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The peritoneal cavity

image of The peritoneal cavity
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Abstract

The peritoneum is a serous membrane, predominantly composed of connective tissue, which lines the peritoneal space and is contained largely within the abdominal cavity. In the normal animal the peritoneal cavity is an almost non-existent space, containing only a small volume of lubricating fluid. The chapter discusses the Normal peritoneum; Peritoneal diseases; Contrast radiography; and Overview of additional imaging modalities.

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Figures

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4.1 Dorsal plane ultrasonogram of the normal mesentery in a 9-year-old West Highland White Terrier. Intestinal loops (arrowed) are present surrounded by the fine hyperechoic streaks and amorphous tissue of the mesentery. The spleen is visible in the near-field.
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4.2 Lateral abdominal radiograph of a skeletally mature medium-breed dog, showing the normal distribution of fat within the abdomen.
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4.3 Lateral abdominal radiograph of a skeletally mature cat. Small fat deposits are present in the falciform and retroperitoneal regions.
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4.4 Lateral abdominal radiograph of an obese skeletally mature cat. Large fat deposits are present in the falciform, umbilical, retroperitoneal and inguinal regions, resulting in central displacement of the abdominal organs. VD abdominal radiograph of an obese cat. Substantial fat deposits highlight the kidney on the left, and result in displacement of small intestines to the right. (Courtesy of F Barr)
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4.5 VD abdominal radiograph of a 4-month-old Hungarian Vizsla. The serosal surfaces of the intestines are poorly visualized due to the lack of intra-abdominal fat. Lateral abdominal radiograph of a 5-month-old cat. There are only small intra-abdominal fat deposits and serosal detail is poor.
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4.6 Lateral abdominal radiograph of a 17-week-old Cavalier King Charles Spaniel with suspected urinary tract rupture. The pendulous body contour with complete effacement of all serosal detail is highly suggestive of free fluid, but the absence of intra-abdominal fat deposits may make interpretation uncertain.
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4.7 Lateral abdominal radiograph of a grossly obese skeletally mature cat. Radiographic scatter is increased, resulting in reduced anatomical detail and tissue contrast.
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4.8 Lateral abdominal radiograph of an emaciated skeletally mature cat with a distended stomach, resulting in distension of the abdomen. Differentiation between emaciation and free peritoneal fluid is very difficult in this case.
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4.9 Lateral abdominal radiograph of a 5-year-old crossbreed dog with gastric perforation secondary to ulceration. Gas lucency can be seen highlighting the crura of the diaphragm and the lobes of the liver dorsally. VD view demonstrating gas (arrowed) behind the ventral portion of the diaphragm. (Courtesy of R O’Brien). Decubitus lateral view showing the accumulation of free gas against the uppermost lateral body wall.
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4.10 Lateral abdominal radiograph of a 10-year-old crossbreed bitch with modified transudate secondary to lymphangiectasia. A small to moderate volume of free abdominal fluid is present.
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4.11 VD abdominal radiograph of a 17-week-old Cavalier King Charles Spaniel with uroabdomen. There is complete effacement of all serosal detail with distension of the body contours.
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4.12 Parasagittal plane ultrasonogram of the cranial abdomen of a 9-year-old male neutered British Shorthaired cat with alimentary lymphosarcoma. A small anechoic triangular shape can be seen separating the liver lobes, indicating a small volume of free fluid.
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4.13 Dorsal plane ultrasonogram of the mid-abdomen of a 17-week-old male Cavalier King Charles Spaniel with uroabdomen. Loops of small intestine and mesentery can be seen surrounded by anechoic fluid.
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4.14 Lateral abdominal radiograph of a large-breed dog with focal peritonitis. There is a hazy loss of detail with irregular contours in the mid-ventral abdomen with displacement of the small intestines caudally and the spleen ventrally.
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4.15 Dorsal plane ultrasonogram of an 8-year-old female neutered Domestic Shorthaired cat with pyoabdomen. Intestinal loops (arrowed) are poorly visualized within a mass of echogenic fluid.
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4.16 Dorsal plane ultrasonogram of a 5-month-old Beagle with bile peritonitis after a road traffic accident 2 weeks previously. The small intestinal loops have a corrugated appearance and are surrounded by homogenous, hyperechoic mesentery. There is a moderate volume of free peritoneal fluid. (Courtesy of F Barr)
