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779.e2 Peritonitis

Peritonitis Client Education
Sheet
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BASIC INFORMATION
○ Organ inflammation/ischemia
• Icterus
○ Iatrogenic • Previous abdominal incision
Definition Nonseptic versus septic: • Hematuria, pyuria
Inflammation of the peritoneum • Nonseptic • Purulent or hemorrhagic vaginal discharge
○ Peritoneal inflammation: mechanical Findings related to sepsis/septic shock:
Epidemiology trauma (e.g., intraabdominal surgery), • Hyperemia, brick-red mucous membranes,
SPECIES, AGE, SEX pancreatitis increased or decreased capillary refill time,
• Any species, breed, age, or sex ○ Sterile foreign material: urine, bile, tachycardia, tachypnea, hyperdynamic or
• Cat: feline infectious peritonitis (FIP [p. 327]) iatrogenic (e.g., surgical sponge) hypodynamic pulse, fever or hypothermia
• Septic (cats)
RISK FACTORS ○ Contamination and subsequent infection
• Abdominal trauma of the peritoneal cavity by an infectious Etiology and Pathophysiology
○ Blunt agent (bacteria most commonly, viruses, • Peritoneal inflammation causes vasculitis and
○ Penetrating protozoa, yeast) increased capillary permeability.
• Intraabdominal surgery • Movement of large volumes of fluid into
○ Gastrointestinal (GI) procedures HISTORY, CHIEF COMPLAINT peritoneal cavity
• Inflammatory/infectious disease of abdominal History varies, depending on underlying cause: ○ Severe hypovolemia or hypovolemic
organ(s) • Known trauma shock
○ Cholecystitis/cholangiohepatitis • Ingestion of foreign material ○ Accompanying loss of protein and
○ Prostatitis/prostatic abscess • Previous abdominal surgery electrolytes
○ Pancreatitis • Ongoing or recent treatment for intra- • Development of coagulation abnormalities
○ Pyometra abdominal organ disease due to release of inflammatory mediators
○ Pyelonephritis • Urinary tract obstruction and cytokines
○ Cystitis • Heat cycle in previous month ○ Hypercoagulable or hypocoagulable state
• GI ulceration • NSAID and/or glucocorticoid use ○ DIC
○ Nonsteroidal antiinflammatory drugs Chief complaint varies, depending on underly- • If septic, bacterial translocation into the
(NSAIDs) ing cause of peritonitis: bloodstream
○ Glucocorticosteroids • Nonspecific complaints ○ Bacteremia
○ GI neoplasia ○ Lethargy, fever, anorexia, vomiting, ○ Sepsis or septic shock
○ Foreign body ingestion decreased/no fecal production, diarrhea
• Cat: environment conducive to transmission • Complaints related to cause of peritonitis DIAGNOSIS
of FIP ○ Wound(s) in abdominal area
○ Jaundice Diagnostic Overview
CONTAGION AND ZOONOSIS ○ Vulvar discharge Diagnosis is suspected based on presenting
Cat: transmission of coronavirus FIP is mainly • Urination history and physical exam findings. Confirma-
by the fecal-oral route; mutation of coronavirus ○ Stranguria tion requires demonstration of inflammation
from less pathogenic form to FIP variant is ○ Oliguria/anuria in intraabdominal fluid and evaluation
necessary to cause clinical FIP. ○ Hematuria of the fluid to determine the cause of the
• Complaints related to developing peritonitis peritonitis.
ASSOCIATED DISORDERS ○ Signs of abdominal discomfort: reluctance
• Sepsis/septic shock to lie down or discomfort when lying Differential Diagnosis
• Coagulopathy/disseminated intravascular down, praying posture, pain on handling/ • Abdominal pain: rule out other causes (organ
coagulation (DIC) touching abdomen (often subtle) enlargement, organ inflammation).
• Systemic inflammatory response syndrome ○ Abdominal distention • Nonabdominal pain: rule out
(SIRS) ○ Spinal (e.g., intervertebral disc disease,
• Acute respiratory distress syndrome (ARDS) PHYSICAL EXAM FINDINGS trauma)
• Multiple organ dysfunction syndrome Findings related to peritoneal inflammation: ○ Pelvic fracture/dislocation
(MODS) • Nonspecific: lethargy, fever, dehydration ○ Thoracic (e.g., trauma-related rib fractures,
• Specific diaphragmatic hernia, other intrathoracic
Clinical Presentation ○ Signs of acute abdomen disease [e.g., pleural pain])
DISEASE FORMS/SUBTYPES ○ Pain on abdominal palpation: localize to ○ Limbs: joint pain/polyarthritis
Primary versus secondary: specific region of abdomen if possible; • Abdominal distention, fluid (abdominocen-
• Primary: peritoneal inflammation or infec- may be absent or subtle (especially in cats) tesis [p. 1056] for confirmation)
tion without pre-existing intraabdominal ○ Abdominal distention (fluid and/or mass) ○ Associated with peritonitis (septic or
condition Findings related to underlying cause of nonseptic exudate)
○ FIP peritonitis: ○ Not associated with peritonitis (transudate,
○ Rare occurrence of bacterial (mycobacteria) • Abdominal trauma (e.g., wounds, contusions, modified transudate, hemorrhage, ascites,
and protozoal primary infections disruption of the abdominal wall) neoplastic effusion) (p. 79)
• Secondary: peritoneal inflammation or infec- • Linear foreign body (p. 353) caught around • Abdominal distention, mass
tion caused by intraabdominal pathologic tongue base. The clinician should apply ○ Not associated with peritonitis: organ
condition dorsal pressure with thumb externally enlargement (e.g., hepatomegaly, spleno-
○ Disruption of GI or urogenital tracts between mandibles to raise tongue for a megaly), cyst formation (e.g., paraprostatic
○ Penetrating trauma proper sublingual exam. cyst)

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