Peritonitis
Basic Information 
Clinical Presentation
Physical Exam Findings
• Variable tachycardia and tachypnea
• Variable signs of abdominal pain (often mild)
• Decreased gastrointestinal (GI) borborygmi
• Variable signs of endotoxemia (injected, hyperemic to purple mucous membranes; prolonged capillary refill time; cool extremities)
• Ventral edema may be present.
• Rectal examination is usually within normal limits, although the presence of intestinal distension or an intraabdominal mass may be noted if peritonitis is secondary to intestinal obstruction or an intraabdominal abscess.
Etiology and Pathophysiology
• Peritonitis is classified as aseptic or septic and can be focal or diffuse.
• Some degree of aseptic peritonitis occurs after abdominal surgery (and routine castration) caused by inflammation induced by invasion of the peritoneal cavity and intestinal handling. This usually resolves without specific therapy.
• Uroperitoneum caused by bladder or ureteral rupture can also induce peritoneal inflammation and result in aseptic peritonitis.
• There are a variety of causes of septic (bacterial) peritonitis, including:
Inflammatory or obstructive intestinal disease, resulting in disruption of the intestinal mucosal barrier and translocation of enteric bacteria
• Systemic bacterial infection
Actinobacillus spp. frequently causes peritonitis in the absence of infection in other body systems in adult horses.
• Iatrogenic after enterocentesis during attempted abdominocentesis or after celiotomy
Diagnosis 
Initial Database
• Passage of a nasogastric tube: Gastric reflux (>2–4 L) is occasionally observed in severe, acute peritonitis caused by intestinal ileus but is not consistently observed.
• Complete blood count: Leukocyte count is variable but usually abnormal.
Leukopenia (neutropenia) and toxic changes in neutrophils are typical in acute, septic peritonitis cases.
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