The liver is responsible for producing and passing bile (a yellowish digestive fluid) into the duodenum (the initial part of the small intestine), as it aids digestion and metabolizes fats.  The abnormal functioning or failure of this process can lead to devastating consequences. Your pet can experience inflammation as the result of a countless number of disorders. It is most commonly seen due to accumulated gallstones (biliary calculi) obstructing the bile duct, an inflamed gallbladder (cholecystitis), or from trauma. Parasites (such as ringworm, roundworm, or tapeworm), as well as neoplastic cells can also cause inflammation and rupture. Pancreatitis (known as inflammation, scarring, or damaging of the pancreas) can occur with the obstruction of the pancreatic ducts caused by biliary calculi. Cholecystitis is usually caused by a bacterial infection that starts in the small intestine and then spreads through plasma into the abdomen and liver, causing pain, severe infection, and inflammation. When this happens to your dog, infected bile seeps through the abdomen, and causes a serious disorder called peritonitis, which can be fatal without the use of aggressive antibiotics and surgery.  Bile peritonitis is a secondary disorder that can occur as a result of the disorders that are listed above.

Septic peritonitis is a serious illness that results as a secondary condition of disease and pertains to injury affecting the peritoneum or the lining of the abdominal cavity. Early intervention is essential for recovery.

Your veterinarian will begin the diagnostic process with a physical examination and will ask you for the recent health history of your pet. The veterinarian may want to take radiographs (x-rays) to identify stones. In addition, ultrasounds can be used to detect the causes and sites of obstruction and diseases leading to rupture. A urinalysis can check for the amount of bilirubin that is being processed within the urine, and additional blood work could also be done to check the levels of bilirubin comparing it to levels within the blood. A complete blood count, a biochemical profile and a sample tissue from a biopsy may be analyzed for neoplastic cancer growth or tumors. Your veterinarian may also want to do percutaneous aspiration known as abdominocentesis, which will indicate the volume, color, proteins, clarity, bilirubin, and nucleated cell count within the abdomen. Any presence of bile indicates rupture, and does not appear in healthy animals.

Fluid therapy is part of the treatment for inflammation of the abdomen due to bile leakage. Electrolytes to prevent dehydration and antibiotics to rid the body of infection will be prescribed.  If the patient is in shock, vasopressor therapy (that constricts the blood vessels) with the use of norepinephrine, epinephrine and dopamine are recommended to resuscitate the cardiac system and regain a normalized blood pressure.  

Your pet may be put under anesthesia, for a surgery procedure known as peritoneal lavage. Using a catheter that is inserted to drain and remove inflammatory and septic material from the peritoneal cavities,  sterile saline is then used to clean and eliminate the infection. Surgery will be conducted once your dog is stabilized according to the underlying site and cause of rupture.  The specific surgery site must accommodate the need for open drainage and for a post-operating feeding tube. If your dog requires surgery to remove a tumor, he will have to undergo chemotherapy within the next 2 to 3 weeks. Euthanasia may be discussed if your veterinarian feels that your dog’s chance of survival or recovery is low.

Your canine companion will typically have to remain hospitalized for at least 4 to 7 days. Pain medication, antibiotics, and corticosteroids will be used to control discomfort, infection and inflammation.  Hypoproteinemia (low protein level) is common in postoperative patients so nutritional support must be maintained with the feeding tube. Once home, your dog will be strictly limited as to exercise, and a check up within 2 weeks will be scheduled so the veterinary team can make sure that your pet’s recovery is moving along as it should.