Thursday, February 28, 2013

Effect of intraurethral administration of atracurium besylate in male cats with urethral plugs


Effect of intraurethral administration of atracurium besylate in male cats with urethral plugs

  1. F. Galluzzi1
  2. F. De Rensis2
  3. A. Menozzi2
  4. G. Spattini1
Article first published online: 2 JUL 2012
DOI: 10.1111/j.1748-5827.2012.01239.x
Journal of Small Animal Practice

Journal of Small Animal Practice

Volume 53Issue 7pages 411–415July 2012

Objective

To evaluate the effect of intraurethral administration of atracurium besylate for urinary obstruction resulting from urethral plugs in male cats.

Methods

Forty-five male cats were divided into the treatment group (n=25), in which 4 mL atracurium besylate solution (0·5 mg/mL) was injected into the urethral lumen, and the control group (n=20), treated with saline. All cats were then submitted to retrograde flushing until the removal of the occlusion was obtained.

Results

The percentage of cats in which the plug was removed at the first attempt was significantly (P<0·05) higher in the treatment group (64%) than in the control group (15%). Moreover, the mean (±SD) time required for the removal of the urethral obstruction was significantly shorter in the treatment group than in the control group (21·1 ±16·2 seconds versus 235·2 ±132·4 seconds; P<0·001).

Clinical Significance

The results of this study indicate that in adult male cats with urethral plugs, urethral administration of atracurium besylate increases the proportion of animals in which the obstruction is removed at the first attempt and reduces the time required to remove the urethral plugs

Acid-base and biochemical stabilization and quality of recovery in male cats with urethral obstruction and anesthetized with propofol or a combination of ketamine and diazepam.


Logo of cjvetres


 2012 Jul;76(3):201-8.


Acid-base and biochemical stabilization and quality of recovery in male cats with urethral obstruction and anesthetized with propofol or a combination of ketamine and diazepam.

Source

Rural Science Center, Federal University of Santa Maria, 97105-900, Santa Maria, RS, Brazil.

Abstract

This study compared acid-base and biochemical changes and quality of recovery in male cats with experimentally induced urethral obstruction and anesthetized with either propofol or a combination of ketamine and diazepam for urethral catheterization. Ten male cats with urethral obstruction were enrolled for urethral catheterization and anesthetized with either ketamine-diazepam (KD) or propofol (P). Lactated Ringer's solution was administered by intravenous (IV) beginning 15 min before and continuing for 48 h after relief of urethral obstruction. Quality of recovery and time to standing were evaluated. The urethral catheter was maintained to measure urinary output. Hematocrit (Hct), total plasma protein (TPP), albumin, total protein (TP), blood urea nitrogen (BUN), creatinine, pH, bicarbonate (HCO3-), chloride, base excess, anion gap, sodium, potassium, and partial pressure of carbon dioxide in mixed venous blood (pvCO2) were measured before urethral obstruction, at start of fluid therapy (0 h), and at subsequent intervals. The quality of recovery and time to standing were respectively 4 and 75 min in the KD group and 5 and 16 min in the P group. The blood urea nitrogen values were increased at 0, 2, and 8 h in both groups. Serum creatinine increased at 0 and 2 h in cats administered KD and at 0, 2, and 8 h in catsreceiving P, although the values were above the reference range in both groups until 8 h. Acidosis occurred for up to 2 h in both groups. Acid-base and biochemical stabilization were similar in cats anesthetized with propofol or with ketamine-diazepam. Cats that received propofol recovered much faster, but the ketamine-diazepam combination was shown to be more advantageous when treating uncooperative cats as it can be administered by intramuscular (IM) injection.


Table I

Wednesday, February 27, 2013

Clinical outcome and diseases associated with extreme neutrophilic leukocytosis in cats: 104 cases (1991–1999)



 cover

Abstract
March 1, 2001, Vol. 218, No. 5, Pages 736-739
doi: 10.2460/javma.2001.218.736

Clinical outcome and diseases associated with extreme neutrophilic leukocytosis in cats: 104 cases (1991–1999)

Michael D. LucroyDVM, MS, DACVIM Bruce R. MadewellVMD, MS, DACVIM
Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616. (Lucroy, Madewell); Present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078. (Lucroy)
Objective
To describe diseases, prognosis, and clinical outcomes associated with extreme neutrophilic leukocytosis in cats.

