Changes

'''Haemoconcentration''' (causing a raised packed cell volume (PCV) and total protein concentration) may occur due to loss of extracellular fluid.

'''Haemoconcentration''' (causing a raised packed cell volume (PCV) and total protein concentration) may occur due to loss of extracellular fluid.

 

*Hypoglycaemia - possible sepsis

Dehydration (which is also responsible for the haemococentration) may also result in pre-renal [[Azotaemia|azotaemia]], increased tissue '''lactate''' production and '''metabolic acidosis'''.

*Increased lactate concentration

*Metabolic acidosis

===Diagnostic Imaging===

===Diagnostic Imaging===

====Radiography====

====Radiography====

*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.

'''Plain radiographs of the abdomen''' may reveal the presence of free gas in the abdomen ('''pneumoperitoneum''') due to intestinal perforation or bacterial production.  The normal serosal detail may be effaced due to the presence of an abdominal effusion and, if a horizontal beam decubitus radiograph is made, a '''fluid line''' may be apparent.

*Thoracic radiograph should be assessed for signs of metastatic disease.

 

In cases where neoplasia is thought to be the cause of the inflammatory process, thoracic radiograph should be assessed for signs of metastatic disease.

====Ultrasonography====

====Ultrasonography====

*This is sensitive to detect free fluid in the abdomen.

This modality has a high sensitivity for the detection of free fluid in the abdomen and it may be used to identify some specific causes of peritonitis, including abscesses of organs or rupture of the [[Biliary Tract - Rupture|biliary tract.

*Possible causes such as abscesses of organs or rupture of [[Gall Bladder - Anatomy & Physiology|gall bladder]] can be identified.

*It can be used to assist abdominocentesis.

===Histopathology===

===Other Tests===

*Abdominal fluid can be collected for laboratory analysis via abdominocentesis.  The fluid should be stained for intracellular bacteria and assessed for:

Free abdominal fluid can be collected under ultrasound guidance and submitted for cytological analysis.  If fluid cannot be obtained on aspiration, '''diagnostic peritoneal lavage''' can be performed by istilling a small volume (~20 ml/kg) of warmed isotonic crystalloid into the abdomen, agitating the abdomen and then re-aspirating this fluid.  Grossly, the fluid may contain vegetable fibres if the gastro-intestinal tract has ruptured or it may be evidently green (indicating the presence of bile) or haemorrhagic.  On cytological examaintion, the sample should be assessed for the presence of neutrophils (and other leucocytes) with intracellular bacteria.

**amylase and lipase for [[Pancreatitis - Dog and Cat|pancreatitis]]

**bile for biliary leak

**glucose (<2.8 mmol/l) and lactate (>5.5 mmol/l) for sepsis

==Treatment==

==Treatment==

It is vital to identify cases which require emergency surgical intervention.  Any of the following is a major indication:

It is vital to identify severe cases promptly as these will require emergency surgical intervention.  Any of the following criteria is a major indication for surgery:

*positive for intracellular bacteria.

*Presence of intracellular bacteria in leucocytes in the abdominal exudate

*free gas visible in the abdominal radiograph.

*presence of penetrating injuries in the abdomen.

*Presence of penetrating injuries to the abdomen.

===Medical===

===Medical===

===Surgery===

===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.

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==

*Tilley, L. P. & Smith, F. W. K. (2007)  '''Blackwell's Five-minute Veterinary Consult: Canine & Feline (Fourth Edition)''' ''Blackwell Publishing''

*Tilley, L. P. & Smith, F. W. K. (2007)  '''Blackwell's Five-minute Veterinary Consult: Canine & Feline (Fourth Edition)''' ''Blackwell Publishing''

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

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

[[Category:Peritoneal_Cavity_-_Inflammatory_Pathology]]

[[Category:Peritoneal_Cavity_-_Inflammatory_Pathology]]

[[Category:To_Do_-_James]]

[[Category:To_Do_-_James]]