Part 69

Treatment does not differ materially from that given for larger animals. Pain may be moderated by belladonna, hyoscyamus, chloral, or even opium, while the sulphate of soda is employed by both mouth and rectum. The abdomen may be enveloped in a damp compress, or a warm bath may be given. Diuretics will be in order and above all antiferments, the latter by enema as well. Distension of the abdomen with fluid may be relieved by puncture, followed by antiseptic irrigation. If there is good ground to suspect a gastric or intestinal lesion or tumors, laparotomy is a much more hopeful resort than in the larger animals.

PERITONITIS IN BIRDS.

From caponizing, accidental traumas, ruptured oviduct, perforations of bowels by foreign bodies or worms, pyogenic susceptibility slight. Symptoms: inappetence, drooping head, wings, tail, erect plumage, stiffness, straining, tense, tender, pendent belly. Treatment: unload cloaca, puncture and irrigate abdomen, laxatives. Prophylaxis, by laxative food, expulsion of worms, antisepsis in operations, unloading cloaca, etc.

Causes. Male birds contract peritonitis from caponizing, and other penetrating wounds of the abdomen, from rupture of the oviduct impacted with egg matter, from perforations of the intestines by foreign bodies, and from perforations by worms.

The danger from ordinary pyogenic germs is, however, at its minimum, since birds stand at the opposite extreme from the horse, and their wounds rarely suppurate.

Symptoms. The bird loses appetite, droops head, wings and tail, ruffles its feathers, walks stiffly and heavily, and expels fæces with much effort and even with cries. When caught the abdomen is found to be full, tense and pendent and very tender to the touch. There is more or less hyperthermia (108° and upward), and the subject becomes more and more dull, stupid and feeble until death.

Treatment. In certain cases relief may be had by the unloading of the cloaca, or the evacuation of peritoneal fluid, followed by antiseptic, irrigation of the cavity. Laxatives may also be resorted to. The most important measures are however prophylactic, and run in the direction of careful manipulation and antisepsis in caponizing, the unloading of impacted cloaca, before it has developed serious disease, the maintenance of a suitably laxative diet, and the prevention and treatment of worms. In case of tumors causing chronic peritonitis, laparotomy can be resorted to with great confidence.

ASCITES IN SOLIPEDS.

Causes: follows peritonitis, obstruction of portal vein, tumors, hepatic diseases, pressure on posterior cava, dilated right heart, heaves, ovarian disease, nephritis or kidney degeneration, hydroæmia. Symptoms: slow advance, pot-bellied, with fluctuation, hollow above, dropsy in limbs, sheath and under belly, percussion sound flat below, weakness, debility, no fever. Diagnosis: Absence of fever, and of fibrine, cells and granules in effusion. Lesions: those of primary disease, amount and composition of effusion. Treatment: treat primary disease glandular swelling or actinomycosis, iodide of potassium, remove diseased ovary or tumor, draw off fluid, compress abdomen, saline laxatives, diuretics, iodides, pilocarpin, electricity, bitters.

Causes. Ascites may be a remnant of a pre-existing chronic peritonitis, or it may occur from any obstruction of the portal vein, such as compression by organized false membranes, thrombus, in the vessel, or pressure by lympadenoma in the portal fissure, melanosis, sarcoma and other tumors. It results from cirrhosis and other diseases of the liver which retard its circulation, from pressure on the posterior vena cava, from insufficiency of the right auriculo-ventricular valves, from dilatation of the right heart, and from heaves or other obstruction in the pulmonic circulation. Other causes are cystic or other disease of the ovary, diseases of the kidney and hydroæmia, the latter two tending to general œdema as well as ascites.

