes. |
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name all of the ligaments that are formed by fold is the omentum
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what is the colloid osmotic pressure of normal peritoneal fluid.
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28 mm Hg
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what is the normal protein and cellularity of peritoneal fluid?
what cells are normally in peritoneal fluid? |
<3g/dL
<300cells/mm macrophages, mesothelial cells, lymphocytes |
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list the normal cell counts and protein numbers in normal peritoneal fluid, transudate, modified transudate, and exudate?
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Normal
Transudate Modified Transudate Exudate Cells/µL <300 <1500 1000–7000 >5000 Protein (g/dL) <3 <2.5 2.5–7.5 >3 |
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which side of the diaphragm has more lymphatics
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The right side of the diaphragm has a much greater distribution of lymphatics than the left side
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in a study comparing drainage of contrast material from the abdomen via open drainage and penrose, what was found?
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Most of the contrast medium drained within 6 hours with open peritoneal drainage and within 24 to 48 hours with sump–Penrose drainage.
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how much fluid can the abdominal cavity absorb?
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at a rate of 3% to 8% of body weight per hour.
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what is the normal range for IAP in dogs?
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2.0 to 7.5 cm H2O (mean, 4.50 ± 0.44 cm H2O)
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what is an indirect method of IAP measurement?
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indwelling transurethral urinary bladder catheter.
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in a study evaluating increased IAP is pigs, what were the effects?
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IAPs of 15 mm Hg (20.4 cm H2O) in pigs induced by CO2 insufflation caused:
increased heart rate increased mean arterial pressure increased systemic vascular resistance decreased cardiac output decreased mesenteric arterial blood flow decreased intestinal mucosal blood flow, increased bacterial translocation |
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how is the clinical diagnosis of acute abdominal compartment syndrome in humans is made?
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when high peak inspiratory pressure is accompanied by oliguria and an apparent tight abdomen.
Urinary bladder pressure measurement greater than 20 to 25 cm H2O is suggestive |
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at what IAP should surgical decompression be considered?
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Surgical decompression should be considered when IAP nears 30 cm H2O, particularly in oliguric animals.
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what treatment was given experimentally in pigs with IAP of 15mmHg to improve intestinal circulation?
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Low-dose infusion of dobutamine (5 µg/kg/min) corrected intestinal mucosal hypoperfusion induced by moderately increased IAP (15 mm Hg or 20.4 cm H2O IAP) experimentally in pigs
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what agents have been shown to reduce adhesion formation in horses?
in lab animals? |
lactated Ringer's solution
intraoperative and postoperative administration of heparin hyaluronate–carboxymethylcellulose membrane implantation intraperitoneal 0.4% hyaluronic acid solution subcutaneous administration of TNP-470 intraabdominal administration of fibrinolytic agents |
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what physical techniques have been advocated to decrease adhesion formation?
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omentectomy and physical barriers,
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what are the mechs of immune function of the peritoneum?
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mediated by the complement system.
Specifically, release of C3a and C5a stimulates neutrophil chemotaxis and degranulation of basophils and mast cells. Other innate defenses include absorption of bacteria through diaphragmatic lymphatics, phagocytosis by resident leukocytes and macrophages, abscess formation, activity of resident natural killer cell |
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what pro-inflammatory cytokine has been asstd with a poor prognosis in primates?
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a primate model of peritonitis, persistent elevation of IL-6 was a poor prognostic sign, with a mortality rate of 42%
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what intraperitoneal substances are known adjuvants in peritonitis?
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gastric mucin, bile salts, hemoglobin, and barium
Peritoneal fluid volume Gastric mucin polysaccharide has a heparin-like anticomplement effect, which inhibits phagocytosis. Bile salts lower surface tension, altering cell adhesion and lysing RBCs, releasing hemoglobin. Hemoglobin interferes with phagocytic cell chemotaxis, phagocytosis, and intracellular killing. Hemoglobin may also play an adjuvant role by providing the iron required by some microorganisms.Hemoglobin also inhibits bacterial clearance from the peritoneal cavity by interfering with lymphatic clearance mechanisms. |
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In canine models of septic shock what happens to intestinal mucosa?
