Changes

====Ultrasonography====

====Ultrasonography====

This modality has a high sensitivity for the detection of free fluid in the abdomen and it may be used to identify some specific causes of peritonitis, including abscesses of organs or rupture of the [[Biliary Tract - Rupture|biliary tract.

This modality has a high sensitivity for the detection of free fluid in the abdomen and it may be used to identify some specific causes of peritonitis, including abscesses of organs or rupture of the [[Biliary Tract - Rupture|biliary tract]].

Ultrasound scans can also be used to guide '''abdominocentesis'''.

Ultrasound scans can also be used to guide '''abdominocentesis'''.

*Presence of penetrating injuries to the abdomen.

*Presence of penetrating injuries to the abdomen.

===Medical===

===Medical Management===

====Fluid therapy====

====Fluid Therapy====

*Aggressive fluid therapy with [[Crystalloids|crystalloid]] and [[Colloids|colloid]] should be given on initial presentation to improve haemodynamic parameters.

Aggressive fluid therapy with [[Crystalloids|crystalloid]] and [[Colloids|colloid]] should be given on initial presentation to improve haemodynamic parameters and this should be mainatined into the peri- and post-operative periods where appropriate and until the patient is normotensive.  If the patient remaines hypotensive, the use of a vasopressor such as [[Dobutamine|dobutamine]], [[Dopamine|dopamine]] or even [[Vasopressin|vasopressin]] should be considered as animals in septic shock are likely to have systemic peripheral vasodilation.

*Fluid therapy is also very important in the postoperative period.  Both crystalloid and colloid should be continued until the patient is normotensive.  However, if hypotension continues, a vasopressor such as [[Vasopressin|vasopressin]] should be considered.

*If severe metabolic acidosis is present, bicarbonate may be given.

*Septic peritonitis can cause [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation (DIC)]] and therefore plasma can be given to replace clotting factors.

Glucose and potassium should be supplemented where these parameters are found to be abnormal and, in cases of severe metabolic acidosis, the use of sodium bicarbonate may be considered.  This product should be used with care as overdoses may result in overshoot metabolic alkalosis, tissue anoxia due to a left-shift of the haemoglobin-oxygen dissociation curve and paradoxical cerebral acidosis as carbon dioxide (not bicarbonate) crosses the blood brain barrier.

*Broad spectrum antibiotics should be given, preferably following culture and sensitivity test.  [[Escherichia coli|Escherichia coli]], [[:Category:Clostridium species|Clostridium spp.]] and Enterococcus spp. are most commonly isolated.

===Surgery===

This may be indicated if the cause of peritonitis is undetermined or intestinal rupture or intestinal obstruction or mesenteric avulsion is suspected.   Abdominal lavage is controversial due to the possibility of dissemination of infection.  It is indicated in cases of generalised peritonitis but care has to be taken in cases of localised peritonitis.  As much of the fluid used for lavage has to be drained as it will hinder the body’s immune system otherwise.

 

====Antimicrobial Drugs====

Broad spectrum bactericidal antibiotics should be administered and, where possible, the choice of product should then be guided by culture and sensitivity of samples of peritoneal fluid.  [[Escherichia coli|''Escherichia coli'']], [[:Category:Clostridium species|''Clostridium spp.'']] and ''[[Enterococcus faecalis]]'' are the species most commonly isolated in cases of septic peritonitis.

 

Surgical intervention is indicated if the cause of peritonitis is undetermined or if it has been caused by intestinal rupture, intestinal obstruction or mesenteric avulsion. Abdominal lavage is a controversial procedure as it carries a risk of disseminating infection throughout the body and it is therefore indicated in cases of generalised peritonitis but should be used with care in cases of localised peritonitis.  A volume of around 200 ml/k fluid should be used to lavage the abdomen and as much of this fluid as possible should be re-aspirated as its continued presence will hinder the immune system by diluting bactericidal factor and preventing leucocyte migration.

 

It is beneficial to maintain peritoneal drainage after lavage by either '''open''' or '''closed''' drainage. Open drainage involves leaving part of the abdominal wall loosely sutured so that peritoneal fluid can leak out under gravity.  The wound must be dressed under sterile conditions and there is a high risk of ascending infection and of continued protein loss with this technique.

 

==Prognosis==

==Prognosis==

Guarded.  Peritonitis is a multifactorial disease and the consequence is fatal in most cases.  A rapid diagnosis and treatment may improve the prognosis.

Guarded.  Peritonitis is a multifactorial disease and the consequence is fatal in most cases.  A rapid diagnosis and treatment may improve the prognosis but it is generally poor in cases of septic peritonitis.

*Fibrinohaemorrhagic peritonitis in infectious canine hepatitis

*Fibrinohaemorrhagic peritonitis in infectious canine hepatitis