Peritonitis

Description

Peritonitis refers to inflammation of the 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.

Classification

Peritonitis may be classified in a number of ways depending on its cause, the nature of the inflammatory exudate formed, the extent of the disease and the chronicity with which it develops.

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.

Different pathological processes result in the formation of different types of inflammatory 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:

Sero-fibrinous, as in Glasser’s disease (Haemophilus parasuis) in pigs
Fibrinopurulent, as with septic peritonitis due to gastro-intestinal perforation or systemic infections such as pasteurellosis in sheep
Purulent, as with Rhodococcus equi in foals
Haemorrhagic, as with splenic rupture
Granulomatous, as with Nocardia infection in dogs

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 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 peritoneum.

Causes of Peritonitis

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.

Physical Peritonitis

Barium if allowed to leak into peritoneal cavity (causes potentially fatal haemorrhagic peritonitis)
Surgical glove powder (granulomatous peritonitis)

Chemical Peritonitis

Chemical peritonitis occurs when irritant fluids effuse or leak into the peritoneal cavity. 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 [1].

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.

In small animals with 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.

Chyle may cause a mild granulomatous serositis if it accumulates in the abdomen.

Bacterial Peritonitis

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

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.

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.

Rupture of other infected tracts (including the urinary tract, reproductive tract and biliary tract) may also cause septic peritonitis.

Umbilicus, systemic infections.

Viral Peritonitis

Image of FIP by Cornell Veterinary Medicine

e.g.

Feline infectious peritonitis - in “wet” (effusive) form, sero-fibrinous fluid with high protein (Ig content), tags of fibrin attach to peritoneum and organs

Parasitic Peritonitis

e.g.

Strongyle migration in horses
Fasciola hepatica - lesions around liver
See Peritoneal Cavity Parasitic

Consequences of 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.

Dogs and Cats

See Peritonitis - Cats and Dogs.

Horses

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[2].

In foals, purulent peritonitis may be caused by generalised Rhodococcus equi infection or fibrinous peritonitis by systemic Actinobacillus equuli infection.

Haemorrhage as a consequence of castration may result in acute non-septic peritonitis.

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.

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)

Sheep

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

Goats

Acute fibrinous peritonintis caused by Mycoplasma mycoides

Pigs

Diffuse fibrinopurulent peritonitis in infections by Actinomyces pyogenes, Escherichia coli or other organisms
Serofibrinous peritonitis in Glasser’s disease Haemophilus parasuis or Mycoplasma or septicaemias caused by Streptococcus suis type 2
Acute gelatinous haemorrhagic peritonitis in Anthrax

References

Image of acute fibrinous peritonitis from Cornell Veterinary Medicine