Difference between revisions of "Peritonitis"

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See also: [[Peritonitis - Cats and Dogs|Peritonitis in Dogs and Cats]]
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===Classification===
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[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=1262 Image of acute fibrinous peritonitis from Cornell Veterinary Medicine]
  
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==Introduction==
 
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Peritonitis refers to [[Inflammation - Pathology|inflammation]] of the [[Peritoneal Cavity - Anatomy & Physiology|peritoneal cavity]] and it may occur in any of the domestic species.  Peritonitis represents a considerable therapeutic challenge in any species and frequently carries a very poor prognosis.
 
  
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==Classification==
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*Usually '''secondary''' to other abdominal pathology but may be '''primary'''
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Peritonitis may be classified in a number of ways depending on its '''cause''', the nature of the '''inflammatory [[Exudate|exudate]]''' formed, the '''extent''' of the disease and the '''chronicity''' with which it develops.
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*'''Localised''' or '''diffuse'''
 +
*'''Acute''' (increased fluid in abdominal cavity and roughening of serosal surface of abdominal organs and [[Peritoneal cavity - Anatomy & Physiology|parietal peritoneum]]) or '''chronic''' (fibrous adhesions involving any of abdominal organs and omentum/mesentery/[[Peritoneal cavity - Anatomy & Physiology|peritoneum]])
 +
*'''Septic''' or '''non-septic'''
 +
*Types of exudate
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**'''Sero-fibrinous''' e.g. Glasser’s disease (''[[Haemophilus parasuis]]'') in pigs
 +
**'''Fibrinopurulent''' e.g. after gut rupture, systemic infection ([[:Category:Pasteurella and Mannheimia species|pasteurellosis in sheep]])
 +
**'''Purulent''' e.g. [[Rhodococcus equi|''Rhodococcus equi'']] in foals
 +
**'''Haemorrhagic''' e.g. splenic rupture
 +
**'''Granulomatous''' e.g. ''[[:Category:Nocardia species|Nocardia]]'' in dogs
  
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The inflammation may affect the entire peritoneal cavity ('''generalised''' or '''diffuse''') or it may affect just one part of the cavity ('''localised''').  The formation of fibrous adhesions in chronic peritonitis may isolate the inflammation in one particular area of the cavity.
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===Causes of peritonitis===
  
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Different pathological processes result in the formation of different types of inflammatory [[Exudate|exudate]] depending on the degree to which the peritoneal vasculature is damaged and on the types of leucocyte which migrate to the site of the inflammation. The following types of peritonitis are recognised based on the nature of the exudate:
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====Chemical====
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*'''Sero-fibrinous''', as in Glasser’s disease (''[[Haemophilus parasuis]]'') in pigs
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[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=3048 Image of bile stained peritonitis in a cat from Cornell Veterinary Medicine]
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*'''Fibrinopurulent''', as with septic peritonitis due to gastro-intestinal perforation or systemic infections such as [[:Category:Pasteurella and Mannheimia species|pasteurellosis in sheep]]
 
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*'''Purulent''', as with [[Rhodococcus equi|''Rhodococcus equi'']] in foals
 
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*'''Haemorrhagic''', as with splenic rupture
 
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*'''Granulomatous''', as with ''[[:Category:Nocardia species|Nocardia]]'' infection in dogs
 
  
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Peritonitis may occur acutely or it may be a chronic process that reaches an advanced stage before it is diagnosed. In cases of '''acute''' peritonitis, there is likely to be an increased amount of fluid in the peritoneal cavity and roughening of serosal surface of the abdominal organs and [[Peritoneal Cavity - Anatomy & Physiology|parietal peritoneum]] due to the presence of fibrin.  Cases of '''chronic''' peritonitis often involve fibrous adhesions between any of the abdominal organs and the omentum, mesentery or [[Peritoneal Cavity - Anatomy & Physiology|peritoneum]].
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e.g.:
 +
*Bile
 +
*Urine
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*[[Pancreas - Anatomy & Physiology#Exocrine Function|Pancreatic enzymes]] ([[Pancreatic Necrosis, Acute|acute pancreatic necrosis]])
 +
*Barium if allowed to leak into peritoneal cavity (causes potentially fatal haemorrhagic peritonitis)
 +
*Surgical glove powder (granulomatous peritonitis)
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*Chyle (mild granulomatous serositis)
  