Design
Retrospective study.

Animals
104 cats with extreme neutrophilic leukocytosis.

Procedure
Medical records from 1991 to 1999 were examined to identify cats that had ≥ 50,000 WBC/µl with ≥ 50% neutrophils. Signalment, absolute and differential WBC counts, rectal temperature, clinical or pathologic diagnosis, duration and cost of hospitalization, and survival time were reviewed.

Results
Mean age of cats was 8.3 years, mean WBC count was 73,055 cells/µl, and mean absolute neutrophil count was 59,046 cells/µl. Mean duration of hospitalization was 5.9 days, and mean cost of hospitalization was $2,010. Twenty-nine (28%) cats were febrile, and 63 (61%) cats died. Overall median survival time was 30 days. Cats with neoplasia were nearly 14 times as likely to die unexpectedly as cats with other diseases.

Conclusions and Clinical Relevance
Extreme neutrophilic leukocytosis was associated with a high mortality rate. The prognostic importance of extreme neutrophilic leukocytosis should not be overlooked. Cats and dogs have similar diseases, mortality rates, and treatment costs associated with extreme neutrophilic leukocytosis. (J Am Vet Med Assoc 2001;218:736–739)

A case-controlled retrospective study of the causes and implications of moderate to severe leukocytosis in dogs in South Africa


A case-controlled retrospective study of the causes and implications of moderate to severe leukocytosis in dogs in South Africa

  1. Sandra M. Weltan1
  2. Andrew L. Leisewitz2,
  3. Amelia Goddard3
Article first published online: 2 JUN 2008
DOI: 10.1111/j.1939-165X.2008.00037.x
Veterinary Clinical Pathology

Veterinary Clinical Pathology

Volume 37Issue 2pages 164–172June 2008

Keywords:

  • Dog;
  • hypoalbuminemia;
  • lymphocytosis;
  • monocytosis;
  • neutrophilia;
  • thrombocytopenia
Background: Previous studies showed that dogs with extreme leukocytosis had specific types of diseases, long hospitalization times, and high mortality rates.
Objectives: The aim of this study was to determine whether dogs with moderate to severe leukocytosis are likely to have similar results compared with age-matched control dogs.
Methods: Records at the Onderstepoort Veterinary Academic Hospital, University of Pretoria, were examined retrospectively from dogs with ≥35 × 109 WBC/L (Leukocytosis Group) and dogs with ≤30 × 109 WBC/L and ≤0.5 × 109 band neutrophils/L (Control Group). Hematologic and serum protein data, final diagnosis, and effect of glucocorticoid treatment were compared between groups.
Results: One hundred eighty-two dogs were included in the Leukocytosis Group and 179 in the Control Group. Compared with dogs in the Control Group, significantly more dogs in the Leukocytosis Group had infections, babesiosis, immune-mediated hematologic disease, and necrosis. Hospitalization time and neutrophil, lymphocyte, and monocyte counts were significantly higher and HCT, eosinophil count, platelet count, and serum albumin concentration were lower in dogs in the Leukocytosis Group (P<.0001). There was no difference in leukocyte counts between glucocorticoid-treated and non-glucocorticoid-treated dogs. Survival did not differ between Leukocytosis and Control Groups; however, a significant relationship was found between total neutrophil (mature+band) count and survival (P=.01).
Conclusions: Dogs with leukocytosis of ≥35 × 109/L are more likely to have bacterial and fungal infections, complicated babesiosis, immune-mediated hematologic disease, and necrosis. The total neutrophil count has a significant impact on outcome

Monday, February 25, 2013

High intravascular tissue factor expression in dogs with idiopathic immune-mediated haemolytic anaemia

Cover image

Volume 144, Issues 3–4, 15 December 2011, Pages 346–354



High intravascular tissue factor expression in dogs with idiopathic immune-mediated haemolytic anaemia

  • a Department of Clinical Sciences of Companion Animals, Utrecht, Utrecht University, PO Box 80154, 3508 TD Utrecht, The Netherlands
  • b Central Institute for Animal Disease Control, PO Box 2004, 8203 AA Lelystad, The Netherlands
  • Abstract