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In canine models of septic shock, adrenergic stimulation increases intestinal venous pressure, injuring the mucosal barrier of the gut and promoting translocation of gut bacterial flora across the intestinal wall.
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what role does fever play in infection?
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The mechanisms of the beneficial effects of fever are unclear but appear to relate to enhanced host defenses through enhancement of cytokine expression, particularly TNF-α and IL-1β. Pharmacologic suppression of an animal's febrile response may be deleterious.
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What was found in the following study:
Kenney, EM, Rozanski, EA, Rush, JE, et al.: Association between outcome and organ system dysfunction in dogs with sepsis: 114 cases (2003–2007). J Am Vet Med Assoc. 236, 2010, |
MODS has recently been reported in a large, multicenter, retrospective series of dogs treated surgically for septic peritonitis secondary to gastrointestinal tract leakage.
Fifty percent of dogs in this study had MODS. The mortality rate was 70% for dogs with MODS and 25% for those without MODS. |
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what organ besides the peritoneum also absorbs bacteria and other particulate matter
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The omentum also absorbs bacteria and other particulate matter; it is the only organ in addition to the peritoneum capable of doing so
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how does peritoneal inflammation induces gastrointestinal ileus?
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Peritoneal inflammation induces gastrointestinal ileus by sympathoadrenergic reflex inhibition.
These inhibitory reflexes completely block myenteric cholinergic neurons, |
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what was shown regarding intestinal motility in a dog model of acute peritonitis by “appendiceal” ligation
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, spike activity was significantly decreased by 3 hours, motility was inhibited by 6 hours, and complete adynamic ileus was established by 9 hours.2
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what is reflex rigidity?
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Peritoneal irritation causes reflex rigidity of the abdominal and diaphragmatic muscles.
Diaphragmatic rigidity impedes respiratory movements. Diaphragmatic rigidity and decreased respiratory movement reduce intraperitoneal circulation and decrease lymphatic clearance of fluid and particulate matter through the diaphragm |
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what was found in the following 2 studies regarding abd pain with septic peritonitis:
Costello, MF, Drobatz, KJ, Aronson, L, et al.: Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990–2001). J Am Vet Med Assoc. 22, 2004 Parsons, KJ, Owen, LJ, Lee, K, et al.: A retrospective study of surgically treated cases of septic peritonitis in the cat (2000–2007). J Small Anim Pract. 50, 2009 |
In two recent retrospective studies of septic peritonitis in cats, signs of pain during abdominal palpation were reported in only 38% to 64%
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how is Peritonitis is most commonly classified ? what type is most common in small animals?
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Peritonitis is most commonly classified as primary or secondary, acute or chronic, localized or generalized, and septic or aseptic.
In small animal practice, acute generalized secondary septic peritonitis is a relatively common occurrence |
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what is the major difference between primary and secondary peritonitis?
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Primary peritonitis is spontaneous inflammation of the peritoneum in the absence of an evident intraabdominal source of infection or history of penetrating peritoneal injury.
In contrast to secondary peritonitis, primary peritonitis is monobacterial in most cases. |
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what is the proposed route of infection in primary peritonitis?
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has been postulated to be primarily hematogenous, but bacterial translocation across the intact intestinal mucosa and bacteremia in portosystemic shunting have also been implicated
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Primary bacterial peritonitis in dogs and cats: 24 cases (1990–2006). J Am Vet Med Assoc. 234, 2009
were infections in animals with primary septic peritonitis mono or polybacterial? what type of bacteria? what was mortality rate? |
A recent retrospective study of primary bacterial peritonitis in 15 dogs and nine cats over a 16-year period revealed monobacterial infection in 56% of canine and 100% of feline cases.
Eighty percent of the bacteria cultured in dogs and 60% of bacteria cultured in cats in this study were gram-positive organisms. Seven of 15 dogs (46.6%) and four of nine cats (44.4%) survived to discharge from the hospital. |
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some pathogens asstd with primary peritonitis in dogs (small number of each):
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Salmonella typhimurium
Chlamydia psittaci Clostridium limosum Mycobacterium microti Citrobacter freundii Blastomyces dermatidis histoplasmosis candidiasis |
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what was the mortality rate in the following study?