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==Causes of Peritonitis==
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====Bacterial====
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Inflammation of the peritoneum may occur as a '''primary''' disease but it is more likely to be '''secondary''' to another pathological process.  The inflammation may be '''septic''' if it involves a bacterial infection or it may be '''non-septic'''.
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[[Image:Tubeculous peritonitis.jpeg|right|thumb|125px|<small><center> Tuberculous peritonitis with phagocytosis of lymphocytes (Sourced from Bristol Biomed with permission)</center></small>]]
  
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====Physical Peritonitis====
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e.g.:
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Substances such as '''barium''' contrast agent may cause inflammation if they are allowed to leak into peritoneal cavity. Barium may cause a potentially fatal haemorrhagic peritonitis.  '''Glove powder''' from surgical gloves may incite a granulomatous peritonitis.
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*Penetrating wound
 +
*Gut rupture
 +
*Surgery
 +
*Inflammatory focus e.g. abscess, bacteraemia
 +
*Umbilicus
 +
*Gangrenous intestine or uterus prior to rupture
  
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====Chemical Peritonitis====
 
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Chemical peritonitis occurs when irritant fluids effuse or leak into the peritoneal cavity.  [[Biliary Tract Rupture|Rupture of the biliary tract]] results in the leakage of '''bile''' into the abdomen.  Initially, this causes few clinical signs but over time, it irritates the visceral and parietal peritoneum and causes them to become inflamed.  If the biliary tract is infected at the time of rupture, a septic peritonitis may develop.  The parietal peritoneum and abdominal organs are typically stained green by the presence of bile.  An image of bile peritonitis in a cat is available [http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=3048 here].
 
  
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Rupture of the urinary tract causes '''urine''' to spill into the abdomen producing a '''uroabdomen'''.  As with bile, the urine irritates the peritoneum after 48-72 hours and causes inflammation but it is likely that the animal will show marked clinical signs of stranguria, anuria and depression before this time.  If the urinary tract is infected at the time of rupture, a septic peritonitis may develop.
 
  
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In small animals with '''[[Pancreatitis|pancreatitis]]''', pancreatic enzymes may leak into the abdomen together with discharge from the necrotic peripancreatic fat.  This usually results in a local peritonitis in the cranial abdomen and the animal may show signs of pain when this area is palpated.
 
  
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[[Chylous Effusion|Chyle]] may cause a mild granulomatous serositis if it accumulates in the abdomen.
 
  
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====Bacterial Peritonitis====
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====Viral====
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[[Image:Tubeculous peritonitis.jpeg|thumb|Tuberculous peritonitis with phagocytosis of lymphocytes<br><small>Sourced from Bristol Biomed with permission</small>]]
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[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=11598 Image of FIP by Cornell Veterinary Medicine]
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The main routes by which bacteria enter the peritoneal cavity are from the gastro-intestinal (GI) tract and from externally. '''Penetrating wounds''' to the abdomen and the introduction of '''foreign bodies''' are likely to introduce bacteria.
 
  
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GI bacteria may enter the peritoneal cavity after perforation or rupture of the intestine. This may occur due to erosion of the intestinal wall by ulcers or neoplasia or due to rupture after a loop of intestine is strangulated. Rectal tears of the higher grades in horses may also lead to the introduction of bacteria. 
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e.g.  
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*[[Feline Infectious Peritonitis|Feline infectious peritonitis]] - in “wet” (effusive) form, sero-fibrinous fluid with high protein (Ig content), tags of fibrin attach to [[Peritoneal cavity - Anatomy & Physiology|peritoneum]] and organs
  
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Rupture of other infected tracts (including the urinary tract, reproductive tract and biliary tract) may also cause septic peritonitis.
 
  
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In immature animals in whom the '''umbilicus''' has not fully closed, peritonitis may occur due to ascending infections through this structure.  Systemic infections may also enter the peritoneal cavity and cause septic peritonitis.
 