    A high mortality occurs in dogs with idiopathic immune-mediated haemolytic anaemia (IMHA) during the first 2 weeks after the diagnosis. The aim of this study was to investigate the inflammatory response and coagulation abnormalities in dogs with IMHA in relation to the prognosis and to establish the contribution of whole blood tissue factor (TF) and IL-8 gene expressions.
    Gene expressions in dogs with IMHA were compared to healthy dogs, dogs with DIC, dogs with sepsis, and in two groups of dogs that underwent intensive care treatment but had no evidence for either DIC or sepsis. The whole blood TF and IL-8 expressions were up regulated in all non-IMHA groups. Similarly, the TF expression in IMHA dogs was high, but the intravascular IL-8 expression was not increased.
    The dogs with IMHA had a pronounced inflammatory response that included a high WBC, left shift and monocytosis in comparison to the other disease groups. Coagulation factor activities in IMHA dogs were decreased fitting consumptive coagulopathy and the acute phase proteins FVIII and fibrinogen were increased. The platelet parameters suggested platelet activation and high platelet turnover in IMHA dogs. The model that best explained mortality contained monocytosis, increased activated partial thromboplastin time and elevated creatinine.
    Whole blood TF gene expression is up regulated and may contribute to consumptive coagulopathy in dogs with IMHA. Increased TF expression by activated platelets is an alternative explanation and should be investigated.

    Full-size image (30 K)

Erythrocyte-bound immunoglobulin isotypes in dogs with immune-mediated hemolytic anemia: 54 cases (2001–2010

Journal of the American Veterinary Medical Association cover


July 15, 2012, Vol. 241, No. 2, Pages 227-232
doi: 10.2460/javma.241.2.227

Erythrocyte-bound immunoglobulin isotypes in dogs with immune-mediated hemolytic anemia: 54 cases (2001–2010)

Kenneth R. HarkinDVM, DACVIMJill A. HicksDVMMelinda J. WilkersonDVM, PhD, DACVP


Address correspondence to Dr. Harkin ().

Objective
To identify erythrocyte-bound immunoglobulin (Ig) isotypes in dogs with primary immune-mediated hemolytic anemia (IMHA).
Design 
Retrospective case series.
Animals
54 dogs with IMHA.
Procedures
Medical records of dogs with IMHA diagnosed between January 2001 and April 2010 were examined. Immunoglobulin isotype (tested via direct immunofluorescence by flow cytometry to identify erythrocyte-bound Ig), Hct, serum bilirubin concentration, presence of autoagglutination, degree of spherocytosis, duration of hospitalization, and 90-day outcome were recorded.
Results
The Hct on admission was significantly lower in dogs with IgG and IgM isotypes bound to erythrocytes, compared with dogs with a single Ig isotype, and the degree of spherocytosis was greater in dogs with IgG and IgM bound to erythrocytes, compared with dogs that only had IgM. Dogs with only IgM were not more likely to have autoagglutination, compared with dogs that only had IgG on the erythrocyte surface. Although Ig isotype was not associated with survival time, initial serum total bilirubin concentration was higher in nonsurvivors.
Conclusions and Clinical Relevance
Results suggested that dogs with IMHA with ≥ 2 Ig isotypes bound to erythrocytes, particularly IgG and IgM, are likely to have a more severe degree of anemia, spherocytosis, and autoagglutination.

Perinuclear antineutrophil cytoplasmic autoantibodies in dogs infected with various vector-borne pathogens and in dogs with immune-mediated hemolytic anemia

American Journal of Veterinary Research cover


September 2012, Vol. 73, No. 9, Pages 1403-1409
doi: 10.2460/ajvr.73.9.1403

Perinuclear antineutrophil cytoplasmic autoantibodies in dogs infected with various vector-borne pathogens and in dogs with immune-mediated hemolytic anemia

Anna E. KaragianniDVM, MResLaia Solano-GallegoDVM, PhDEdward B. BreitschwerdtDVMFrédéric P. GaschenDr med vet, Dr habilMichael J. DayBVMS, PhD, DScMichele TrottaDVM, PhDBarbara WielandDr med vet, PhDKarin AllenspachDr med vet, PhD



Address correspondence to Dr. Allenspach ().

