Page 1542 - Cote clinical veterinary advisor dogs and cats 4th

Peritonitis 779.e3

Initial Database ○ Culture and susceptibility (C&S) testing • Consideration of need for postoperative
• CBC (p. 1333): drainage of the abdominal cavity
VetBooks.ir • Serum biochemistry profile Advanced or Confirmatory Testing placement Diseases and Disorders
○ Specific sites in the abdomen; drain
Aerobic and anaerobic
○ Regenerative left shift: inflammation
■
○ Degenerative left shift: sepsis
Pancreatic abscess
■
○ Azotemia: dehydration (prerenal) versus
Necrotizing cholecystitis
uroabdomen (postrenal) • Contrast radiographic studies ■ ■ Prostatic abscess
○ Uroabdomen: cystography (lower urinary
○ Electrolyte imbalance (e.g., hypokalemia tract) or excretory urography (p. 1101) ○ Entire abdominal cavity
or hyperkalemia) (upper urinary tract; less commonly indi- ■ Open abdominal drainage
○ Hypoproteinemia (leakage into peritoneal cated) to confirm site of disruption before ■ Closed suction drainage
cavity, decreased production); hyperglobu- surgery ■ Vacuum-assisted drainage
linemia associated with FIP • Coagulation profile (p. 1325): DIC • Postoperative intensive care with continuous
○ Hypoglycemia or hyperglycemia: blood monitoring of animal until peritonitis has
glucose ≥ 20 mg/dL (≥1.1 mmol/L) TREATMENT resolved
higher than peritoneal fluid glucose
may be predictive of septic peritonitis; Treatment Overview Nutrition/Diet
> 38 mg/dL is even more sensitive and • Patients with primary peritonitis (e.g., FIP) • Early nutritional support decreases length of
specific for septic peritonitis require supportive care and specific medical hospitalization and reduces mortality rates.
○ Lactate: peritoneal fluid lactate concen- treatment of the underlying cause. • Feeding tube placement (pp. 1106 and 1107)
tration > 2 mmol/L greater than blood • Patients with secondary peritonitis often if anorexic
lactate concentration may predict septic require surgical exploration of the abdomen. • Coax feeding (p. 1199)
peritonitis in the dog. ○ Surgical correction of the cause
○ Hyperbilirubinemia: bile leakage (bile ○ Peritoneal lavage and possible drainage Recommended Monitoring
peritonitis) or sepsis ○ Intensive postoperative care Depends on cause of peritonitis; see chapters
• Urinalysis: avoid cystocentesis in animals with • Many cases with secondary nonseptic on Peritonitis (pp. 779 and 1439), Sepsis and
peritonitis; catheter is preferable (indwelling peritonitis (e.g., severe pancreatitis) may Septic Shock (p. 907), Systemic Inflammatory
may be desired for critical cases; contrast have elements favoring and disfavoring Response Syndrome, and Multiple Organ
cystography for uroperitoneum and monitor- surgical exploration, and consultation with an Dysfunction Syndrome (p. 665).
ing urine production) internist or a surgeon should be considered
• Survey abdominal radiographs: findings sug- for optimal planning. PROGNOSIS & OUTCOME
gesting peritonitis include presence of free
fluid (causing loss of serosal detail) and/or Acute General Treatment • Varies, depending on underlying cause
free gas (causing mottling throughout viscera • Correction of fluid and electrolyte • FIP in cats is fatal.
or gas cap effect [clearest with horizontal abnormalities
beam radiograph]), evidence of ileus, and ○ Hypovolemia PEARLS & CONSIDERATIONS
mass effect(s). ○ Hypokalemia (p. 1240): potassium
• Abdominal ultrasound exam supplementation Comments
○ Integrity of organs ○ Hyperkalemia (p. 1235): potassium-free Septic peritonitis cases can rapidly deteriorate
○ Evaluate mass(es). fluids: 0.9% NaCl and require continuous assessment.
○ Confirm presence of fluid and obtain • Blood products (p. 1169) if necessary
sample for analysis (see below). ○ Whole blood (if anemia or bleeding Technician Tips
• Abdominal fluid analysis disorder) Patients with septic peritonitis are often in a
○ Obtain fluid by ultrasound-guided ○ Packed red cells (if anemia) critical state and require intensive care. Tech-
abdominocentesis (p. 1056) (preferable ○ Fresh-frozen plasma (if hypoproteinemia nicians treating and caring for these patients
to blind abdominocentesis or diagnostic or coagulopathy) should be familiar with and competent in a
peritoneal lavage) • Appropriate antimicrobial therapy if septic number of intensive care techniques:
○ Glucose, lactate concentrations (see Initial ○ Empirical therapy (aerobic and anaerobic • Fluid and blood component therapy
Database, serum biochemistry profile, above) coverage) • Intensive patient monitoring, including blood
○ Urea nitrogen, creatinine concentrations: ■ Second-generation cephalosporin pressure, CBC, serum biochemistry profile,
fluid/blood creatinine concentration ratio (cefoxitin 30 mg/kg IV q 2h during blood gases, and urine output
≥ 2 : 1 highly predictive of uroabdomen the perioperative period, then q 6h) • Nutritional support
in the dog ■ Combination therapy: enrofloxacin • Analgesia
○ Electrolytes: fluid/blood potassium con- 2.5-5 mg/kg (diluted 1 : 1 in sterile
centration ratio ≥ 1.4 : 1 highly predictive saline and given by slow IV q 12h; SUGGESTED READING
of uroabdomen in the dog for cats, do not exceed 5 mg/kg/day) in Kirby BM: Peritoneum and retroperitoneum. In
○ Bilirubin concentration: fluid bilirubin combination with ampicillin 22 mg/kg Johnston SA, et al, editors: Veterinary surgery—
concentration > serum concentration IV q 6h or metronidazole 10-15 mg/ small animal, ed 2, St. Louis, 2018, Elsevier, pp
highly suggestive of bile peritonitis kg IV q 12h 1610-1631.
○ Cytology ○ Ultimately based on culture results
Neutrophils (Inflammation: increased • Appropriate analgesia because most of these
■ ADDITIONAL SUGGESTED
count, nondegenerative, no intracellular patients are in pain. READINGS
bacteria. Septic peritonitis: increased ○ Opioids
count, toxic changes, intracellular ○ Avoid NSAIDs in septic patients Bonczynski JJ, et al: Comparison of peritoneal fluid
bacteria) • Surgical exploration of abdomen to identify and peripheral blood pH, bicarbonate, glucose,
Plant material: GI leakage and correct underlying cause of peritonitis if and lactate concentration as a diagnostic tool
■ for septic peritonitis in dogs and cats. Vet Surg
Bacteria: Gram stain to aid choice of appropriate (e.g., septic peritonitis; uroabdo-
■ 32:161-166, 2003.
antibiotic therapy pending culture men; bile peritonitis) Grimes JA, et al: Identification of risk factors for
results ○ Thorough lavage of the abdominal cavity septic peritonitis and failure to survive following
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