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Diseases of the Peritoneum in farm animals

ByDr. Ali H. Sadiek

Prof. of Internal Veterinary Medicine and Clinical Laboratory Diagnosis

Dept. of Animal MedicineFaculty of Veterinary Medicine

Assiut University- Assiut, EGYPT

E-mail: Sadiek59@yahoo.com

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Peritonitis• Inflammation of the peritoneum. • It may be acute or chronic, local or

diffuse,• Most commonly is secondary to

contamination of the peritoneal cavity. • It is often accompanied by abdominal

pain, fever, toxemia, and reduced fecal output.

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Causes of peritonitis

Secondary to Glässer’s disease “Porcine polyserositis, Infectious polyarthritis” ; ileal perforation

Pigs

Esophagostomum spp, intestinal abscess rupture; serositiscaused by Mycoplasma spp

Sheep

Infectious, chemical, or parasitic injury; cecal, colonic, gastric, or rectal rupture

Horses

Serositis caused by Mycoplasma sppGoats

TRP; abomas. ulcer perforation; Abomas. volvulus; rumenitis 2ndry to Acid indigestion; cesarean section; intestinal, rectal, uterine, or vaginal rupture; deposition of semen into perit. cavity; injection of sterile hypertonic or nonsterile solutions

Cattle

Traumatic perforation of abdominal wall; faulty surgical asepsis; leakage of infarcted GI wall; spread from subperitoneal sites in spleen, liver, umbilical vessels

All species

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Pathogenesis of peritonitis1-Toxins produced by bacteria and tissue breakdown

are readily absorbed through the peritoneum. ▼

Toxemia2-Endotoxins absorbed from the peritoneal cavity have

systemic effects leading to ▼

hypotension, shock, and systemic inflammatory response syndrome (SIRS) and disseminated

intravascular coagulation (DIC).3-Endotoxins, myocardial depressant factor, acid-base,

and electrolyte disturbances directly affect the cardiac function,

▼leading to reduced cardiac output.

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Pathogenesis of peritonitis4- Bacterial or chemical irritants increase

serosal capillary permeability▼

leakage of plasma proteins, solutes, and water into the peritoneal cavity.

5-Exudation of protein-rich fluid ▼

hypoproteinemia and bacterial proliferation.

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Pathogenesis of peritonitis6-The combined effect of large fluid losses into the peritoneal

cavity and vasodilatory effects of absorbed toxins ▼

Profound hypotension and hypovolemia. 7-Rupture of the GI tract, with spillage of large volumes of

intestinal contents, ▼

Acute peritonitis and paralytic ileus.8- Large volumes of inflammatory exudates may be secreted into

the peritoneal cavity during peritonitis and may lead to▼

Impaired respiration by impinging on the diaphragm.

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Pathogenesis of peritonitis9- Infected Uterine rupture in cows

▼shock and hemorrhage may be minor

following. 10-Peritoneal trauma

▼leads to secretion of fibrinogen and formation of fibrinous adhesions.

▼localize the inflammation but may cause

mechanic. or functional obst. of the GI tract

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Pathogenesis of peritonitis13-Death due to :

Endotoxic shock, Shock and hemorrhage associated with rupture of the gut or uterus with infection of the GI or reproductive tracts;

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Clinical signs of peritonitis• Toxemia and septicemia, shock, hemorrhage,

abdominal pain, paralytic ileus, fluid accumulation, and adhesions all contribute to the clinical signs and progression of peritonitis.

• Signs are nonspecific and vary accord.to the type of peritonitis (1ry or 2ndry) as follow:

1- Abdominal pain may be generalized and severe:The animal guards the abdomen, walks with a stiff gait, or is recumbent. Cattle may have a shuffling, cautious gait, with a rigid, arched back; Grunting when walking or when passing urine or feces is common.

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Clinical signs of peritonitisDeep, firm palpation of the abdominal wall results in an easily recognized pain response in cattle Pain responses in all species are most evident in the early stages of the disease.

2- Fever is common but may be suppressed by prostaglandin inhibitors. In dogs fever is a common with peritonitisCats may be hypothermic with concomitant shock. In Cattle fever is typical during the first 24-36 hr in acute, local peritonitis. High fever suggests acute, diffuse peritonitis.

3- Abdominal distention, which may be inapparent, due to accumulation of peritoneal exudate and may be accompanied by hemorrhage, septicemia, toxemia, paralytic ileus, shock, and adhesions

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Clinical signs of peritonitis4- Fluid transudation sequesters electrolytes

and protein in the abdominal cavity and atonicgut, and venous stasis leads to:Hypotension, Acid-base disturbances, and Circulatory collapse.

5- Shock and Icterus attributed to toxemia and bacteremia in generalized biliary peritonitis.

6-Animals with secondary peritonitis may also exhibit signs of the primary illness.

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Clinical signs of peritonitis7- Appetite:

Anorexia and depression often accompanied by vomiting and feces may not be passed in small animals. In Large animals, anorexia may be seen in acute, diffuse peritonitis, in large animals, while decreased appetite may occur in less severe and chronic cases.In chronic cases, tympany, ruminal contractions is weak, reduced or absent.

8- Rectal palpation may reveal little or no feces, tacky, dry mucosa and fibrinous adhesions between intestinal loops.