Objective
To determine the prevalence of perinuclear antineutrophil cytoplasmic autoantibodies (pANCA) in dogs with confirmed or suspected immune-mediated hemolytic anemia (IMHA) or dogs infected with various vector-borne pathogens, including Rickettsia rickettsii, Bartonella henselae, Bartonella vinsonii subsp berkhoffii, Ehrlichia canis, Borrelia burgdorferi, and Leishmania infantum.
Animals
55 dogs with confirmed or suspected IMHA, 140 dogs seroreactive for vector-borne pathogens, and 62 healthy dogs and dogs seronegative for vector-borne pathogens.
Procedures
Samples were allocated to subgroups on the basis of the health status of the dogs and the degree of seroreactivity against various vector-borne pathogens. Serum samples were tested retrospectively via indirect immunofluorescence assay to determine pANCA status.
Results
26 of 55 (47%) dogs with confirmed or suspected IMHA and 67 of 140 (48%) dogs seroreactive for vector-borne pathogens had positive results when tested for pANCA. Serum samples with the highest antibody concentrations against L infantum antigen had the highest proportion (28/43 [65%]) that were positive for pANCA. One of 20 (5%) dogs seronegative for tick-borne pathogens and 8 of 22 (36%) dogs seronegative for L infantum had positive results for pANCA. One of 20 (5%) healthy dogs had serum antibodies against pANCA.
Conclusions and Clinical Relevance
pANCA were detected in a high percentage of dogs with IMHA and vector-borne infectious diseases. Therefore, pANCA may be a relatively nonspecific marker for dogs with inflammatory bowel disease, although they could represent a biomarker for immune-mediated diseases and infections.

Sunday, February 24, 2013

Retrospective evaluation of presenting temperature of urethral obstructed male cats and the association with severity of azotemia and length of hospitalization: 243 cats (2006–2009)


Retrospective evaluation of presenting temperature of urethral obstructed male cats and the association with severity of azotemia and length of hospitalization: 243 cats (2006–2009)

  1. Mitchell Fults DVM*
  2. Lee V. Herold DVM, DACVECC
Article first published online: 21 MAY 2012
DOI: 10.1111/j.1476-4431.2012.00733.x
Journal of Veterinary Emergency and Critical Care

Journal of Veterinary Emergency and Critical Care

Volume 22Issue 3pages 347–354June 2012


Keywords:

  • azotemia;
  • lower urinary tract;
  • renal/urinary tract;
  • small animal;
  • urethral obstruction

Abstract

Objectives

To evaluate whether the presenting rectal temperature and level of azotemia predicts the length of hospitalization (LOH) in a population of obstructed male cats. To describe the relationships between physical examination parameters, blood electrolytes, and azotemia in a clinical population of obstructed male cats.

Design

Retrospective clinical study.

Setting

Emergency and referral specialty hospitals.

Animals

Two hundred and forty-three male cats that presented with urethral obstruction between 2006 and 2009.

Interventions

None.

Measurements and Main Results

No significant association between the hours of hospitalization and rectal temperature was detected (P = 0.39). Blood urea nitrogen (BUN) and creatinine (CREA) concentrations were positively correlated with LOH (P < 0.01). BUN and CREA were significantly higher (P < 0.01) for the hypothermic group compared to the normothermic group. Potassium was negatively correlated to heart rate and rectal temperature but positively correlated to BUN and CREA.

Conclusion

No association with regard to rectal temperature and LOH could be demonstrated in this population of cats. However, the presence of azotemia in obstructed male cats appears to provide the clinician with additional information regarding the necessary LOH and eventual cost to the client.

Thursday, February 21, 2013

Assessment of the variation in American Society of Anaesthesiologists Physical Status Classification assignment in small animal anaesthesia


Assessment of the variation in American Society of Anaesthesiologists Physical Status Classification assignment in small animal anaesthesia

  1. Matthew McMillan*
  2. Jacqueline Brearley
Article first published online: 12 FEB 2013
DOI: 10.1111/vaa.12007


Abstract

Objective

To evaluate the interobserver variability in the assignment of the American Society of Anesthesiologists Physical Status Classification (ASA-PSC) to compromised small animal patients amongst a group of veterinary anaesthetists.