Ralphs, SC, Jessen, CR, Lipowitz, AJ: Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991–2000). J Am Vet Med Assoc. 223, 2003 |
In one study, 85% of dogs that developed intestinal anastomotic leakage died despite aggressive treatment.
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how can you diagnose a surgical sponge retention?
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Ultrasonography and ultrasound-guided fine needle aspiration may assist diagnosis.
Surgical swab granuloma is sonographically characterized as a hypoechoic mass with an irregular hyperechoic center. Cytology may reveal mononuclear inflammatory cells and multinucleate giant cell along with fibers. The combination of survey abdominal radiographs and sonography enabled detection of retained surgical sponges in six of seven dogs (86%) in one study |
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how is the diagnosis of starch-induced peritonitis made
what is the Treatment how can you prevent contamination of the peritoneal cavity |
diagnosis of starch-induced peritonitis can be made by iodine staining or polarized light microscopic examination of peritoneal fluid.
Treatment with corticosteroids is recommended. To prevent contamination of the peritoneal cavity with surgical glove powder, gloves should be washed or wiped with sterile saline before entering the abdomen. |
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can you use chlorohex in the peritoneum?
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Povidone–iodine solutions in 3% and 10% concentrations cause intense peritoneal irritation and marked diffuse hemorrhagic peritonitis.
Even normal saline solution causes mild peritoneal inflammation, possibly because of its acidity. |
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what is sclerosing peritonitis?
why does it happen? how is it diagnosed? how is it treated? |
It is a chronic form of peritonitis in which the abdominal organs become encased in thick, “cocoon-like” layers of collagenous connective tissue.
Peritoneal fluid may show large numbers of RBCs, macrophages with erythrophagia, mixed inflammatory cells, reactive mesothelial cells, and fibroblasts. In the first three dogs reported, etiologic agents and pathogenesis of the lesions was not apparent. Four of five animals in the second report had potential causes of the lesions, including steatitis and fat necrosis in the cat, fiberglass ingestion in one dog, bacterial peritonitis in one dog, and chylous effusion in one dog. Surgical exploration and biopsy from multiple abdominal organs is recommended. In one dog, fluid accumulation resolved with lavage and Penrose drainage for 11 days. Corticosteroid therapy may reduce inflammation, slow progression, and control ascites. Surgical dissection resulted in multiple sites of intestinal wall disruption and euthanasia of the dog. |
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what types of parasitic peritonitis have been reported?
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Toxoplasma gondii
nymphal pentastomiasis Porocephalus crotali. Mesocestoides spp. leishmainia |
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what was the general source of peritonitis in the following study?
Hosgood, G, Salisbury, SK: Generalized peritonitis in dogs: 50 cases (1975–1986). J Am Vet Med Assoc. 193, 1988 |
In a retrospective study of 50 dogs with generalized peritonitis, the gastrointestinal tract was the source of contamination in 60% of the dogs, most commonly secondary to surgical wound dehiscence
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Costello, MF, Drobatz, KJ, Aronson, L, et al.: Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990–2001). J Am Vet Med Assoc. 22, 2004
what was the cause of peritonitis in this study |
Leakage from the gastrointestinal tract was the cause of septic peritonitis in 47% of 51 cats in a retrospective study.
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what was the cause of peritonitis is dogs in this study?
Winkler, KP, Greenfield, CL: Potential prognostic indicators in diffuse peritonitis treated with open peritoneal drainage in the canine patient. J Vet Emerg Crit Care. 10, 200 |
In another retrospective study of the outcome of open peritoneal drainage in dogs with peritonitis, leakage from the gastrointestinal tract was the cause in 12 of 19 (63%) participants
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what were risk factors for anastomotic leakage identified in the following study
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In a retrospective study of risk factors for leakage after intestinal anastomosis in 90 dogs and 25 cats, preoperative peritonitis was identified as a significant risk
Other factors associated with anastomotic leakage in this study include hypoalbuminemia and intestinal foreign body |
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what was the incidence of leakage with GI FB in the following study?