Symptoms. The disease comes on slowly and insidiously and at first it usually passes unnoticed. When more fully developed the abdomen is distended but somewhat pendent (pot-bellied), fluctuating below, with falling in beneath the lumbar transverse processes. Later the whole abdomen may be full, rounded, smooth and tense, and the hind limbs œdematous to above the fetlocks or hocks. There may be œdema of the sheath or lower wall of the abdomen. Fluctuation can still be felt as a shock when an assistant makes sudden concussion with the fist on the opposite side from that on which the hand is pressed. This may be felt even more distinctly by the hand introduced into the rectum. Percussion gives a flat sound below and more or less resonant above. The pulse is small, weak, and accelerated, heart beats irritable (sometimes palpitating), and respiration labored and with lifting of the flank. From first to last there is no hyperthermia.

If the cause is irremediable the issue is necessarily fatal sooner or later.

Diagnosis from peritonitis depends largely on the absence of hyperthermia, and of abdominal tenderness, and on the nature of the ascitic fluid which is incoagulable, and comparatively destitute of leucocytes cells and granules.

Lesions. The quantity of effused liquid is often enormous (50 qts. Reynal, 80 qts. Woodger, 150 qts. Friedberger and Fröhner). It is very watery and poor in salts and albuminoids, of a density near 1012, neutral or slightly alkaline, does not coagulate spontaneously, and is not associated with false membranes. The peritoneum shows no congestion, but is pale, and, like the abdominal walls, infiltrated. Tumors, cysts and venous obstructions referred to under causes may be found.

Treatment. When ascites depends on actinomycosis or glandular enlargement a course of iodide of potassium may remove the cause. In other cases an operation may remove the offending tumor or ovary. Too often, however, the cause is beyond remedy and palliative treatment only is available. The most urgent indication is the removal of the accumulated fluid, and paracentesis under proper antiseptic precautions is the readiest means to this end. Compression by a tight bandage is necessary to prevent the sensation of vacuity and tendency to fainting which come from the removal of the fluid and to counteract the disposition to the instant effusion of more. Even with the compress it is judicious not to draw off all of the fluid at once in bad cases, but to make two or three operations and allow the patient to become accustomed to the change in the intervals. These may be repeated as circumstances demand. Saline purgatives, or diuretics (saltpetre 1 oz., digitalis 25 grs., squill 3 ozs., iodide of potassium 2 drs.), are useful, and pilocarpin is the most efficient agent of this kind, but also dangerous by reason of the extreme depletion which it causes. Electricity has been employed with alleged advantage, also poultices of digitalis applied over the loins.

Cholagogues are also recommended especially in cases of liver disease. Bitters may prove useful.

ASCITES IN RUMINANTS.

Causes: as in horse, tuberculosis, in sheep distomatosis, chills when heated and fatigued. Symptoms: pot-belly, fluctuating on percussion, gives flat sound, debility, pallid mucosæ, sunken eyes, superficial dropsies on belly, in limbs, and under jaw, in distomatosis, great emaciation, weakness, paperskin, ova of distoma in fæces. Diagnosis: from ruptured bladder by passage of urine, and perhaps by sex, and absence of urinous odor in liquid, from hydrometra by fluctuation over whole belly. Lesions: those of solipeds, also tubercles or enlarged gall ducts with distomata. Treatment: as for solipeds. Tuberculosis demands separation or destruction, distomatosis, prevention.

Causes. These are in the main those which operate in the horse and need not be repeated. In cattle, however, the affection is to a large extent the result of abdominal tuberculosis, while in sheep it is a constant result of advanced distomatosis. Gellé says it is common in working oxen, which are turned out, hot and perspiring, to pass the night in cold and wet.

Symptoms. The belly is enlarged and pendent, bulging out back of the ribs, with fluctuation and dullness on percussion. The animal is in very low condition, the mucosæ pale or yellowish white, the eyes dull and sunken, panting and palpitations may be roused on the least exertion, and swellings often appear along the lower aspect of the body and between the branches of the lower jaw. In distomatosis it is common to find dropsy of the chest, pallor and attenuation of the skin, complete absence of the subcutaneous fat (paperskin), and great emaciation and weakness. Ova of the distoma can be found in the fæces. (See distomatosis). By turning the sheep on its back or setting it up on its croup the percussion dullness will be made to shift, always to the dependent part of the abdomen.

