peritonitis

RE: peritonitis

Julie Innes — Fri, 27 Sep 2019 18:33:52 GMT

yay! Brilliant news

RE: peritonitis

Clive Ansell — Fri, 27 Sep 2019 18:19:08 GMT

RE: peritonitis

Gillian Mostyn — Fri, 27 Sep 2019 17:44:04 GMT

He's aok.

RE: peritonitis

David Mills — Sun, 22 Sep 2019 17:28:46 GMT

No problem, it came from a similar case I had a few years ago, and it was in the BSAVA formulary then - just checked and it still is so must still be considered OK. I guess with reduced appetite absorption is going to be reduced so parenteral the way to go initially. Glad the dog is doing better, hopefully continues.

RE: peritonitis

Gillian Mostyn — Sun, 22 Sep 2019 14:26:04 GMT

Thanks all for trying to help, but I'm very grateful to David Mills On Saturday morning I contacted the vet working this weekend and she actually went to the dog's home to give him s/c MTZ (she didn't know you could do that either) and synulox....PTS booked today INI as he really wasn't very well.

BUT he's loads better today, eating and had a short walk to the park!!!

Not out of the woods, but the progress is very promising.

Sometimes I can't see the wood for the trees .... very glad I asked for help. Seems obvious now.

RE: peritonitis

Gillian Mostyn — Sat, 21 Sep 2019 12:13:11 GMT

[quote user="David Mills"]Yes you can use it sq, same prep, same volume. It's useful for those cases where no IV. I assumed this dog wasn't hospitalised due to cost, but agree use iv if so, it is easier. [/quote]

Thank you...really helpful.

No, not hospitalised after first 2 days.

RE: peritonitis

David Mills — Sat, 21 Sep 2019 09:58:58 GMT

Yes you can use it sq, same prep, same volume. It's useful for those cases where no IV. I assumed this dog wasn't hospitalised due to cost, but agree use iv if so, it is easier.

RE: peritonitis

Anthony Todd — Sat, 21 Sep 2019 09:44:41 GMT

[quote user="Gillian Mostyn"] - no significant gut surgery done,[/quote]

Sorry, I didn't realise that [a friend has just had about his 4th gut surgery, stomas for years etc so i was imagining something similar.]

RE: peritonitis

vetbl.locum — Sat, 21 Sep 2019 09:03:38 GMT

[quote user="David Mills"]

Iv meds hardly ever if ever indicated in our patients, to my mind (im just as quick).

[/quote]

That maybe true but instead of multiple IM and/or large volume SC if have IV catheter in place why not use it?

Surely the patient will be happier?

IV metronidazole is same price as SC metronidazole!

RE: peritonitis

Gillian Mostyn — Sat, 21 Sep 2019 08:45:57 GMT

Thanks all.

I'm obv being a bit slow here, but I've only ever used mdz IV. Is it the same preparation given s/c or a different prep?

Absolutely agree we should have given the synulox s/c ... lots of case handovers (I'm only there one day a week) so just didn't get started when it was becoming clear the tablets weren't getting in there. No deliberate omission.

RE: peritonitis

Michael Woodhouse — Fri, 20 Sep 2019 23:28:18 GMT

[quote user="David Mills"]Sq will do. Both mdz and amoxclav can be given that way once a day. [/quote]

I often send farmers home with injectable antibiotics for pets - it's so much easier and often cheaper!

RE: peritonitis

Beats — Fri, 20 Sep 2019 22:48:06 GMT

Ideally I'd vastly prefer to open up and flush/suction with 10L or so and check for any bits of leaking intestines, but you say that is not an option, so:

[quote user="Gillian Mostyn"]marbocyl[/quote]

This is exactly the sort of case that I confess I bring out vitamin-M in. I'd give at 4mg/kg SC daily.

I'd give amox/clav (eg synulox RTU) once daily SC also at a decent dose also.

And I'd give metronidazole SC once or twice daily at decent dose also.

Marbocyl has virtually no anaerobic activity, so probably worth adding at least one of amoxicillin/metronidazole/clindamycin to it in case like this.

A needle tap of the abdo, ideally after checking is free-fluid wiht ultrasound, might be of some value... or not...