Study design

Anonymous internet survey.

Animals

Hypothetical case presentations.

Methods

Sixteen hypothetical small animal cases with differing degrees of physiological or patho-physiological compromise were presented as part of an internet survey. Respondents were asked to assign a single ASA-PSC to each case and also to answer a number of demographic questions. ASA-PSC scores were considered separately and then grouped as scores of I–II and III–V. Agreement was analysed using the modified kappa statistic for multiple observers. Data were then sorted into various demographic groups for further analysis.

Results

There were 144 respondents of which 60 (~42%) were anaesthesia diplomates, 24 (~17%) were post-residency (nondiploma holders), 24 (~17%) were current anaesthesia residents, 21 (~15%) were general practitioners, 12 (~8%) were veterinary nurses or technicians, and 3 (~2%) were interns. Although there was a majority agreement (>50% in a single category) in 15 of the 16 cases, ASA-PSC were spread over at least three ASA-PS classifications for every case. Overall agreement was considered only fair (κ = 0.24, mean ± SD agreement 46 ± 7%). When comparing grouped data (ASA-PSC I–II versus III-V) overall agreement remained fair (κ = 0.36, mean ± SD agreement 69 ± 19%). There was no difference in ASA-PSC assignment between any of the demographic groups investigated.

Conclusions and clinical relevance

This study suggests major discrepancies can occur between observers given identical information when using the ASA-PSC to categorise health status in compromised small animal patients. The significant potential for interobserver variability in classification allocation should be borne in mind when the ASA-PSC is used for clinical, scientific and statistical purposes.

Monday, February 18, 2013

Diffuse Bacterial Peritonitis in Dogs and Cats: Considerations About Surgical Management


