What is a normal amount of peritoneal fluid? < 1ml/kg
- Aspetic
- Spetic (primary, secondary, or tertiary)
Classifications of Peritonitis (4)
- Local
- generalized
Primary Peritonitis AKA spontaneous bacterial peritonitis, peritonitis without an identifiable source
- Hematogenous spread (ex: FIP)
Causes of Primary Peritonitis (2)
- Bacterial translocation (usually from GIT or uterus (pyometra))
non-surgical-- treating the underlying disease process (pyometra, FIP, etc) will improve clinical
Primary Peritonitis is generally
signs
Infectious
- intra-abdominal leakage of bacteria
- infection/abscess from various organs (liver, gall bladder, pancreas, spleen, UG tract, lymph
nodes)
Non-Infectious
Causes of Secondary Peritonitis (7) - Neoplasia (necrotic tumors that have outgrown their blood supply)
- Pancreatitis
- Iatrogenic foreign bodies (surgical gauze)
- bile
- urine
peritonitis of unknown etiology in which fibrous adhesions for around the organs
- poor prognosis as there is a high rate of recurrence after surgical treatment
Sclerosing Encapsulating Peritonitis (2)
- GI (most common)
What body systems are commonly implicated in the etiology of peritonitis? (3) - urogenital
- hepatobiliary
- ideally, mesentery and omentum are able to wall ott the area of inflammation and keep in
contained/localized (this does not always occur)
What is the role of the mesentery and omentum in peritonitis? (2)
- increases blood and lymphatic flow to the area to increase healing
- trauma
- neoplasia
History Commonly Associated with Peritonitis (4)
- recent abdominal surgery
- intact females
- abdominal pain
- abdominal distension
1/5
, - fever
- anorexia
Clinical Signs of Peritonitis (6)
- vomiting
- diarrhea
*Findings early in the course of disease may be minor
1. Evidence of perfusion impairment
- dehydration
PE Findings Common with Peritonitis (5)
- dull mentation
- pale or hyperemic mucus membranes
- weak pulses
- low blood pressure
- presence of free gas in the peritoneum
Pneumoperitoneum (3) - can occur with peritonitis
- NORMAL finding for up to 21 days post-abdominal surgery
- Radiographs (pneumoperitoneum, fluid (loss of serosal detail), areas of ileus, masses)
- Ultrasound (hyperechoic mesentery (indicates inflammation), masses))
Diagnosing Peritonitis (4)
- Bloodwork
- Abdominocentesis
How much fluid must be present in the peritoneum to show up on radiographs? > 8mL/kg
What is the most useful diagnostic for peritonitis? Abdominocentesis-- allows for analysis of peritoneal fluid
*Depend on where in the course of disease the patient is
- leukocytosis
- anemia
Clin Path Findings Common with Peritonitis (6)
- hypoproteinemia
- electrolyte imbalances
- acid-base disturbances
- pre-renal azotemia
- ultrasound guided (least invasive)
Methods of Abdominocentesis (3) - four quadrant technique
- diagnostic peritoneal lavage
Pure Transudate
- non-clotting
- clear to straw colored
Characteristics of Normal Peritoneal Fluid (5)
- < 2.5 g/dL protein
- < 3000 mucleated cells / µL
- 50/50 macrophages and lymphocytes
If you perform ab abdominocentesis and you get bloody fluid that is clotting, what is the most you aspirated an organ or blood vessel-- even bloody fluid from a hemoabdomen usually
likely reason this occurred? does NOT clot
What amount of fluid must be aspirated from an abdominocentesis to be diagnostic? 5-7ml/kg
If you are unable to get the amount of fluid needed for diagnosis from abdominocentesis, Diagnostic Peritoneal Lavage-- 20ml/kg warm, sterile saline added into the abdomen and
what is the alternative method? then resampled-- lavage is diagnostic at 1-3ml/kg
Characteristics of Transudate (2)
2/5
- Aspetic
- Spetic (primary, secondary, or tertiary)
Classifications of Peritonitis (4)
- Local
- generalized
Primary Peritonitis AKA spontaneous bacterial peritonitis, peritonitis without an identifiable source
- Hematogenous spread (ex: FIP)
Causes of Primary Peritonitis (2)
- Bacterial translocation (usually from GIT or uterus (pyometra))
non-surgical-- treating the underlying disease process (pyometra, FIP, etc) will improve clinical
Primary Peritonitis is generally
signs
Infectious
- intra-abdominal leakage of bacteria
- infection/abscess from various organs (liver, gall bladder, pancreas, spleen, UG tract, lymph
nodes)
Non-Infectious
Causes of Secondary Peritonitis (7) - Neoplasia (necrotic tumors that have outgrown their blood supply)
- Pancreatitis
- Iatrogenic foreign bodies (surgical gauze)
- bile
- urine
peritonitis of unknown etiology in which fibrous adhesions for around the organs
- poor prognosis as there is a high rate of recurrence after surgical treatment
Sclerosing Encapsulating Peritonitis (2)
- GI (most common)
What body systems are commonly implicated in the etiology of peritonitis? (3) - urogenital
- hepatobiliary
- ideally, mesentery and omentum are able to wall ott the area of inflammation and keep in
contained/localized (this does not always occur)
What is the role of the mesentery and omentum in peritonitis? (2)
- increases blood and lymphatic flow to the area to increase healing
- trauma
- neoplasia
History Commonly Associated with Peritonitis (4)
- recent abdominal surgery
- intact females
- abdominal pain
- abdominal distension
1/5
, - fever
- anorexia
Clinical Signs of Peritonitis (6)
- vomiting
- diarrhea
*Findings early in the course of disease may be minor
1. Evidence of perfusion impairment
- dehydration
PE Findings Common with Peritonitis (5)
- dull mentation
- pale or hyperemic mucus membranes
- weak pulses
- low blood pressure
- presence of free gas in the peritoneum
Pneumoperitoneum (3) - can occur with peritonitis
- NORMAL finding for up to 21 days post-abdominal surgery
- Radiographs (pneumoperitoneum, fluid (loss of serosal detail), areas of ileus, masses)
- Ultrasound (hyperechoic mesentery (indicates inflammation), masses))
Diagnosing Peritonitis (4)
- Bloodwork
- Abdominocentesis
How much fluid must be present in the peritoneum to show up on radiographs? > 8mL/kg
What is the most useful diagnostic for peritonitis? Abdominocentesis-- allows for analysis of peritoneal fluid
*Depend on where in the course of disease the patient is
- leukocytosis
- anemia
Clin Path Findings Common with Peritonitis (6)
- hypoproteinemia
- electrolyte imbalances
- acid-base disturbances
- pre-renal azotemia
- ultrasound guided (least invasive)
Methods of Abdominocentesis (3) - four quadrant technique
- diagnostic peritoneal lavage
Pure Transudate
- non-clotting
- clear to straw colored
Characteristics of Normal Peritoneal Fluid (5)
- < 2.5 g/dL protein
- < 3000 mucleated cells / µL
- 50/50 macrophages and lymphocytes
If you perform ab abdominocentesis and you get bloody fluid that is clotting, what is the most you aspirated an organ or blood vessel-- even bloody fluid from a hemoabdomen usually
likely reason this occurred? does NOT clot
What amount of fluid must be aspirated from an abdominocentesis to be diagnostic? 5-7ml/kg
If you are unable to get the amount of fluid needed for diagnosis from abdominocentesis, Diagnostic Peritoneal Lavage-- 20ml/kg warm, sterile saline added into the abdomen and
what is the alternative method? then resampled-- lavage is diagnostic at 1-3ml/kg
Characteristics of Transudate (2)
2/5
