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==Introduction==

==Description==

'''Peritonitis''' is defined as inflammation of the [[Peritoneal Cavity - Anatomy & Physiology|peritoneum]]. The inflammatory response involves vasodilation, [[Exudate|exudation]] of protein-rich fluid, cellular infiltration, pain and, chronically, formation of fibrous adhesion. The disease can be classified into primary and secondary cases.

'''Peritonitis''' is defined as inflammation of the [[Peritoneal Cavity - Anatomy & Physiology|peritoneum]]. The inflammatory response involves vasodilation, [[Exudate|exudation]] of protein-rich fluid, cellular infiltration, pain and, chronically, formation of fibrous adhesion. The disease can be classified into primary and secondary cases.

*'''Perforation of the gastro-intestinal tract''' due to foreign bodies, [[Intussusception|intussuscepta]], invasive [[Neoplasia - Pathology|neoplasia]], deep ulceration or dehiscence of surgical wounds or biopsy sites. Peritonitis as a result of wound dehiscence is most likely to occur 3-5 days post-operatively.   

*'''Perforation of the gastro-intestinal tract''' due to foreign bodies, [[Intussusception|intussuscepta]], invasive [[Neoplasia - Pathology|neoplasia]], deep ulceration or dehiscence of surgical wounds or biopsy sites. Peritonitis as a result of wound dehiscence is most likely to occur 3-5 days post-operatively.   

*'''Penetration of the abdomen''' by a stick, gunshot or other foreign body.

*'''Penetration of the abdomen''' by a stick, gunshot or other foreign body.

*Rupture of an infected uterus ('''pyometra'''), [[Biliary Tract - Rupture|biliary tract]] or urinary tract.

*Rupture of an infected uterus ('''pyometra'''), [[Biliary Tract Rupture|biliary tract]] or urinary tract.

The bacteria causing septic peritonitis or their products may spread systemically causing sepsis or endotoxaemia.

The bacteria causing septic peritonitis or their products may spread systemically causing sepsis or endotoxaemia.

===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 [[Biliary Tract - Rupture|rupture of the 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 [[Biliary Tract Rupture|rupture of the biliary tract]].

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

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

===Other Tests===

===Other Tests===

Free abdominal fluid can be collected under ultrasound guidance and submitted for cytological analysis. If fluid cannot be obtained on aspiration, '''diagnostic peritoneal lavage''' can be performed by instilling a small volume (~20 ml/kg) of warmed isotonic crystalloid into the abdomen, agitating the abdomen and then re-aspirating this fluid. Grossly, the fluid may contain vegetable fibres if the gastro-intestinal tract has ruptured or it may be evidently green (indicating the presence of bile) or haemorrhagic. On cytological examination, the sample should be assessed for the presence of neutrophils (and other leucocytes) with intracellular bacteria.

Free abdominal fluid can be collected under ultrasound guidance and submitted for cytological analysis. If fluid cannot be obtained on aspiration, '''diagnostic peritoneal lavage''' can be performed by instilling a small volume (~20 ml/kg) of warmed isotonic crystalloid into the abdomen, agitating the abdomen and then re-aspirating this fluid. Grossly, the fluid may contain vegetable fibres if the gastro-intestinal tract has ruptured or it may be evidently green (indicating the presence of bile) or haemorrhagic. On cytological examination, the sample should be assessed for the presence of neutrophils (and other leucocytes) with intracellular bacteria. If motile organisms are observed when examining your sample microscopically, this is a good indication that you have accidentally taken a sample of intestinal contents.

Further possible tests include:

Further possible tests include:

*Measurement of '''amylase''' and '''lipase''' where the cause is suspected to be [[Pancreatitis - Dog and Cat|pancreatitis]]

*Measurement of '''amylase''' and '''lipase''' where the cause is suspected to be [[Pancreatitis|pancreatitis]]

*'''Bile''' where [[Biliary Tract - Rupture|biliary tract rupture]] is suspected.

*'''Bile''' where [[Biliary Tract Rupture|biliary tract rupture]] is suspected.

