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What are triage findings with an acute abdomen? (4)
- pain (caused by distension, ischemia, traction, and/ or inflammation)
- fluid wave/ ballottement
________ should be a rule out for abdominal pain because they can appear similarly.
How can you determine if an animal has abdominal pain? (4)
reluctance to move, praying position, does not rest abdomen on floor, grunts/ bites when abdomen is palpated
When palpating the abdomen and localizing pain, focal suggests __________, regional pain suggests __________, diffuse pain suggests _____(2)_____.
FB; pancreatitis; peritonitis, enteritis
What is the rule of thumb for severity of abdominal pain?
- the more encapsulated an organ is, the more painful distention will be
- Ex. kidneys are very encapsulated and therefore very painful when enlarged; liver is not encapsulated and can have a huge mass with no pain
What are the 4 general causes for abdominal pain?
- distention of hollow viscus or organ capsule
- traction (intestinal FB)
- ischemia (volvulus, thrombus)
- inflammation (parvo,pancreatitis)
What diagnostics will help you in the initial work up of an acute abdomen? (9)
- Shock work-up: PCV-TP, BP/ECG, glucose, lactate, electrolytes, blood gas
- Abdomen work-up: abdominal FAST, abdominocentesis, fluid analysis
What information with CBC/Chem/UA can help you work up an acute abdomen?
- CBC: eval red cells, platelet count, inflammatory status
- Chem: metabolic status of patient, organ dysfunction
- UA: renal function, urinary tract abnormalities
What are the advantages of using radiographs in cases of acute abdomen? (3)
- Great for evaluating:
- presence of air or air/gas distention
- metallic or mineral FB
- +/- size of organs
What are the advantages of using ultrasound in cases of acute abdomen? (3)
- Great for evaluating:
- detection of fluid
- helps with FNA or belly tap
- aspect of the organs (gall bladder)
What are the anatomic locations for an abdominal FAST scan?
- diaphragmatic- hepatic
- hepato-renal (right)
- spleno-renal (left)
What parameters should you analyze when performing fluid analysis from abdominal fluid? (5)
- PCV/ TP
- total nucleated cell count (TNCC)
- +/- others
Describe a transudate.
- clear/ colorless
- TP < 2.5
- TNCC < 1,000
- Cells are mononuclear
- SG < 1.018
- hypoalbuminemia, portal vein obstruction, R-CHF
Describe a modified transudate.
- variable color
- TP 2.5-7.5
- TNCC 1,000- 10,000
- Cells are variable inflammatory cells
- SG is variable
- HWD, neoplasia, liver disease
Describe an exudate.
- TP > 3.0
- TNCC > 10,000
- Cells vary with cause and species
- SG > 1.018
- septic vs. non-septic, neoplastic
Describe the fluid analysis results from a tap of septic peritonitis.
- inflammatory cells
- intracellular bacteria
- paired glucose/ lactate: blood glucose >20 higher than abdominal glucose; abdominal effusion lactate < 2 higher than blood lactate
Describe the fluid analysis results from a uroabdomen.
- creatinine 2x greater in effusion than peripheral blood
- potassium conc is 1.5 (dogs)- 2(cats)x higher in effusion than peripheral blood
__________ is a poor marker for uroabdomen because it quickly equilibrates across the peritoneum.
Describe the fluid analysis results for bile peritonitis.
- phagocytosed bile pigment on cytology
- effusion bilirubin is 2-3x higher than peripheral blood
Describe the fluid analysis results from hemoabdomen.
- clotting versus non-clotting blood (non-clotting means active hemoabdomen)
- effusion PCV > 10% consistent with hemoabdomen
Most cases of acute abdomen are ___________.
surgical emergencies (except pencreatitis)
What are the mainstays of general treatment of acute abdomen? (3)
- [definitive therapy depends on cause]
- Analgesia- opioids (AVOID NSAIDS)
- IV Fluids- correct shock
- Nutrition- consider placing feeding tube if unable to eat
___________ is a good prognosticator in GDV for necrosis of stomach.
Lactate clearance (lactate clearance of >50% in 12 hours is correlated with survival)