  
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====Viral Peritonitis====
 
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[[File:FIP Punktat.jpg|thumb|Image of the protein-rich effusion produced in cats with FIP<br><small>Copyright Kalumet 2006 Wikimedia Commons]]</small>
 
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The 'wet' or effusive form of [[Feline Infectious Peritonitis|'''feline infectious peritonitis''']] is caused by pyogranulomatous inflammation of the venules of the omentum and aprietal and visceral peritoneum.  This vasculitis results in the effusion of sero-fibrinous fluid with a high protein and immunoglobulin content and tags of fibrin attach to the [[Peritoneal Cavity - Anatomy & Physiology|peritoneum]] and abdominal organs.
 
  
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====Parasitic Peritonitis====
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====Parasites====
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The migration of large '''stronglyes''' (particularly ''[[Strongylus vulgaris]]'' in the abdominal vasculature of horses may result in intestinal infarction and septic peritonitis.  Severe signs of colic are usually the first sign of this syndrome which typically occurs in late winter/early spring.
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e.g.
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*Strongyle migration in horses
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*[[Trematodes|Fasciola hepatica]] - lesions around [[Liver - Anatomy & Physiology|liver]]
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*See [[Peritoneal Cavity - Parasitic Pathology|Peritoneal Cavity Parasitic]]
  
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The migration of the larvae of the '''liver fluke''' [[Fasciola hepatica|''Fasciola hepatica'']] may produce lesions around the liver that subsequently become inflamed producng a localised peritonitis.  Sheep and cattle are most commonly infected by this trematode.
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===Sequelae to peritonitis===
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See also [[Peritoneal Cavity - Parasitic Pathology|'''Peritoneal Cavity - Parasitic Pathology''']]
 
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==Consequences of Peritonitis==
 
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Initially, the GI tract of affected animals is hypermotile but this quickly progresses to hypomotility and paralytic ileus.  This hypomotility may be appreciable on auscultation in large animals in which borborygmi should normally be audible.
 
  
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*Hypermotility initially → hypomotility
 
**Ileus - reduces distribution of exudates by intestinal motility
 
**Ileus - reduces distribution of exudates by intestinal motility
 
**Fibrinous adhesions may develop
 
**Fibrinous adhesions may develop
 
*Impaired CV function and acid-base imbalance  
 
*Impaired CV function and acid-base imbalance  
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**Due to sequestration of fluid and protein in exudate, hypomotile gut, bacterial exo/endotoxins absorbed directly from [[Peritoneal Cavity - Anatomy & Physiology|peritoneal cavity]] and causing vascular permeability, loss of intestinal absorption
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**Due to sequestration of fluid and protein in exudate, hypomotile gut, bacterial exo/endotoxins absorbed directly from [[Peritoneal cavity - Anatomy & Physiology|peritoneal cavity]] and causing vascular permeability, loss of intestinal absorption
 
*May resolve, become chronic-active or lead to adhesions.
 
*May resolve, become chronic-active or lead to adhesions.
  
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==Peritonitis in the Domestic Species==
 
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===Dogs and Cats===
 
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See [[Peritonitis - Cats and Dogs]].
 
  
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===Horses===
 
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Diffuse acute septic peritonitis (as caused by rectal tears or GI rupture) is frequently fatal in horses and affected animals are often euthanased when after a diagnosis is made.  Septic peritonitis occurs most commonly due to rupture of the strangulated loops of small intestine or rupture of a stomach distended by fluid refluxed from the duodenum.  For an image of acute fibrinous peritonitis in a horse, see[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=6111|here].
 
  
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In foals, purulent or granulomatous peritonitis may be caused by generalised [[Rhodococcus equi|''Rhodococcus equi'']] infection or fibrinous peritonitis by systemic ''[[Actinobacillus equuli]]'' infection.
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===In dogs===
 +
 
 +
*Fibrinohaemorrhagic peritonitis in infectious canine hepatitis
 +
*Septic peritonitis caused by various agents, often [[Escherichia coli|''Escherichia coli'']] and anaerobic bacteria through perforation of the gut, rupture of [[Urinary Bladder - Anatomy & Physiology|urinary bladder]] or an abscess
 +
*Putrid peritonitis in uterine rupture with pyometra or septic metritis
 +
*''[[:Category:Nocardia species|Nocardia]]'' infection reults in profuse pink/red fluid due to blood and chronic inflammatory cells
 +
*Granulomatous peritonitis caused by [[Fungi|fungi]], ''[[:Category:Nocardia species|Nocardia]]'' and ''[[:Category:Actinomyces|Actinomyces]]''
 +
 