Diffuse Bacterial Peritonitis in Dogs and Cats: Considerations About Surgical Management
World Small Animal Veterinary Association World Congress Proceedings, 2009
Theresa W. Fossum, DVM, MS, PhD, DACVS
Texas A&M University College of Veterinary Medicine, College Station, TX, USA
19506706
Peritonitis is inflammation of the peritoneal cavity. It may be primary (e.g., hematogenous infection of the peritoneum as in feline infectious peritonitis) or secondary (i.e., resulting from chemical or septic contamination of the peritoneal cavity) and may be generalized (i.e., diffuse) or localized (i.e., only a small portion of the abdomen is involved). Chemical peritonitis is caused by the effect of irritating agents on the peritoneum (e.g., bile, urine, pancreatic secretions).
Diagnosis
Signalment
Any age, sex, or breed of dog or cat may develop peritonitis. It is particularly common in young animals that have perforating foreign bodies and in those that receive abdominal trauma (i.e., vehicular trauma and bite wounds).
History
The history is often nonspecific. The animal may not show signs of illness for several days after the traumatic episode. Mesenteric avulsions often do not cause clinical signs of peritonitis for 5 to 7 days after the injury. Animals with traumatic bile peritonitis may be asymptomatic for several weeks after the injury. Most animals are presented for lethargy, anorexia, vomiting, diarrhea, and/or abdominal pain.
Physical Examination Findings
Affected animals are usually painful on abdominal palpation. The pain may be localized but generalized pain is more common and the animal will often tense or "splint" the abdomen during palpation. Vomiting and diarrhea may be noted. Abdominal distension may be noted if sufficient fluid has accumulated. Pale mucous membranes, prolonged capillary refill times, and tachycardia may indicate that the animal is in shock. Dehydration and arrhythmias may also occur.
Radiography/Ultrasonography
The classic radiographic finding in animals with peritonitis is loss of abdominal detail with a focal or generalized "ground-glass" appearance. The intestinal tract may be dilated with air and/or fluid. Free air in the abdomen may be noted with rupture of a hollow organ or sometimes occurs with gas-producing anaerobes, without gut rupture. A more localized peritonitis may occur secondary to pancreatitis and cause the duodenum to appear fixed and elevated. Ultrasonography is useful to localize fluid accumulation and help determine etiology.
Laboratory Findings
The most common laboratory finding in animals with peritonitis is a marked leukocytosis. The predominant cell type is the neutrophil and a left shift is often apparent. Other abnormalities may include anemia, dehydration, and electrolyte and acid-base abnormalities. Following abdominocentesis, the amount of blood in the abdominal cavity can be estimated by observing the lavage sample. A red color reflects the presence of RBCs and a deep-red color usually indicates severe hemorrhage. If newsprint cannot be read through the plastic tubing, then hemorrhage is significant. If print can be seen through the tubing, only moderate or minimal hemorrhage is present. Surgical intervention is indicated when there is a substantial increase in the PCV of lavage samples taken within 5 to 20 minutes of each other, or if an animal in shock does not respond to aggressive fluid therapy.
Surgical Treatment
Abdominocentesis (see below) is the percutaneous removal of fluid from the abdominal cavity, usually for diagnostic purposes, although it may occasionally be therapeutic. Indications include shock without apparent cause, undiagnosed disease with signs involving the abdominal cavity, suspicion of postoperative GI dehiscence, blunt or penetrating abdominal injuries (i.e., gunshot wounds, dog bites, automobile accidents), and undiagnosed abdominal pain. A multifenestrated catheter should be used to enhance fluid collection. Physical and radiographic examinations should precede abdominocentesis to rule out instances where it may not be safe and to guide needle placement. Four-quadrant paracentesis may be performed if simple abdominocentesis is not successful in retrieving fluid. It is similar to simple abdominocentesis except that multiple abdominal sites are assessed by dividing the abdomen into four quadrants through the umbilicus and tapping each of these four areas. Diagnostic peritoneal lavage should be performed in animals with suspected peritonitis if the above methods are unsuccessful in obtaining fluid for analysis Exploratory surgery is indicated when the cause of peritonitis cannot be determined or when bowel rupture, intestinal obstruction (e.g., bowel incarceration, neoplasia), or mesenteric avulsion is suspected. Serosal patching and plication are techniques that decrease the incidence of intestinal leakage, dehiscence, or repeated intussusception. Animals requiring surgery and that have peritonitis secondary to intestinal trauma (disruption of mesenteric blood supply, bowel perforation, chronic intussusception, foreign body) are frequently hypoproteinemic. The role that protein levels play in healing intestinal incisions is not well understood. However, most surgeons are concerned that hypoproteinemic patients may not heal as quickly as patients with normal protein levels despite one study that showed similar complication rates among animals with normal protein levels and those that were hypoproteinemic and undergoing intestinal surgery. Most experimental evidence has shown that retardation of wound healing is not seen with moderate protein depletion but only with severe deficiencies (less than 1.5 to 2 g/dl).
Although the practice of lavaging the abdominal cavity of animals with peritonitis is controversial, lavage is generally indicated with diffuse peritonitis. Lavage should be done with care in animals with localized peritonitis to prevent causing diffuse dissemination of infection. When lavage is performed, as much of the fluid as possible should be removed because fluid inhibits the body's ability to fight off infection, probably by inhibiting neutrophil function. Historically, many different agents have been added to lavage fluids, especially antiseptics and antibiotics. Povidone-iodine is the most widely added antiseptic; however, its use may be contraindicated in established peritonitis. Furthermore, no beneficial effect of this agent has been shown in repeated experimental and clinical trials in animals. Although a great many antibiotics have been added to lavage fluids over the years, there is no substantial evidence that their addition is of any benefit to patients who are being treated with appropriate systemic antibiotics. Warmed sterile physiologic saline is the most appropriate lavage fluid.
Open abdominal drainage (OAD) is a useful technique for managing animals with peritonitis. Reported advantages include improvement in the patient's metabolic condition secondary to improved drainage, reduced abdominal adhesion and abscess formation, and access for repeated inspection and exploration of the abdomen. With this technique the abdomen is left open and sterile wraps are placed around the wound. The frequency of the wrap changes is dependent upon the amount of fluid being drained and the amount of external soiling. Complications of open abdominal drainage include persistent fluid loss, hypoalbuminemia, weight loss, adhesions of abdominal viscera to the bandage, and contamination of the peritoneal cavity with cutaneous organisms.
Anesthesia
Animals with peritonitis are often endotoxic and/or hypotensive. Small amounts of endotoxins are normally absorbed from the intestine and transported via the portal system to the liver, where they are removed and destroyed by hepatocytes. Hypotension in dogs is associated with intense portal vasoconstriction. This vasoconstriction causes breakdown of the intestinal mucosal barrier, allowing increased endotoxin to be absorbed from the intestines. If hepatic function is impaired (common in septic animals), small doses of endotoxin that would normally be nonharmful may be lethal. Thus hypotension should be corrected before and prevented during and after surgery in animals with peritonitis. Animals with total protein less than 4.0 g/dl or albumin less than 1.5 g/dl may benefit from perioperative colloid administration. Colloids may be given preoperatively, intraoperatively, and/or postoperatively for a total dose of 20 ml/kg/day. If colloids are given during surgery (7 to 10 ml/kg), acute intraoperative hypotension should be treated with crystalloids.
Techniques
Abdominocentesis
Insert an 18 or 20-gauge, 1-1/2 inch plastic over-the-needle catheter (with added side holes) into the abdominal cavity at the most dependent part of the abdomen. Do not attach a syringe, instead allow the fluid to drip from the needle and collect it in a sterile tube. If sufficient fluid is obtained, place the fluid in a clot tube, and EDTA tube, submit samples for aerobic and anaerobic culture, and make 4 to 6 smears for analysis. If fluid is not obtained, apply gentle suction using a 3cc syringe. It is difficult to puncture bowel by this method since mobile loops of bowel move away from the tip of the needle as it strikes them. Perforations created by a needle this size usually heal without complications. The major disadvantage of needle paracentesis is that it is insensitive to the presence of small volumes of intraperitoneal fluid and hence a negative result can be meaningless. At least 5 or 6 ml of fluid/kg body weight must be present in the abdominal cavity of dogs to obtain positive results in a majority of cases using this technique.
Diagnostic Peritoneal Lavage
Make a 2-cm skin incision just caudal to the umbilicus and ligate any bleeders to avoid false positive results. Spread loose subcutaneous tissues and make a small incision in the linea alba. Hold the edges of the incision with forceps while the peritoneal lavage catheter (without the trocar) is inserted into the abdominal cavity. Direct the catheter caudally into the pelvis. With the catheter in place, apply gentle suction. If blood or fluid cannot be aspirated, connect the catheter to a bottle of warm sterile saline and infuse 22 ml/kg of fluid into the abdominal cavity. When the calculated volume of fluid has been delivered, roll the patient gently from side to side, place the bottle on the floor, vent it, and collect the fluid by gravity drainage. Do not attempt to remove all the fluid.
Figure 1. Diagnostic peritoneal lavage.
Figure 1. Diagnostic peritoneal lavage.

