Peritonitis

Question 1

What’s the gold standard for diagnosing peritonitis?

Answer 1

ULTRASOUND (with regard to imaging…)

with regard to CONFIRMING a diagnosis of peritonitis (septic or not),
cytology: ultrasound guided sampling - AFAST*
—> degenerative neutrophils with intracellular bacteria

+culture…

Question 2

How long can residual FREE air remain after abdominal surgery?

Answer 2

30 days!

Question 3

In a dog presenting with septic peritonitis, what would we expect from effusion analysis?

Answer 3

peritoneal fluid glucose concentration
​will always be lower
than the blood glucose concentration

Question 4

If the peritoneal fluid includes a creatinine concentration greater than the serum creatinine concentration, what is the source of peritonitis?

Answer 4

• *urogenital**
• diagnostic for* ​uroperitoneum

Question 5

If the peritoneal fluid bilirubin concentration is
MORE THAN 2.5X
the serum bilirubin,
what is the source of peritonitis?

Answer 5

Bile peritonitis 100%

Question 6

What are the “big 3” antibiotics we use for treating septic peritonitis and how do we administer?

Answer 6

• *ampicillin** (Unasyn),
• *baytril** (amikacin can substitute),
• *metronidazole**

administer IV

Question 7

What is the recommended peritoneal drainage management?

Answer 7

closed suction (active)
i.e. Jackson Pratt
*requires external vacuum to create negative pressure in the cavity*

Question 8

What is the best feeding tube choice in a post-surgical septic peritonitis case?

Answer 8

Post-gastric feeding:

• *gastrojejunostomy** tube (directly in the intestinal tract and exit out body wall)
• allows for dual lumen access without the risk of making an incision in the small intestine*

Question 9

How do we classify peritonitis?

Answer 9

• *primary** (G+ common & MONObacterial)
• Spontaneous inflammation in the absence of intraperitoneal source*
• coronavirus: FIP in cats
• hemato/lymphogenous bacT spread
• transmutation bacT migration from GIT
• bacT spread from oviducts
• *secondary (G- common & POLYmicrobial)**
• consequence of underlying 1^o disease (COMMON)*
• bowel leakage/translocation
• urine/bile/blood extravasation
• neoplastic invasion
• pancreatitis (acid by-products)

Question 10

if you were looking for a rupture of the GIT secondary to an NSAID, what location would we want to focus on?
what about the same situation secondary to a steroid?

Answer 10

proximal duodenum;

​proximal descending colon

Question 11

What are the 2 main offenders (from bowel) in septic peritonitis?

Answer 11

1. E.coli
   alpha-hemolysin endotoxin
2. ​Bacteroides fragilus
   (anaerobic; potentiates E.coli**)

Question 12

How can we diagnose septic peritonitis in the dog and cat based on abdominal vs. serum concentrations of glucose and lactate?

Answer 12

Both:
​glucose 20 points lower in abdominal fluid than serum

dogs only, really:
lactate 2 points higher in abdominal fluid