Difference between revisions of "Peritonitis - Cats and Dogs"
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==Description== | ==Description== | ||
| − | Peritonitis is defined as the inflammation of the peritoneum | + | '''Peritonitis''' is defined as the inflammation of the peritoneum, which can be septic or non-septic. Septic peritonitis results from free bacteria in the peritoneal cavity, caused by perforating injuries to the gastrointestnal tract due to foreign bodies, necrosis secondary to obstruction or intussusception. Non-septic, also known as chemical peritonitis, may be the result of leakage of bile, urine or pancreatic enzymes. However, non-septic peritonitis can cause septic peritonitis, for example cases where septic urine is present. |
| + | |||
| + | Peritonitis is a multifactorial disease and the consequence if fatal in most cases. | ||
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===Fluid therapy=== | ===Fluid therapy=== | ||
*Aggressive fluid therapy with crystalloid and colloid should be given on initial presentation to improve haemodynamic parameter. | *Aggressive fluid therapy with crystalloid and colloid should be given on initial presentation to improve haemodynamic parameter. | ||
| − | *Fluid therapy is also very important in the postoperative period. | + | *Fluid therapy is also very important in the postoperative period. Both crystalloid and colloid should be continued until the the patient is normotensive. However, if hypotension continues, a vasopressor such as vasopressin should be considered. |
===Analgesia=== | ===Analgesia=== | ||
| Line 61: | Line 63: | ||
===Antimicrobial=== | ===Antimicrobial=== | ||
*Broad spectrum antibiotics should be given, preferably following culture and sensitivity test. | *Broad spectrum antibiotics should be given, preferably following culture and sensitivity test. | ||
| − | |||
==Prognosis== | ==Prognosis== | ||
| − | + | Guarded. A rapid diagnosis and treatment improves the prognosis. | |
Revision as of 15:44, 18 August 2009
 |
This article is still under construction. |
Signalment
Description
Peritonitis is defined as the inflammation of the peritoneum, which can be septic or non-septic. Septic peritonitis results from free bacteria in the peritoneal cavity, caused by perforating injuries to the gastrointestnal tract due to foreign bodies, necrosis secondary to obstruction or intussusception. Non-septic, also known as chemical peritonitis, may be the result of leakage of bile, urine or pancreatic enzymes. However, non-septic peritonitis can cause septic peritonitis, for example cases where septic urine is present.
Peritonitis is a multifactorial disease and the consequence if fatal in most cases.
Diagnosis
Clinical Signs
- Depressed
- Tachycardia
- Tachypnoea
- Pale, cyanotic or muddly mucous membranes
- Hypothermia or hyperthermia
- Abdominal pain
Laboratory Tests
Haematology
- Significant leucocytosis or leucopaenia
Biochemistry
- Hypoglycaemia
- Increased lactate concentration
Diagnostic Imaging
Radiography
- Abdominal radiography may reveal free gas in the abdomen. This is highly suggestive of peritonitis
- Thoracic radiograph should be assessed for signs of metastatic disease.
Histopathology
- Abdominal fluid collected for laboartory analysis via abdominocentesis. The fluid should be stained for intracellular bacteria and assessed for:
- amylase and lipase for pancreatitis
- bile for biliary leak
- creatinine for urine
- glucose (2.8 mmol/l) and lactate (>5.5 mmol/l) for sepsis
Treatment
It is vital to identify cases which require emergency surgical intervention. Any of the following is a major indication:
- positive for intracellular bacteria.
- free gas visible in the abdominal radiograph.
- presence of penetrating injuries in the abdomen.
Fluid therapy
- Aggressive fluid therapy with crystalloid and colloid should be given on initial presentation to improve haemodynamic parameter.
- Fluid therapy is also very important in the postoperative period. Both crystalloid and colloid should be continued until the the patient is normotensive. However, if hypotension continues, a vasopressor such as vasopressin should be considered.
Analgesia
- Opiods should be given.
Antimicrobial
- Broad spectrum antibiotics should be given, preferably following culture and sensitivity test.
Prognosis
Guarded. A rapid diagnosis and treatment improves the prognosis.
References
- Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
- Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
- Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.