Diagnosis. From rupture of the bladder it is distinguished, by its occurrence in females as well as males, by the absence of fever, and of the complete suppression of urine and emptiness and tenderness of the bladder which characterize the latter. Liquid drawn from the abdomen has no urinous odor. From hydrometra, pyometra, and hydramnios it is distinguished by the fact that the water accumulates in the lower part of the abdomen, and is not confined to the womb. On rectal exploration the outline of the empty womb is made out.

Lesions. Besides the lesions described for solipeds, one finds in cattle, tuberculosis of the liver, spleen, and lymph glands, and extensive clusters of tubercles on the peritoneum. In sheep the white branching lines on the back of the liver may indicate the distension of gall ducts infested by distomata.

Treatment does not differ from that recommended for solipeds. In tuberculous cases, sanitary considerations demand the destruction of the animal and disinfection of the carcass. In distomatosis treatment must be preventive, as the distomata are difficult to reach with vermifuges.

ASCITES IN CARNIVORA.

Causes: obstructed flow of blood in hepatic, portal or renal veins, or in vena cava, renal, heart, liver or splenic diseases, pulmonary congestion, asthma, tuberculosis. Symptoms: pot-belly, hollow above, drooping back and loins, flat percussion sound and fluctuation, change of position changes area of flatness, anæmia, debility, scanty urine, diarrhœa, no fever. Diagnosis: absence of fever, general fluctuation changing its seat by turning the patient, not confined to a given organ like the bladder or womb. Lesions: quantity and composition of liquid, lesions of primary diseases. Treatment: Correct if possible the primary disease, evacuate the liquid, compress on abdomen, iodine solution for irrigation, saline purgatives, diuretics, pilocarpine, bitters, iron, sunshine.

Causes. Ascites is generally the result of some obstruction to the return of blood from some abdominal organ, but may also come from renal disease, or hydroæmia in which general dropsy is likely to occur. The dog is specially subject to heart disease, and disease of the right heart (tricuspid insufficiency, dilatation, hydro-pericarditis, fatty degeneration, etc.) throws the blood back on the whole venous system and the extensive and dilatable portal veins are especially liable to suffer. Diseases of the liver, so common in pampered house dogs, still more directly block the portal circulation and induce ascites. Tumors in the liver or spleen or in the lymph glands of the porta act in this way, also cirrhosis, tuberculosis, cancer, hepatic congestion, and degeneration. Constrictions of the vena portæ by false membranes the result of former peritonitis must also be recognized. As more distant causes, must be named obstruction to the pulmonary circulation, as in congestion, asthma, tuberculosis and diseases of the left heart. Seventy-eight cases were traced as follows: to diseases of the heart and pericardium, 10; to tuberculosis, 8; to pleurisy, 4; to malignant tumors of the liver and lung, 2; to hepatic disease without heart lesion, 3; to cancer of the liver, 1; (Cadiot).

Symptoms. Enlargement of the belly is marked and peculiar, the liquid accumulating below, pushing outward the lower ends of the ribs, and making the lower part of the abdomen baggy while the upper part, under the lumbar transverse processes, is flattened or hollow. The back and loins droop forming a concavity superiorly, so that the belly may almost drag on the ground. On palpation this pendent abdominal sac gives the sensation of a mobile fluid without the usual firm outlines of the intestinal masses, and when percussed it gives out a flat, dull sound and produces a fluctuation or shock at the opposite side of the abdomen. In the upper part of the abdomen over the hollow flank more or less resonance is found. If the animal is made to stand on his hind limbs the saccular dilatation and flatness on percussion are in the region adjoining the pelvis; if held up by its hind limbs they are transferred to the epigastric and hypochondriac regions and the respiration is seriously interfered with; if turned upon his back, the resonance is obtained on the linea alba and at each side, while the percussion dullness is next to the vertebræ. The clearness of the fluctuation is in ratio with the amount of liquid present.

As in other animals, there are anæmia, pale mucosæ, poor condition, thin, dry, unhealthy skin, weak pulse, irritable heart and interference with respiration proportionate to the amount of liquid. The urine is scanty, and there may be diarrhœa.