 +
===In cats===
 +
 
 +
*Putrid peritonitis in uterine rupture due to pyometra or fetal putrefaction
 +
*Peritonitis due to penetrating wounds
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*Septic peritonitis due to anaerobes in cat bite abscesses
 +
*Serous peritonitis in cats with [[Feline Infectious Peritonitis|feline infectious peritonitis]] especially in the wet form but exudate occurs also in the dry form
 +
**Viscous, clear, pale to deep yellow fluid, may contain strands of fibrin
 +
 
 +
 
 +
 
  
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Haemorrhage as a consequence of '''castration''' may result in acute non-septic peritonitis.
 
  
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Peritonitis may also occur secondary to '''parasitic intestinal infarctions''' caused by ''[[Strongylus vulgaris]]'' but this is now rare in the UK due to widespread anthelmintic treatment.
 
  
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===Cattle===
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===In horses===
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Peritonitis may occur due to traumatic or iatrogenic perforation of an abdominal organ, usually the [[Reticulum - Anatomy & Physiology|reticulum]] or [[Uterus - Anatomy & Physiology|uterus]].  This produces an acute diffuse fibrinopurulent peritonitis or, in some cases, the inflammation may be confined to a smaller area of the peritoneal cavity by the exuberant formation of fibrous tissue.
 
  
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[[Traumatic Reticulitis|Traumatic reticuloperitonitis]] occurs when an ingested foreign body becomes lodged in the reticulum and subsequently perforates this organ. This usually produces a localised peritonitis between the reticulum and diaphragm but, in severe cases and in cows around parturition, generalised inflammation may develop. The foreign body may penetrate cranially through the diaphragm and into the pericardial sac. Potential sequelae include acute haemorrhage due to penetration of the left gastro-epiploic artery and vagal indigestion.
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[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=6111 Image of acute fibrinous peritonitis in a horse from Cornell Veterinary Medicine]
  
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Local chronic peritonitis, abscesses containing usually ''[[Actinomyces pyogenes]]''
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*Diffuse acute peritonitis often fatal
 +
*Mostly caused by rupture of [[Forestomach - Anatomy & Physiology|stomach]] or intestine
 +
*In foals purulent peritonitis may be caused by [[Rhodococcus equi|''Rhodococcus equi'']] or fibrinous peritonitis by ''[[Actinobacillus equuli]]''
 +
*Haemorrhage as a consequence of castration may result in acute non-septic
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*Secondary to [[Peritoneal Cavity - Parasitic Pathology|verminous lesions]]
  
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Other less common causes of peritonitis in cattle include:
 
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*Fibrinopurulent peritonitis after umbilical infection in calves
 
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*Fibrinous peritonitis in calves with septicaemic [[Escherichia coli|colibacillosis]]
 
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*Serofibrinous peritonitis associated with sporadic bovine encephalomyelitis
 
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*Diffuse fibrinohaemorrhagic peritonitis with clostridial haemoglobinuria caused by ''[[Clostridium haemolyticum]]''
 
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*Localised peritonitis in [[Septicaemia and Enteritis, Bacterial|clostridial enterotoxaemia]] caused by [[Clostridium perfringens type B|''Clostridium perfringens'' type B]] and [[Clostridium perfringens type C|type C]] and [[Clostridium septicum|''Cl. septicum'']] ('''Braxy''')
 
  
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===Sheep===
 
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Fibrinopurulent peritonitis may occur in postpartum ewes that develop septic metritis due uterine contamination at parturition or retention of a lamb or a portion of the placenta.
 
  
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Serofibrinous peritonitis may occur in diseases caused by [[:Category:Mycoplasmas|''Mycoplasma spp'']].
 
  
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Peritonitis may also occur after penetration of the intestines by larvae of [[Oesophagostomum|''Oesophagostomum columbianum'']].
 
  
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===Goats===
 
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Acute fibrinous peritonintis may be caused by infection with [[Mycoplasma mycoides subsp. mycoides|''Mycoplasma mycoides'']].
 