Hayes, G: Gastrointestinal foreign bodies in dogs and cats: a retrospective study of 208 cases. J Small Anim Pract. 50, 2009 |
In a retrospective study of dogs and cats treated surgically for gastrointestinal foreign bodies from a first-opinion charity practice in which cases with preexisting peritonitis were excluded, 5% of the animals developed postoperative peritonitis presumably secondary to gastrointestinal dehiscence and leakage.
None of these animals survived. In this study: a longer duration of clinical signs the presence of a linear foreign body multiple intestinal procedures were associated with significantly increased mortality |
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what was the % leakage in this study? what were the risk factors?
Shales et al.: Complications following full-thickness small intestinal biopsy in 66 dogs: a retrospective study. J Small Anim Pract. 46, 2005 |
Enteric wound breakdown and septic peritonitis was diagnosed in 12% of 66 dogs with full-thickness small intestinal biopsy studied retrospectively, with no parameters predictive of enteric wound dehiscence identified.
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what was the dehischence rate in this study?
Gorman, SC, Freeman, LH, Mitchell, SL, et al.: Extensive small bowel resection in dogs and cats: 20 cases (1998-2004). J Am Vet Med Assoc. 228, 2006 |
In dogs undergoing resection of greater than 50% of the length of small intestine secondary to foreign body, enteric wound dehiscence was reported in 2 of 13 (15%) of dogs, both of which were euthanized
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hats a major complication of gastrostomy tubes?
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In a retrospective study of gastrostomy tubes for nutritional management of renal failure in 56 dogs, peritonitis was a complication in 5%, resulting in the death of one dog.94
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what is the incidence of ruptured uterus with pyometra?
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In a retrospective study of 183 cases of pyometra in cats, the uterus was ruptured in seven cats, with fatal septic peritonitis in four.
Septic peritonitis appears to be rare in dogs with pyometra. In a retrospective study of 80 cases of pyometra (73 dogs), only one bitch was described with ruptured uterus and peritonitis |
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how frequent does bile culture positive?
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In a retrospective study of gallbladder rupture in 45 dogs, 11 of 40 dogs had positive bacterial cultures, with aerobic organisms isolated in 10 dogs and anaerobic organisms isolated in only one dog.
Bile is a known adjuvant in peritonitis, and conventional wisdom suggests sterile bile peritonitis will progress to septic bile peritonitis. However, sterile biliary effusions of 30 days or more duration have been described |
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what is the prognosis asstd with bile peritonitis?
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Survival in patients with sterile bile peritonitis was 100%, but survival in those with septic bile peritonitis was only 27% in one study.
A 79% mortality rate was reported in a retrospective study of hepatic abscesses in 14 cats, with septic peritonitis diagnosed in 67% by cytology. In another study of variables associated with outcome in 60 dogs undergoing extrahepatic biliary surgery, the mortality rate was 55% in dogs with septic bile peritonitis compared with 13% in dogs with sterile bile peritonitis. |
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what was survival in this study?
Crews et al.: Clinical, ultrasonographic, and laboratory findings associated with gallbladder disease and rupture in dogs: 45 cases (1997–2007). J Am Vet Med Assoc. 234, 2009 |
In a more recent retrospective study, an 82% survival rate was reported for dogs with bacterial bile infection and gallbladder rupture
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what is a major complication of peritoneal dialysis?
most common isolate? |
Septic peritonitis secondary to peritoneal dialysis accounted for 4% of cases of generalized peritonitis in dogs in one retrospective study.
In a retrospective study of 27 dogs and cats treated with peritoneal dialysis, eight animals developed bacterial peritonitis. The most common isolate was Klebsiella spp |
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what is the incidence of peritonitis in dogs undergoing sx for gdv?
Ralphs, SC, Jessen, CR, Lipowitz, AJ: Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991–2000). J Am Vet Med Assoc. 223, 2003 |
In a retrospective study of 166 dogs treated surgically for gastric dilatation and volvulus, peritonitis was a complication in 4.8% and was a risk factor for mortality.
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are there mostly aerobes or anaerobes in the colon?
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The colon has very dense bacterial concentration, with obligate anaerobes in excess of aerobes by approximately 1000 : 1.
