Changes

==Classification==

==Classification==

Peritonitis may be classified in a number of ways depedning on its '''cause''', the nature of the '''inflammatory [[Exudate|exudate]]''' formed, the '''extent''' of the disease and the '''chronicity''' with which it develops.

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.

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.

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 type of inflammatory [[Exudate|exudate]] depending on the degree to which the peritoneal vasculatur 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:

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:

*'''Sero-fibrinous''' e.g. Glasser’s disease (''[[Haemophilus parasuis]]'') in pigs

*'''Sero-fibrinous''', as in Glasser’s disease (''[[Haemophilus parasuis]]'') in pigs

*'''Fibrinopurulent''' e.g. after gut rupture, systemic infection ([[:Category:Pasteurella and Mannheimia species|pasteurellosis in sheep]])

*'''Fibrinopurulent''', as with septic peritonitis due to gastro-intestinal perforation or systemic infections such as [[:Category:Pasteurella and Mannheimia species|pasteurellosis in sheep]]

*'''Purulent''' e.g. [[Rhodococcus equi|''Rhodococcus equi'']] in foals

*'''Purulent''', as with [[Rhodococcus equi|''Rhodococcus equi'']] in foals

*'''Haemorrhagic''' e.g. splenic rupture

*'''Haemorrhagic''', as with splenic rupture

*'''Granulomatous''' e.g. ''[[:Category:Nocardia species|Nocardia]]'' in dogs

*'''Granulomatous''', as with ''[[:Category:Nocardia species|Nocardia]]'' infection in dogs

Peritonitis may occur acutely or it may be a chronic process that has reached an advanced stage before it is diagnosed.  In cases of '''acute''' peritonitis, there is likely to be increased amounts 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]].

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]].

==Causes of peritonitis==

==Causes of Peritonitis==

*Usually '''secondary''' to other abdominal pathology but may be '''primary'''

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'''.

*'''Septic''' or '''non-septic'''

[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=3048 Image of bile stained peritonitis in a cat from Cornell Veterinary Medicine]

*Barium if allowed to leak into peritoneal cavity (causes potentially fatal haemorrhagic peritonitis)

*Barium if allowed to leak into peritoneal cavity (causes potentially fatal haemorrhagic peritonitis)

*Surgical glove powder (granulomatous peritonitis)

*Surgical glove powder (granulomatous peritonitis)

====Bacterial====

====Chemical Peritonitis====

[[Image:Tubeculous peritonitis.jpeg|right|thumb|125px|<small><center> Tuberculous peritonitis with phagocytosis of lymphocytes (Sourced from Bristol Biomed with permission)</center></small>]]

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].

 

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 - Dog and Cat|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.

e.g.:

[[Chylous Effusion|Chyle]] may cause a mild granulomatous serositis if it accumulates in the abdomen.

====Viral====

====Viral Peritonitis====

[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=11598 Image of FIP by Cornell Veterinary Medicine]

[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=11598 Image of FIP by Cornell Veterinary Medicine]

*[[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

*[[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

 

====Parasitic Peritonitis====

 

 

====Parasites====

e.g.  

e.g.  

*Strongyle migration in horses

*Strongyle migration in horses

*See [[Peritoneal Cavity - Parasitic Pathology|Peritoneal Cavity Parasitic]]

*See [[Peritoneal Cavity - Parasitic Pathology|Peritoneal Cavity Parasitic]]

===Sequelae to peritonitis===

===Consequences of Peritonitis===

*Hypermotility initially → hypomotility  

*Hypermotility initially → hypomotility  

===In dogs===

===Dogs and Cats===

*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

Diffuse acute septic peritonitis (as caused by [[Rectal Perforation|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].

*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===

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

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

*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

 

===Cattle===

 

 

 

===In horses===

 

 

 

 

 

 

 

 

===In cattle===

*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

*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

*Localised peritonitis in [[Septicaemia and Enteritis, Bacterial|clostridial enterotoxaemia]] ([[:Category:Enteropathogenic and Enterotoxaemic Clostridia|''Clostridium perfringens'' types B and C]] and braxy)

*Localised peritonitis in [[Septicaemia and Enteritis, Bacterial|clostridial enterotoxaemia]] ([[:Category:Enteropathogenic and Enterotoxaemic Clostridia|''Clostridium perfringens'' types B and C]] and braxy)

   

   

 

===Sheep===

===In sheep===

*Fibrinopurulent peritonitis in postpartum septic metritis

*Fibrinopurulent peritonitis in postpartum septic metritis

*In penetration of intestines by larvae of [[Strongyloidea|''Oesophagostomum columbianum'']]

*In penetration of intestines by larvae of [[Strongyloidea|''Oesophagostomum columbianum'']]

===In goats===

===Goats===

*Acute fibrinous peritonintis caused by [[Mycoplasma mycoides subsp. mycoides|''Mycoplasma mycoides'']]

*Acute fibrinous peritonintis caused by [[Mycoplasma mycoides subsp. mycoides|''Mycoplasma mycoides'']]

 

===Pigs===

===In pigs===

*Diffuse fibrinopurulent peritonitis in infections by ''[[Actinomyces pyogenes]]'', [[Escherichia coli|''Escherichia coli'']] or other organisms

*Diffuse fibrinopurulent peritonitis in infections by ''[[Actinomyces pyogenes]]'', [[Escherichia coli|''Escherichia coli'']] or other organisms