  
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===Pigs===
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===In cattle===
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Diffuse fibrinopurulent peritonitis may occur with severe systemic infections of ''[[Actinomyces pyogenes]]'', [[Escherichia coli|''Escherichia coli'']] or other bacterial organisms.
 
  
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Serofibrinous peritonitis occurs in '''Glasser’s disease''' caused by ''[[Haemophilus parasuis]]'' as part of a more severe polyserositis affecting the pleural cavity, pericardium and synovial spaces.  Serofibrinous peritonitis may also be caused by infection with [[:Category:Mycoplasmas|''Mycoplasma spp'']] or septicaemias caused by ''[[Streptococcus suis]]'' type 2.
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*Perforation of an abdominal organ, usually [[The Reticulum - Anatomy & Physiology|reticulum]] or [[[[Female Reproductive Tract -The Uterus - Anatomy & Physiology|uterus]], results in acute diffuse fibrinopurulent peritonitis or local acute and chronic, with adhesions
 +
*[[Traumatic Reticulitis|Traumatic reticuloperitonitis]] (hardware disease) may evolve into reticulopericarditis
 +
*Local chronic peritonitis, abscesses containing usually ''[[Actinomyces pyogenes]]''
 +
*Fibrinopurulent peritonitis through umbilical infection in calves
 +
*Fibrinous peritonitis in calves with septicaemic colibacillosis
 +
*Serofibrinous peritonitis in sporadic bovine encephalomyelitis
 +
*Diffuse fibrinohaemorrhagic peritonitis in clostridial haemoglobinuria
 +
*Localised peritonitis in [[Septicaemia and Enteritis, Bacterial|clostridial enterotoxaemia]] ([[:Category:Enteropathogenic and Enterotoxaemic Clostridia|''Clostridium perfringens'' types B and C]] and braxy)
 +
  
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Acute gelatinous haemorrhagic peritonitis may occur as part of a systemic disease caused by ''[[Bacillus anthracis]]'' ('''Anthrax''')
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===In sheep===
  
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{{Learning
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*Fibrinopurulent peritonitis in postpartum septic metritis
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|Vetstream = [https://www.vetstream.com/felis/search?s=peritonitis Peritonitis]
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*Serofibrinous peritonitis in diseases caused by [[:Category:Mycoplasmas|''Mycoplasma'']]
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|flashcards = [[Cytology Q&A 15]]
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*In penetration of intestines by larvae of [[Strongyloidea|''Oesophagostomum columbianum'']]
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}}
 
  
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== References ==
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===In goats===
  
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The following images are available: [http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=1262 Image of acute fibrinous peritonitis from Cornell Veterinary Medicine] [http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=11598 Image of FIP by Cornell Veterinary Medicine]  
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*Acute fibrinous peritonintis caused by [[Mycoplasma mycoides subsp. mycoides|''Mycoplasma mycoides'']]
  
  
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{{unfinished}}
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===In pigs===
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[[Category:To_Do_-_Alimentary]][[Category:To Do - Major]] [[Category:Peritoneal_Diseases_-_Cattle]] [[Category:Donkey]] [[Category:Peritoneal_Diseases_-_Sheep]] [[Category:Alimentary_Diseases_-_Goat]] [[Category:Alimentary_Diseases_-_Pig]] [[Category:Alimentary_Diseases_-_Birds]] [[Category:Peritoneal_Cavity_-_Inflammatory_Pathology]] [[Category:Peritoneal_Cavity_Diseases_-_Horse]]
 
  
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==Webinars==
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*Diffuse fibrinopurulent peritonitis in infections by ''[[Actinomyces pyogenes]]'', [[Escherichia coli|''Escherichia coli'']] or other organisms
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<rss max="10" highlight="none">https://www.thewebinarvet.com/gastroenterology-and-nutrition/webinars/feed</rss>
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*Serofibrinous peritonitis in Glasser’s disease ''[[Haemophilus parasuis]]'' or [[:Category:Mycoplasmas|''Mycoplasma'']] or septicaemias caused by ''[[Streptococcus suis]]'' type 2
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*Acute gelatinous haemorrhagic peritonitis in [[Bacillus anthracis|Anthrax]][[Category:Peritoneal Cavity - Inflammatory Pathology]]
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[[Category:To_Do_-_Clinical]]