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what 2 species of bacteria predominate in the peritoneal cavity in bowel perforation,
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E. coli and Bacteroides fragilis
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what toxin increases the virility of e.coli in the peritoneal cavity?
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α-Hemolysin is a common exotoxin of E. coli postulated to play a key role in facilitating the pathogenicity of E. coli in the peritoneal cavity.
α-Hemolysin is toxic to many mammalian cells, α-Hemolysin: decreases intraperitoneal pH, lyses intraperitoneal erythrocytes reduces recoverable viable leukocytes when present in the peritoneal cavity. The presence of α-hemolysin markedly increases patient mortality and increases likelihood of recovery of E. coli and B. fragilis. |
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what types of bacteria are most commonly isolate in septic peritontiis?
multiple or single aerobic or anaerobic? |
In a retrospective study of 23 cases of septic peritonitis in dogs, there were multiple organisms identified in 14 of 28 cultures, including anaerobic organisms in 26% of the cases.
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what type of fungal infection is most common from bowel leakage?
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fungal secondary peritonitis is most often a result of infection with Candida albicans and is related to leakage of the stomach or duodenum. Candidal infection of the peritoneal cavity carries a grave prognosis
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what volume of peritoneal fluid can be palpated?
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Peritoneal fluid volume of 10 mL/kg body weight can be detected on physical examination by ballottement
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are cats with septic peritonitis usually hyperthermic?
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Cats with septic peritonitis are more commonly hypothermic
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how often do you see SIRS with septic cats?
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Cats with septic peritonitis are more commonly hypothermic
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SIRS criteria in Cats?
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Rectal temperature
>39.7° C (103.5° F) or <37.8° C (100° F) Heart rate >225 bpm or <140 bpm Respiratory rate >40 bpm WBC (cells/µL) >19,500 or <5000 Band neutrophil >5% |
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SIRS criteria for dogs
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Rectal temperature
>39° C (104° F) or <38° C (100.4° F) Heart rate >120 bpm Respiratory rate >20 bpm WBC (cells/µL) >18,000 or <5000 |
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how many SIRS criteria need to be met?
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3 or more for cats
2 or more for dogs |
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what factors are associated with an increased risk of dehiscence in this study?
Allen, DA, Smeak, DD, Schertel, ER: Prevalence of small intestinal dehiscence and associated clinical factors: a retrospective study of 121 dogs. J Am Anim Hosp Assoc. 28, 1992 |
in a retrospective of intestinal dehiscence, there was a significantly increased incidence of dehiscence when enterotomies or anastomoses were performed for traumatic injuries and foreign body entrapment.
Thus, a history of recent enterotomy for trauma or foreign body warrants a still higher index of suspicion |
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can you use barium if you suspect a gastro- intestinal perf?
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Iodinated water-soluble contrast agents should be used in preference to barium when leakage from a hollow viscus or foreign body entrapment is suspected.
Leakage of intestinal contents plus barium into the peritoneal cavity is associated with higher mortality rate than either contaminant alone |
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what is "double effusion"?
what diseases are asstd? what are the proposed mechs? |
he rate of double effusions was highest in peritonitis or pleuritis caused by infectious agents and in pancreatitis. The presence of double effusion was associated with a 3.3 times increased risk of death. The mechanism of double effusion was considered an extension of abdominal disease through the diaphragmatic hiatus to the pleural space and vice versa or as a sequela to disseminated intravascular coagulopathy.304
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what biochemical parameters have been associates with survival in dogs?
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Significant differences in alanine transaminase (ALT) and gamma-glutamyltransferase (GGT) values were noted between survivors and nonsurvivors in a retrospective study of diffuse peritonitis in dogs.
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what effect does effusion volume have on obtaining diagnosis?
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single abdominal paracentesis results are reported to be positive in 20% of animals with a peritoneal effusion volume of 3 mL/kg and in 80% of animals with a 10-mL/kg effusion volume.
Experimentally, intraperitoneal fluid volume of 5.2 to 6.6 mL/kg was required for positive results of needle paracentesis, but only 1.0 to 4.4 mL/kg was necessary for positive results using a peritoneal dialysis catheter to obtain the sample |