*'''Creatinine''' and '''potassium''' if the effusion is thought to be a uroabdomen.

*'''Creatinine''' and '''potassium''' if the effusion is thought to be a uroabdomen; creatinine levels in a peritoneal sample that are higher than serum concentrations indicate uroperitoneum.

*'''Glucose''' (<2.8 mmol/l) and '''lactate''' (>5.5 mmol/l) should be measured and, where their values are below those shown, the inflammation is likely to be septic.

*'''Glucose''' and '''lactate''' should be measured; where their values are <2.8 mmol/l and >5.5 mmol/l respectively the inflammation is likely to be septic.

<font color = 'green'> Where the difference between blood and peritoneal fluid glucose concentration is greater then 2.8mmol/l (20mg/dl) and blood and peritoneal fluid lactate concentration is less than 5.5mmol/l (2.0mmol/l), the inflammation is likely to be septic. - Peritoneal fluid has less glucose and more lactate than blood.</font color>

Lactate levels are indicative of a hypoxic crisis and levels are occasionally used as a prognostic indicator - rising levels in the face of vigorous treatment of peritonitis seem to be anecdotally  more prognostically useful than absolute cut off values. NB. Measurement of lactate on some machines such as hand held blood gas analysers may require a heparin sample.

*Culture is indicated where a bacterial infection is suspected, and should include an anaerobic culture.

In cats with [[Feline Infectious Peritonitis]], the effusion usually has a high protein content (>35g/l) with a high globulin: albumin ratio.  There is a variably high cellularity mainly composed of lymphocytes.

In cats with [[Feline Infectious Peritonitis]], the effusion usually has a high protein content (>35g/l) with a high globulin: albumin ratio.  There is a variably high cellularity mainly composed of lymphocytes.

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.

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.

Septic peritonitis can cause [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation (DIC)]] which represents a very large therapeutic challenge. Plasma my be administered to replace used clotting factors and some authors advocate the use of low doses of heparin to prevent further coagulation.

Septic peritonitis can cause [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation (DIC)]] which represents a very large therapeutic challenge. Plasma may be administered to replace used clotting factors and some authors advocate the use of low doses of heparin to prevent further coagulation.

====Antimicrobial Drugs====

====Antimicrobial Drugs====

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.

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.

==Literature Search==

[[File:CABI logo.jpg|left|90px]]

|Vetstream = [https://www.vetstream.com/felis/search?s=peritonitis Peritonitis]

 

|literature search = [http://www.cabdirect.org/search.html?q=title%3A%28peritonitis%29+AND+od%3A%28cats%29+ Peritonitis in cats publications]

 

[http://www.cabdirect.org/search.html?q=title%3A%28peritonitis%29+AND+od%3A%28cats%29+ Peritonitis in cats publications]

[http://www.cabdirect.org/search.html?q=title%3A%28peritonitis%29+AND+od%3A%28dogs%29+ Peritonitis in dogs publications]

[http://www.cabdirect.org/search.html?q=title%3A%28peritonitis%29+AND+od%3A%28dogs%29+ Peritonitis in dogs publications]

==References==

==References==

*Tilley, L. P. & Smith, F. W. K. (2007)  '''Blackwell's Five-minute Veterinary Consult: Canine & Feline (Fourth Edition)''' ''Blackwell Publishing''

*Tilley, L. P. & Smith, F. W. K. (2007)  '''Blackwell's Five-minute Veterinary Consult: Canine & Feline (Fourth Edition)''' ''Blackwell Publishing''

For further information on peritonitis see: [http://inpractice.bvapublications.com/cgi/reprint/26/7/358 maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=haemoabdomen&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT] In Practice article

For further information on peritonitis see the following In Practice article on SA Peritonitis: [http://inpractice.bvapublications.com/cgi/reprint/26/7/358 maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=haemoabdomen&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT]  

 

 

 

[[Category:Peritoneal_Cavity_-_Inflammatory_Pathology]]

[[Category:Peritoneal_Cavity_-_Inflammatory_Pathology]]

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