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4.17 Lateral abdominal radiograph of a 9-year-old male Golden Retriever with carcinomatosis. Compare this image with that in Figure 4.10 . Both radiographs show mottled loss of serosal detail. (Courtesy of C Lamb)
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4.18 Dorsal plane ultrasonogram of the abdomen of the dog in Figure 4.17 , showing echogenic fluid and hyperechoic irregularly rounded thickened mesentery. (Courtesy of C Lamb)
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4.19 Lateral abdominal radiograph of a medium-breed dog with splenic haemangiosarcoma. There is a soft tissue opacity mass in the cranioventral abdomen with caudodorsal displacement of the stomach and intestines. The liver is enlarged and irregular and there is hazy loss of serosal detail, indicating free fluid.
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4.20 Dorsal plane ultrasonogram of the abdomen of a 4-year-old male neutered Domestic Shorthaired cat with a palpable abdominal mass. Ultrasonography revealed a large hypoechoic mass (arrowed) in the cranial abdomen, extending throughout the mesentery and involving the common bile duct and pancreas. Ultrasound-guided fine-needle aspiration biopsy revealed carcinoma.
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4.21 Lateral abdominal radiograph of an adult dog with a lipoma in the broad ligament. A large relatively radiolucent mass is present in the centre of the abdomen, causing cranioventral displacement of the small intestines and dorsal displacement of the kidneys and descending colon. (Courtesy of F Barr)
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4.22 CT slice at the level of the fourth lumbar vertebra of a 10-year-old male Labrador with multiple lipomas. A large hypoattenuating, fairly well defined mass can be seen causing dramatic peripheral displacement of the small intestines to the right and the descending colon ventrally. The cranial pole of the bladder can be seen just lateral to the descending colon. The spleen is lateral to the colon. (Fat-optimized window: width 500 HU, level −200 HU)
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4.23 Dorsal plane ultrasonogram of the mesentery in the left dorsal abdomen of a 7-year-old Lhasa apso, 2 weeks after splenectomy. There is an oval area of hyperechoic mesentery with a hypoechoic centre (between cursors). This was thought to be a mesenteric haematoma and had resolved on re-examination 3 weeks later.
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4.24 Lateral abdominal radiograph of a skeletally mature large-breed dog with a retained surgical swab. A large stripy mottled mixed soft tissue and gas opacity is present in the cranioventral abdomen. (Reproduced from with permission from )
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4.25 An 8-year-old female neutered Domestic Shorthaired cat with pyoabdomen. Lateral abdominal radiograph. Serosal detail is lost throughout the abdomen and the gas-filled intestines appear more dorsal in the abdomen than normal, suggesting the presence of a homogenous soft tissue opacity mass rather than just fluid. Dorsal plane ultrasonogram revealed an echogenic mass of tissue within the abdomen. Poorly defined small intestine loops (arrowed) can be seen within the tissue. Laparotomy and histopathology confirmed the presence of grossly inflamed peritoneum with a moderate volume of thick pus.
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4.26 Lateral abdominal radiograph of an 8-year-old female neutered Domestic Shorthaired cat with mineralized mesenteric lymph nodes, visible as speckled, granular mineralized foci in the mid-abdomen, with peripheral displacement of the intestines.
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4.27 Lateral radiograph of the caudal abdomen of a skeletally mature cat with a small smooth mineralized focus superimposed on the dorsal aspect of the bladder. This was determined to be nodular fat necrosis of no clinical significance. (Courtesy of C Lamb)
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4.28 Lateral abdominal radiograph of an adult dog taken after a laparotomy. A fine linear metallic opacity is present in the mid-abdomen. Small intestinal loops are present ventral to this opacity. There is a moderate to large volume of free gas within the abdomen and the serosal surface of the colon can be clearly seen. (Courtesy of F Barr)
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4.29 Post-contrast CT slice at the level of the second lumbar vertebra of an 8-year-old male Weimaraner showing contrast medium in the left renal pelvis and proximal ureter. Intestinal loops can be seen throughout the abdomen surrounded by a small amount of hypoattenuating fat. (Window: width 2000 HU, level −200 HU)
Image of 4.30
4.30 CT slice at the level of the first lumbar vertebra of a 10-year-old male Labrador with a body wall mass. A large hypoattenuating mass can be seen on the left ventral aspect of the abdomen, between the rectus abdominis and transversus abdominis muscles. The CT study provided information that the mass was external to the peritoneal cavity, facilitating surgical planning. The left adrenal gland (arrowed) can be seen ventrolateral to the aorta. (Fat-optimized window: width 500 HU, level −200 HU)

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