Chapter 6: Let's study X rays #13 الجدPeritoneal& retroperitoneal free fluid & gas سوائل هواء البطن

Chapter 6: Let's study X rays #13 الجدPeritoneal& retroperitoneal free fluid and gas
أعمل أيه في سوائل البطن في حالة هواء في البطن
Fluids: Loss of contrast conclusion:
Emaciated ? Effusion? Young ? Maybe peritonitis ?
Fluid vs fats , generalized or localized inflammation
Peritoneal effusion what then ? fluid cytology and analysis
Bowl movement during effusion ? Free moving or not  If non-central bowl containing gas with a patient having large amount of peritoneal fluid that suggests presence of abdominal mass or adhesions that prevent free-roaming of intestinal segments
Retroperitoneal vs peritoneal space to compare
Absorption time ? Non-proteinaceous ( fluids , electrolyte , water  24hr ) , proteinaceous ( serum , blood , lymph ) within 1-2 Weeks
How sick you patient is . You treat patient not rads or BW numbers
DDX:
Lack of intraabdominal fat, cachexia
Young patient Puppies and kittens (brown fat, small amounts of fluid)
Peritoneal effusion (transudate, modified exudate, exudate)
Peritonitis
Feline infectious peritonitis (FIP)
Sepsis: bacterial infection.
Peritoneal neoplasia (primary or metastatic)
Hemorrhage. Ruptured mass(liver, kidney, spleen, etc.), abscess etc.
Serosal malignancy such as carcinomatosis. Cake?
Uroabdomen urinary tract leakage.
Right-sided heart failure.
Hypoproteinemia.
Portal hypertension
Mass effect caused by crowding
Superimposed external material (wet hair, ultrasound gel, etc.)
Underexposure

Peritoneal gas Common causes:
Previous surgery.
readily visible amounts for up to 10 days.
Minimal amounts for up to 30 days after surgery
Penetrating Abd wall wounds(can’t tell ruptured organ or penetrating)
infections with gas-forming organisms.
Rupture of a hollow viscus (stomach or intestine)
may also result in free peritoneal gas.
not every perforation leads to peritoneal gas
With severe intestinal distention secondary to ileus, gas may diffuse into the peritoneal cavity across the thin intestinal wall. This has also been reported subsequent to gastric volvulus. 

retroperitoneal gas common causes:
Perforation injury or migrating foreign body or surgical access
Secondary to laparoscopy or secondary to spinal surgery.
Perforation or rupture of hollow viscus such as rectum or vagina in females
It can cause extension of pneumomediastinum it is best seen in lateral radiograph.