 
Exploratory Laparotomy
Perform a ventral midline incision from the xiphoid to the pubis. Obtain a sample of fluid for culture and analysis. Explore and inspect the entire abdomen. Find the source of infection and correct it. Break down adhesions that may hinder drainage. Lavage the abdomen with copious amounts of warm sterile saline if the infection is generalized. Remove as much necrotic debris and fluid as possible. Close the abdomen routinely or perform open abdominal drainage.
Open Abdominal Drainage
After completing the abdominal procedure, leave a portion of the abdominal incision (usually the most dependent portion) open to drain. Close the cranial and caudal aspects of the incision with monofilament suture using a continuous suture pattern. Place a sterile laparotomy pad over the opening, then place a sterile wrap over the laparotomy pad. Change the wrap at least twice daily initially with the animal standing (sedation is seldom necessary). Break down adhesions to the incision that may interfere with drainage. Abdominal lavage may be attempted, but is seldom necessary. Place a diaper over the wrap to decrease contamination from urine. Assess the fluid daily for bacterial numbers and cell morphology. When bacterial numbers have decreased and normal neutrophil morphology is present (non-degenerative), close the incision (generally in 3 to 5 days). If the opening is small it may be left to heal by second intention.
Prognosis
The prognosis for animals with generalized peritonitis is guarded; however, with proper and aggressive therapy, many survive. Some authors have suggested that the mortality rate approaches 50%. The mortality rates reported in animals with generalized peritonitis treated with open abdominal drainage have varied from 20% to 48%.
Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)Theresa W. Fossum, DVM, MS, PhD, DACVS
Texas A&M University
College of Veterinary Medicine
College Station, TX