Revision as of 22:49, 28 June 2010

Classification

Image of acute fibrinous peritonitis from Cornell Veterinary Medicine


  • Usually secondary to other abdominal pathology but may be primary
  • Localised or diffuse
  • Acute (increased fluid in abdominal cavity and roughening of serosal surface of abdominal organs and parietal peritoneum) or chronic (fibrous adhesions involving any of abdominal organs and omentum/mesentery/peritoneum)
  • Septic or non-septic
  • Types of exudate

Causes of peritonitis

Chemical

Image of bile stained peritonitis in a cat from Cornell Veterinary Medicine

e.g.:

  • Bile
  • Urine
  • Pancreatic enzymes (acute pancreatic necrosis)
  • Barium if allowed to leak into peritoneal cavity (causes potentially fatal haemorrhagic peritonitis)
  • Surgical glove powder (granulomatous peritonitis)
  • Chyle (mild granulomatous serositis)

Bacterial

Tuberculous peritonitis with phagocytosis of lymphocytes (Sourced from Bristol Biomed with permission)

e.g.:

  • Penetrating wound
  • Gut rupture
  • Surgery
  • Inflammatory focus e.g. abscess, bacteraemia
  • Umbilicus
  • Gangrenous intestine or uterus prior to rupture



Viral

Image of FIP by Cornell Veterinary Medicine

e.g.



Parasites

e.g.

Sequelae to peritonitis

  • Hypermotility initially → hypomotility
    • Ileus - reduces distribution of exudates by intestinal motility
    • Fibrinous adhesions may develop
  • Impaired CV function and acid-base imbalance
    • Due to sequestration of fluid and protein in exudate, hypomotile gut, bacterial exo/endotoxins absorbed directly from peritoneal cavity and causing vascular permeability, loss of intestinal absorption
  • May resolve, become chronic-active or lead to adhesions.


In dogs

  • Fibrinohaemorrhagic peritonitis in infectious canine hepatitis
  • Septic peritonitis caused by various agents, often Escherichia coli and anaerobic bacteria through perforation of the gut, rupture of urinary bladder or an abscess
  • Putrid peritonitis in uterine rupture with pyometra or septic metritis
  • Nocardia infection reults in profuse pink/red fluid due to blood and chronic inflammatory cells
  • Granulomatous peritonitis caused by fungi, Nocardia and Actinomyces

In cats

  • Putrid peritonitis in uterine rupture due to pyometra or fetal putrefaction
  • Peritonitis due to penetrating wounds
  • Septic peritonitis due to anaerobes in cat bite abscesses
  • Serous peritonitis in cats with feline infectious peritonitis especially in the wet form but exudate occurs also in the dry form
    • Viscous, clear, pale to deep yellow fluid, may contain strands of fibrin




In horses

Image of acute fibrinous peritonitis in a horse from Cornell Veterinary Medicine

  • Diffuse acute peritonitis often fatal
  • Mostly caused by rupture of stomach or intestine
  • In foals purulent peritonitis may be caused by Rhodococcus equi or fibrinous peritonitis by Actinobacillus equuli
  • Haemorrhage as a consequence of castration may result in acute non-septic
  • Secondary to verminous lesions




In cattle

  • Perforation of an abdominal organ, usually reticulum or [[uterus, results in acute diffuse fibrinopurulent peritonitis or local acute and chronic, with adhesions
  • Traumatic reticuloperitonitis (hardware disease) may evolve into reticulopericarditis
  • Local chronic peritonitis, abscesses containing usually Actinomyces pyogenes
  • Fibrinopurulent peritonitis through umbilical infection in calves
  • Fibrinous peritonitis in calves with septicaemic colibacillosis
  • Serofibrinous peritonitis in sporadic bovine encephalomyelitis
  • Diffuse fibrinohaemorrhagic peritonitis in clostridial haemoglobinuria
  • Localised peritonitis in clostridial enterotoxaemia (Clostridium perfringens types B and C and braxy)


In sheep

  • Fibrinopurulent peritonitis in postpartum septic metritis
  • Serofibrinous peritonitis in diseases caused by Mycoplasma
  • In penetration of intestines by larvae of Oesophagostomum columbianum

In goats


In pigs

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