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Clinical signs of peritonitis10- In horses, Septic peritonitis is frequently fatal,

despite intensive treatment.Severe colic, ileus, distended intestines on rectal palp., gastric reflux, and occasionally diarrhea.Intestinal stasis leads to reduced peristaltic sounds but sounds of paralytic ileus may be audible. Tachycardia, weak pulses, poor peripheral perfusion, and fever are common. In cases of cecal rupture during foaling, mares suddenly stop straining, and progress toward parturition stops. Shock develops, followed by death in 4-5 hr

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Clinical signs of peritonitis12- Peracute, diffuse peritonitis

Extreme weakness, depression & circ. failure (tachycardia with a weak pulse). Body temperature is often subnormal (99-100°F [37-37.5°C]).

13- Chronic peritonitis is associated with development of fibrous adhesions. Cattle may have chronic indigestion and toxemia. Weight loss, intermittent pain, and diminished gut sounds may be observed in horses .Liters of turbid, infected peritoneal fluid may be produced but may be difficult to distinguish from ruminal contents on physical examination

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Diagnosis of peritonitisDiagnosis can be difficult because the clinical signs are nonspecific.

I-The most reliable clinical indicators of peritonitis include:

• Abnormal feces (scanty, or absent)• Intestinal stasis • Abdominal pain (diffuse or focal), • Fibrinous abdominal adhesions, • Abnormal peritoneal fluid .

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Diagnosis of peritonitisII-Rectal palpation in large animals is a useful

means of evaluating the intestines. III -Abdominal radiographs may reveal GI

obstruction (bowel dilatation, free abdominal air), ascites, or radiodense foreign material.

• Loss of serosal detail (a “ground glass”appearance) is indicative of abdominal fluid.

IV- Ultrasonography is a valuable adjunct test to evaluate size, shape, and contents of other viscera (eg, gallbladder, prostate gland) suspected to be the source of peritonitis.

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Diagnosis of peritonitisV-Abdominal paracentesis or peritoneal lavage:for

cytologic examination and culture: • The presence of intra- or extracellular bacteria

confirms septic peritonitis. Neutrophils are degenerative in the presence of sepsis.In dogs with septic effusion, peritoneal glucose conc. < blood glucose conc. A blood-to-fluid glucose difference of >20 mg/dL. In addition, a blood-to-fluid lactate difference of <2.0 mmol/L is equally sensitive and specific. In cats, blood-to-fluid glucose difference was 86% sensitive and 100% specific for septic peritonitis

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Diagnosis of peritonitisVI- Blood profile

Hypoglycemia may develop but is not areliable indicator.Hypoalbuminemia and hyperbilirubinemia are frequently present in dogs and cats. Septic animals may have hemolysis (immune-mediated, toxic, or secondary to electrolyte derangements)Acute, diffuse peritonitis with toxemia is usually accompanied by leukopenia, neutropenia, and a marked increase in immature neutrophils (degenerative left shift).In less severe acute peritonitis, leukocytosis may occur as a result of increased neutrophil production. Acute, localized peritonitis may reveal a normal WBC count with a regenerative left shift. The total WBC count in chronic peritonitis may be normal, with an occasional increase in lymphocytes and monocytes.

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Abdominal sonography: Reticular abscess

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Abdominal paracentesis: Fluid containing degenerative neutrophils, macrophages, and free bile pigment (black

material) (Dog, bile peritonitis, Wright-Leishman stain . (

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Treatment of peritonitisInitial treatment must be directed toward :1-Stabilizing the metabolic consequences of peritonitis

(electrolytes, acid-base, coagulation abnormalities) by:Replacement fluids, electrolytes, plasma, or whole blood may be necessary to maintain cardiac output.

2-Determine the nidus of /infection and correcting it by: Broad-spectrum antimicrobial therapy should be initiated, usually by a parenteral route, untill the results of cytologicevaluation and culture and sensitivity of perit. Fluid are obtained. Aminoglycoside or quinoline antibiotics are effective against gram-negative organisms, and penicillins or cephalosporinsare effective against gram-positive organisms. In horses include gentamicin (2.2-3.3 mg/kg, IV, bid-tid ), penicillin (22,000 IU/kg, IV or IM, bid-qid ), and metronidazole(15-25 mg/kg, PO).

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Treatment of peritonitis• In small animals, • Enrofloxacin or aminoglycosides (for G –

ve bacteria) may be combined with penicillins, first-generation cephalosporins, or clindamycin ((for G +ve bacteria).

• Second- or third-generation cephalosporins or imipenum are good candidates for single-agent therapy.

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Treatment of peritonitis3- Surgical interference, once animal is

stabilized, to:Explore the abdomen and to repair any defects (eg, a ruptured viscus). Peritoneal lavage with an isothermic, isotonic, balanced electrolyte solution. Abdominal drains to allow postoperative lavage and open peritoneal drainage (small animals) are sometimes used to treat severe peritonitis. Survival in dogs and cats managed with closed versus open drainage is very similar.

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Treatment of peritonitis4- Post-operative management:• Serum protein and electrolyte levels should

be monitored periodically, because both are lost with drainage of exudate.

• Parenteral antimicrobials are continued. • Nutritional support should be anticipated, as

many animals with peritonitis will not eat postoperatively.

• Enteral nutrition helps maintain the health of the intestinal mucosa; however, vomiting or anorexia may force the consideration of alternatives.

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Treatment of peritonitis• Feeding tube placement in small animals

(esophagostomy, gastrostomy, or jejunostomy tubes) at the time of surgical closure is easily performed.

• In animals with toxemia and shock, IV fluids and electrolytes are crucial elements of treatment, especially during the first 24-72 hr following surgery in horses.

• Flunixin meglumine (0.25-1.1 mg/kg, IV, bid-tid ) is recommended for treatment of shock, although efficacy is unknown.

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