F eline I nfectious P eritonitis

FELINE INFECTIOUS PERITONITISAccession #137373

Christina Copple, DVM

“FIVER”, 5MTH OLD, MALE, SINGAPURA Clinical Complaint: Chronic

inappetance with acute onset anorexia, vomited once?

PE abnormalities: Decreased to absent lung

sounds Prominent LNs on palpation Abdomen distended, palpable

fluid wave Fast US in ER: moderate

peritoneal & pleural effusion

“HE’S GOT FLUID” Thoracocentesis & Abdominocentesis

yellow, viscous fluid TP = 4.8 Modified transudate with disproportionate

increase in protein + Rivalta precipitates = more consistent with

exudate

Peritoneal Fluid

UB

Medullary Rim Sign

Peritonitis & Functional Ileus

FELINE INFECTIOUS PERITONITIS Mutated Feline Enteric Coronavirus Risk Factors:

Mutlicat household or cattery Purebred - cattery Sexually intact Young to middle aged (<5yrs)

Higher incidence (75%) in males 2 Forms:

Effusive Noneffusive

EFFUSIVE FORM ----- FIVER Immune-mediated vasculitis

Activated macrophages which contain actively replicating FIP virus

Loss of protein-rich fluid: peritoneal effusion, pleural effusion or pericardial effusion Subcapsular space of kidneys Effusion – high-protein, moderately cellular ==

modified transudate

NONEFFUSIVE FORM Pyogranulomatous or Granulomatous

Inflammation Multiple organs affected

Eyes Brain Kidney Omentum Focal intestinal lesions

ABDOMINAL ULTRASONOGRAPHIC FINDINGS ASSOCIATED WITH FELINE

INFECTIOUS PERITONITIS: A RETROSPECTIVE REVIEW OF 16 CASES

13 had necropsy, remaining 3 were combo of histo, cyto, and clinpath findings highly suggestive of FIP

Normal US does not exclude possibility of FIP No US findings were specific or sensitive for

hepatic or splenic changes associated with FIP Liver: normal in 11 (69%), diffusely hypoechoic in 3

(19%), focally hyperechoic in 1 (0.6%) and focally hypoechoic in 1 (0.6%)

Spleen: normal in 14 (88%), hypoechoic in 2 (1.2%)JAAHA 2010;46:152-160

ABDOMINAL ULTRASONOGRAPHIC FINDINGS ASSOCIATED WITH FELINE

INFECTIOUS PERITONITIS: A RETROSPECTIVE REVIEW OF 16 CASES

With appropriate clinical signs and a combination of the following findings, the index of suspicion for FIP should increase Renomegaly Irregular renal contour & hypoechoic subcapsular

echogenicity Abdominal lymphadenopathy Peritoneal or retroperitoneal effusion Diffuse changes within intestines

JAAHA 2010;46:152-160

JAAHA 2010;46:152-160

Figure 1—Transverse ultrasound image of a left kidneyshowing irregular renal margins, hypoechoic subcapsularinfiltration (white arrows), and mottled echogenicity.

Figure 2—Ultrasound image of a right kidney demonstrating mottled renal echogenicity, hypoechoic subcapsular infiltration (white arrows), and decreased corticomedullary definition. Both kidneys were subjectively enlarged.

ABDOMINAL ULTRASONOGRAPHIC FINDINGS ASSOCIATED WITH FELINE

INFECTIOUS PERITONITIS: A RETROSPECTIVE REVIEW OF 16 CASES

Pyogranulomatous or granulomatous hepatitis, nephritis, or pleuritis

Pleural & peritoneal effusion Pyogranulomatous orchitis Pyogranulomatous enteritis

Diffuse intestinal involvement more than solitary lesions 3 (19%) intestinal thickening

More often small intestine vs large intestine 1 - diffuse small intestinal thickening 1 - duodenal thickening 1 – colonic thickening with loss of layering JAAHA 2010;46:152-160