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Peritonitis - Cats and Dogs (view source)
Revision as of 21:22, 24 August 2009
, 21:22, 24 August 2009no edit summary
==Description==
==Description==
'''Peritonitis''' is defined as the inflammation of the peritoneum, which can be '''septic''' or '''non-septic'''. The inflammatory process leads to vasodilation, cellular infiltration, pain and adhesion.
'''Peritonitis''' is defined as the inflammation of the peritoneum. The inflammatory process leads to vasodilation, cellular infiltration, pain and adhesion. This can be classified into primary or secondary peritonitis.
Primary peritonitis occurs spontaneously without pre-existing pathology in the abdomen. In cats, this form of peritonitis is associated with feline infectious peritonitis.
'''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.
Secondary peritonitis occurs as the result of a pathological condition in the abdomen. This can be further classified into '''septic''' or '''non-septic''' peritonitis. '''Septic peritonitis''' results from free bacteria in the peritoneal cavity. This can be caused by perforation of the gastrointestinal tract due to foreign bodies, necrosis, intussusception, neoplasia, foreign bodies or dehiscence. Peritonitis as a result of wound dehiscence is most likely to occur 3-5 days post-operatively. Septic peritonitis is the most common form that occurs in dogs. '''Non-septic''', also known as '''chemical peritonitis''', may be the result of leakage of bile, urine or pancreatic enzymes. Non-septic peritonitis can however cause septic peritonitis, for example in cases where septic urine is present.
*Depressed
*Depressed
*Vomiting
*Vomiting
*Tachycardia
*Diarrhoea
*Hypotension and shock
*Hypotension and shock
*Hypothermia or hyperthermia
*Hypothermia or hyperthermia
===Laboratory Tests===
===Laboratory Tests===
====Haematology====
====Haematology====
*Neutrophilia ± left shift or neutropaenia
*Leucocytosis; predominantly neutrophilia ± left shift or neutropaenia
*Haemoconcentration
*Haemoconcentration
*Hypoproteinaemia
*Hypoproteinaemia
===Diagnostic Imaging===
===Diagnostic Imaging===
====Radiography====
====Radiography====
*Abdominal radiography may reveal free gas in the abdomen. This is highly suggestive of peritonitis. The serosal details may be loss. If taken with the patient standing, a fluid line may be seen.
*Abdominal radiography may reveal free gas in the abdomen. This is highly suggestive of peritonitis. The visceral details are loss. If radiograph is taken with the patient standing, a fluid line may be seen.
*Thoracic radiograph should be assessed for signs of metastatic disease.
*Thoracic radiograph should be assessed for signs of metastatic disease.
====Ultrasonography====
====Ultrasonography====
*This is senstive for any free fluid in the abdomen.
*This is sensitive to detect free fluid in the abdomen.
*Possible causes such as abscesses of organs or rupture of gallbladder can be identified.
*Possible causes such as abscesses of organs or rupture of gallbladder can be identified.
*It can be used to assist abdominocentesis.
===Histopathology===
===Histopathology===
*Abdominal fluid can be collected for laboartory analysis via abdominocentesis. The fluid should be stained for intracellular bacteria and assessed for:
*Abdominal fluid can be collected for laboratory analysis via abdominocentesis. The fluid should be stained for intracellular bacteria and assessed for:
**amylase and lipase for pancreatitis
**amylase and lipase for pancreatitis
**bile for biliary leak
**bile for biliary leak
*presence of penetrating injuries in the abdomen.
*presence of penetrating injuries in the abdomen.
===Fluid therapy===
===Medical===
*Aggressive fluid therapy with crystalloid and colloid should be given on initial presentation to improve haemodynamic parameter.
====Fluid therapy====
*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.
*Aggressive fluid therapy with crystalloid and colloid should be given on initial presentation to improve haemodynamic parameters.
*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 should be considered.
*Supplementaion of glucose and potassium may be needed.
*Supplementaion of glucose and potassium may be needed.
*If severe metabolic acidosis is present, bicarbonate may be given.
*Septic peritonitis can cause disseminated intravascular coagulation (DIC) and therefore plasma can be given to replace clotting factors.
===Analgesia===
====Antimicrobial====
*Broad spectrum antibiotics should be given, preferably following culture and sensitivity test. Escherichia coli, Clostridium spp. and Enterococcus spp. are most commonly isolated.
*Broad spectrum antibiotics should be given, preferably following culture and sensitivity test.
===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.
==Prognosis==
==Prognosis==
Guarded. Peritonitis is a multifactorial disease and the consequence if 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.
==References==
==References==
*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
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: [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 Pra