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Peritonitis, Septic 1439

Peritonitis, Septic
VetBooks.ir

History:
• Abdominal pain Suspicion of peritonitis Examination:
• Abdominal pain
• Anorexia • Fever
• Depression • Peritoneal effusion
• Vomiting • Shock, dehydration
• Recent abdominal surgery • “Praying” posture
• Penetrating abdominal wound
Abdominocentesis:
Diagnostic investigation • Single tap or 4-quadrant
• Ultrasound guided if necessary
Diagnostic imaging: • Diagnostic peritoneal lavage
Radiographs: (if no fluid produced by
• Free fluid abdominocentesis and
• Free air (normal if <14 days peritonitis still suspected)
postoperatively)
• Ileus Peritoneal fluid
Ultrasonography: Cytology:
• Free fluid • Diff-Quik and Gram stain
• Localize primary problem
Degenerative neutrophils

Intracellular bacteria

Culture and sensitivity
Septic peritonitis confirmed Fluid analysis:
• Fluid lactate > serum
• Fluid glucose < serum
Preoperative treatment:
• Baseline CBC, serum biochemistry
profile +/- blood gas analysis +/-
coagulation profile
• Intravenous fluid therapy
• Intravenous broad-spectrum
bactericidal antibiotics
• Analgesics

Surgical treatment

Celiotomy: Treat primary problem: Peritoneal lavage:
• Xyphoid to pubis • Locate and remove, if possible • Isotonic crystalloid fluid at body
• Suction fluid • Consider serosal patching temperature: at least 200-300 mL/kg
• Thorough exploration • Consider omentalization or until returning fluid is clear

Open peritoneal drainage
Primary celiotomy closure: • Cases not permitting primary celiotomy
• Monobacterial infection closure (see Primary celiotomy in cell to left)
• Source of peritonitis removed Clinical Algorithms
• Minimal residual contamination
• No intensive care capabilities
• No colloids or plasma available Postoperative treatment: Delayed closure
• Use closed suction drain • Special consideration to fluid and electrolyte • Closing culture
balance, hypoproteinemia, hypoglycemia
• B lood transfusion, plasma, colloids
as required
• Parenteral antimicrobial therapy, adjust as
required on basis of culture and sensitivity
• Nutritional support
(Modified from Slatter DH: Textbook of small animal surgery, ed 3, St. Louis, 2003, Saunders.)

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