RE: peritonitis

David Mills — Fri, 20 Sep 2019 22:35:17 GMT

[quote user="Gillian Mostyn"]He was also on metronidazole and co-amox until a couple of days ago but he really was a nightmare to tablet and he wasn't hospitalised for IV meds[/quote]

Sq will do. Both mdz and amoxclav can be given that way once a day.

Iv meds hardly ever if ever indicated in our patients, to my mind (im just as quick).

I don't think there's an answer to the sx question. Don't think you did anything wrong.

RE: peritonitis

Gillian Mostyn — Fri, 20 Sep 2019 20:38:17 GMT

Thanks David.

He was also on metronidazole and co-amox until a couple of days ago but he really was a nightmare to tablet and he wasn't hospitalised for IV meds. But, you're right, maybe them stopping was responsible for the deterioration..... . But he is one of those dogs that no matter how far back you eventually manage to get the tablet, he retches it back out again.

I agree ... I don't think metacam is doing much. He was also on paracetamol for the first few days.

I didn't separate all the guts out at the first surgery. Just elevating them and dissecting out the affected area caused a lot of bleeding and needed sharp dissection. It would certainly not have been possible to gently tease them apart. I assumed that the degree of haemorrhage and likelihood of adhesions reforming immediately would make it pointless anyway. And the dog was still eating, with no v+, right up to the day of surgery. (Hence why it was in there for so long). Just for next time .() do it you think it would be better to separate them all out?

RE: peritonitis

David Mills — Fri, 20 Sep 2019 18:49:42 GMT

Maximise abx coverage, add metronidazole and amox/clav. Throw as many abx you can at these, they can come round.

Have used c/St in the past. Generally find nsaids about as useful as water for visceral inflammatory pain. Cat are used in some human variants of peritonitis.

RE: peritonitis

Gillian Mostyn — Fri, 20 Sep 2019 18:19:12 GMT

Thanks all - sticking with the metacam.

We're giving him until tomorrow.

RE: peritonitis

Julie Innes — Fri, 20 Sep 2019 17:54:24 GMT

Hate cases like these . I went to a good lecture on septic peritonitis a couple of weeks ago at Scottish BSAVA, so had a look through my notes for you, but no mention of steroids, so no help to you really! there was some interesting stats about measuring lactate levels for prognosis, but the lecturer said post surgery it was less informative/ useful, so no real help there either! Anything on abdominocentesis? I suppose cytology of any fluid in house would be somewhat useful. Otherwise it seems you are doing all you can. I suppose there could be necrotic gut/ areas of penetration that went undetected, but if exlap is not on the cards you can't know, and it sounds like it would be a marathon effort to go back in!

I would throw lots of antibiotics at it, but as he can't take tablets it does limit your choices! Good luck

RE: peritonitis

Anthony Dennison — Fri, 20 Sep 2019 17:51:34 GMT

Did you separate out all the intestines once sorted or did they stay all adhesed together? Could there be some strictures present now?

Generally if it was that bad initially unfortunately it will probably need surgery.

Weird, we've had a run of nasty peritonitis cases too.

RE: peritonitis

Gillian Mostyn — Fri, 20 Sep 2019 17:21:32 GMT

[quote user="Clive Ansell"]Would an US scan and abdominocentesis looking for free fluid be out of the question?[/quote]

Unfortunately yes - no ultrasound here.

I know I am too emotionally invested - gorgeous little stoic border terrier. Grasping at straws.

Tony - no significant gut surgery done, only had a small hole closed where skewer was poking through. Doesn't rule out septic peritonitis, I know.

As far as 'quick ex lap' - if you'd seen the state of the gut 1 week ago during the last ex-lap, you'd know that is impossible in this dog. It would take hours to simply exteriorise and investigate the gut loops. He is passing normal faeces so gut is certainly patent.

RE: peritonitis

Clive Ansell — Fri, 20 Sep 2019 17:11:50 GMT

Would an US scan and abdominocentesis looking for free fluid be out of the question?

RE: peritonitis

Anthony Todd — Fri, 20 Sep 2019 17:08:42 GMT

Leaking anastomosis? Leaking bowel? Stricture? Even I can't see the rationale for the roids unless you include ABs

Um, the "quick ex-lap between appointments will be rewarding and may save the dog?