Peritonitis in Dogs

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The peritoneum is a membrane that lines the abdominal cavity and produces a small amount of fluid that lubricates the abdominal contents. In addition, the peritoneum is also responsible for forming adhesions, or scars, in the presence of an inflammatory process.

Peritonitis is an inflammatory process affecting the peritoneum that can be very serious, or even life-threatening. Peritonitis results in the accumulation of excessive fluid within the abdominal cavity. It can be associated with abdominal trauma, abdominal surgery or pancreatitis.

What to Watch For

  • Vomiting
  • Diarrhea
  • Weakness
  • Fever
  • Lack of appetite
  • Abdominal distention
  • Abdominal pain

    Diagnosis

    Various diagnostic tests are performed to help determine the presence of peritonitis and the severity of the infection. Tests may include:

  • An abdominal tap to obtain a fluid sample
  • Complete blood count
  • Biochemical profile
  • Culture of the abdominal fluid to determine the type of bacteria
  • Abdominal X-rays
  • Abdominal ultrasound

    Treatment

    Peritonitis can be treated medically or surgically, depending on the underlying cause of the peritonitis. Medical therapy includes:

  • Intravenous fluids
  • Antibiotics
  • Medication to control pain

    Surgery is performed if moderate or severe peritonitis is present. Surgery includes:

  • Exploratory surgery to address the underlying cause of the peritonitis
  • Placing a feeding tube
  • Flushing the abdominal cavity and cleaning with saline
    The incision may be closed or left open for a short period of time to allow the remaining fluid to be removed.

    Home Care and Prevention

    After treatment, animals are often continued on antibiotics for a period of time. The animal is monitored for vomiting, lack of appetite or depression.

    Peritonitis can be difficult to prevent, but prompt diagnosis and effective treatment of underlying illness can help reduce the risk.

  • Peritonitis is an inflammatory process within the abdomen that involves the peritoneum and can be localized or generalized. Localized peritonitis can occur following surgery, trauma or mild pancreatitis and usually responds to medical therapy.

    Generalized peritonitis is very serious and potentially life threatening and is due to inflammation that overwhelms the body's normal responses. Fluid accumulates within the abdomen and eventually dehydration, weakness and metabolic abnormalities occur. Some animals may progress to septic shock. The dehydration often results from a lack of available body fluid. These losses are associated with vomiting, diarrhea, pooling of abdominal fluid and fever. Generalized peritonitis can occur following gastrointestinal surgery, penetrating injury and severe pancreatitis. Generalized peritonitis requires aggressive medical and often surgical therapy.

    Causes

    There are a variety of causes of peritonitis, and it can be primary or secondary. Primary peritonitis is uncommon and is caused by a direct infection of the peritoneum. Feline infectious peritonitis is the only significant cause of primary peritonitis in dogs and cats.

    Secondary peritonitis is more common in companion animals. Secondary peritonitis is caused by contamination of the abdomen. Some causes include ruptured urinary bladder, ruptured bile ducts or gallbladder, ruptured tumors or pancreatitis (inflammation of the pancreas) leading to leakage of pancreatic enzymes. Other causes include penetrating abdominal injury, perforated gastrointestinal ulcers, gastrointestinal foreign bodies, ruptured infected uterus, ruptured liver or prostatic abscess, severe pancreatitis and breakdown of a recent intestinal surgery site.

    The most common cause of peritonitis is a loss of integrity of the bowel. This can occur due to perforation or dehiscence and is a main cause of peritonitis.

    Diagnosis In-depth

    Various diagnostic techniques are used to diagnose peritonitis. These include:

  • An abdominal tap. A needle and syringe are used to obtain a fluid sample. This sample is then analyzed for the presence of bacteria and certain cells, including white blood cells and red blood cells. The protein level can also be determined.

  • Complete blood count. A complete blood count (CBC) can determine the number of white blood cells, red blood cells and platelets. In peritonitis, the white blood cell count is often elevated. The red blood cell count may be elevated if the animal is dehydrated.

  • Biochemical profile. A biochemical profile is performed to determine the function of the body's organs. Depending on the underlying cause of the peritonitis, various abnormalities may be present. The kidney and liver functions may be abnormal. The electrolytes, such as sodium, potassium and chloride may be low due to excessive vomiting. If the animal has developed an overwhelming body infection (sepsis), the blood sugar level may be low. Pancreatic enzymes, lipase and amylase, may be elevated if pancreatitis is present.

  • Culture. The abdominal fluid can be cultured to determine the type of bacteria present and which antibiotics are most effective.

  • X-rays. Abdominal X-rays are taken to determine if there is fluid present in the abdomen or if there are any tumors, masses or intestinal blockages.

  • Abdominal ultrasound can be performed to help confirm the presence of fluid and to help determine the underlying cause of the peritonitis. Abdominal ultrasound can help detect liver abscesses, pancreatitis, intestinal blockage or gall bladder rupture.

    Treatment In-depth

    Peritonitis can be treated medically or surgically, depending on the underlying cause of the peritonitis. If peritonitis is mild, medical therapy may be sufficient. Prompt surgery should be performed in cases of moderate or severe peritonitis or if the gastrointestinal tract, urinary bladder or gall bladder is ruptured.

    Medical therapy is crucial in correcting electrolyte abnormalities, controlling bacterial infections and controlling pain. Medical therapy includes:

  • Intravenous fluids or other types of fluids. If the protein level is low, hetastarch may be administered.

  • Antibiotics should be selected based on culture and sensitivity. While waiting for the results, a combination of an aminoglycoside and a penicillin or cephalosporin can be administered. A commonly used combination is gentamicin and cefazolin.

  • Pain can be treated by using morphine or similar drugs.

    Surgery is recommended in cases of moderate to severe generalized peritonitis or if gastrointestinal, urinary bladder or bile duct rupture is suspected or confirmed.

  • Exploratory surgery is often the treatment of choice. This allows for exploration of the abdominal cavity to correct the underlying cause of the peritonitis. This may involve intestinal surgery, repair of a ruptured urinary bladder, abscess or mass removal or other surgical procedures.

  • After correction of the underlying cause, a feeding tube may be placed.

  • In addition, the abdomen is thoroughly lavaged with sterile saline solution.

  • Depending on the severity of contamination and the ability to remove all fluid and debris, the abdomen is either surgically closed or left open. If left open, the animal is hospitalized and the abdomen is bandaged. The bandage is changed often until there is minimal fluid. The incision is then closed. This may take several days before the abdomen can be closed and the animal sent home.

    Follow-up

    Antibiotics are often continued for 1 to 2 weeks. Pain control may also be needed for several days. Additional follow-up will depend on the underlying cause of the peritonitis and the animal's response to therapy.

    Animals diagnosed and treated for peritonitis require close monitoring immediately after discharge from the hospital. A complete blood count and biochemical profile may be repeated until the values are within normal ranges.

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