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Small Animal (Poppy) > Abdominal Disease > Flashcards

Abdominal Disease Flashcards

1
Q

Causes of cranial abdominal pain

A

Liver (hepatitis)
Gall bladder (obstruction)
Stomach (gastritis/GDV)
Spleen (splenitis)
Pancreas (pancreatitis)
Diaphragm?

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2
Q

Causes of dorsal abdominal pain

A

Kidneys (pyonephritis/AKI)
Spine
Spleen (splenic torsion/rotation)
Radiating pain from other organs

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3
Q

Causes of caudal abdominal pain

A

Bladder
Uterus
Colon
Prostate (prostatitis/prostatic abscess)

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4
Q

Where can spinal pain be transferred to?

A

Pain on palpation of whole abdomen as palpation affects posture

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5
Q

Endocrine disease that can present with acute abdominal pain

A

Addison’s

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6
Q

Meaning of ‘acute abdomen’

A

Acute abdominal pain
(Shock, collapse due to shock, vomiting could be related to pain/shock/cause)

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7
Q

Types of shock seen with acute abdomen

A

Hypovolaemic
Distributive
Obstructive (reduced cardiac output due to obstruction of blood vessels)
Cardiogenic (reduced cardiac output due to abnormal heart)

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8
Q

How to identify type of shock in an acute abdomen?

A

POCUS (mushroom view for ejection fraction, caudal vena cava should be bounding, cardiac tamponade, DCM, abdominal fluid)

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9
Q

Which fluid types may be present in the abdomen?

A

Blood
Urine
Inflammatory exudate
(Bile)
(Transudates)

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10
Q

What ultrasound finding in the abdomen is an emergency?

A

Free fluid

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11
Q

Laboratory tests for the acute abdomen

A

Haematology (neutrophilia, PCV)
Biochemistry (ALT/ALP, urea/creatinine, albumin)
Lactate (assess tissue perfusion)

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12
Q

Will abdominal fluid have the same PCV as blood in the acute or chronic situation?

A

Acute

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13
Q

Diagnostic tests for the acute abdomen

A

Ultrasound
Radiograph
Haem/biochem
Blood pressure
ECG
Blood gas analysis

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14
Q

Metabolic acidosis

A

Low pH
Caused by lactate/urea

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15
Q

Fluid choice for metabolic acidosis

A

Hartmann’s (alkanising)

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16
Q

Metabolic alkalosis is pathognomic for what?

A

Pyloric obstruction

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17
Q

Fluids for metabolic alkalosis

A

Saline (NaCl and water, dissociates to NaOH and HCl)

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18
Q

Typical prognosis for ascites

A

Poor

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19
Q

What would you be suspicious of if a dog had abdominal distension, abdominal discomfort, dyspnoea and lethargy?

A

Ascites

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20
Q

Differentials for abdominal distension

A

Organomegaly
Abdominal mass
Ascites
Pregnancy
Bladder distension
Obesity
Gastric distension

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21
Q

Diagnosis of ascites

A

History
Clinical exam
BCS
Ballottment
Ultrasound
Tap fluid

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22
Q

Opaque and foul smelling abdominal fluid

A

Septic fluid

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23
Q

Diagnostics when identifying abdominal fluid type

A

Gross appearance/smell
Cellularity (smear, microscope)
Protein content (refractometer, TP scale)

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24
Q

What fluid type is clear/colourless/pale straw colour, TP<20, TNCC<1.5 with neutrophils, macrophages and some mesothelial cells?

A

Protein poor transudate

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25
Q

What fluid type is yellow/blood tinged/turbid, TP>20, TNCC<5 with macrophages, mesothelial cells and increasing neutrophils and small lymphocytes?

A

Protein rich/modified transudate

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26
Q

What fluid type is turbid, various colours, TP>20, TNCC>5 with neutrophils and sometimes macrophages?

A

Exudate

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27
Q

Investigations when protein poor transudate is found in abdomen

A

Biochemistry (confirm hypoalbuminaemia)
Urinalysis (look for kidney failure)
Ultrasound (liver disease)

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28
Q

Differentials for protein poor transudate

A

Protein-losing enteropathy
Protein-losing nephropathy
Hepatic failure

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29
Q

Pathophysiology of protein poor transudate in abdomen

A

Hypoalbuminaemia = decrease in plasma colloid oncotic pressure

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30
Q

Pathophysiology of protein rich transudate

A

Increased hydraulic pressure in blood/lymph circulation = protein leaks from permeable capillaries = ascites develops when resorptive capacity of lymphatics is overwhelmed

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31
Q

Differential diagnoses for protein rich transudate

A

Cardiovascular disease
Chronic liver disease (post hepatic portal hypertension)
Neoplasia
Thrombosis (rare)

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32
Q

Investigation of protein rich transudate

A

Ultrasound (heart and liver)
Radiography (thorax metastasis)
Biochemistry

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33
Q

Exudate pathophysiology

A

Inflammatory process (septic or non-septic) = high TNCC, increased vascular permeability

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34
Q

Septic causes of exudative ascites

A

Penetrating wound
Surgical complication
Rupture of infected lesion
Bacteraemia (rare)

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35
Q

Does ascites with a septic cause have a better or worse prognosis than other ascites?

A

Better (there is something to ‘fix’)

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36
Q

Non-septic causes of exudative ascites

A

Neoplasia
Uroperitoneum
Bile peritonitis
FIP

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37
Q

Differentials for a lymphatic abdominal effusion

A

Cardiac disease
Hepatic disease
Neoplasia
Steatitis (inflammation of fat)

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38
Q

Pathogenesis of gastric dilation and volvulus

A

Aerophagia (swallow more gas than usual)

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39
Q

Risk factors for GDV

A

Eating quickly
Stress/anxiety/pain
Exercise (oesophagus opens after feeding)
Thoracic width to depth ratio (Red Setters, GSDs, Dobermanns, Dashchunds)

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40
Q

Pathophysiology of gastric dilation and volvulus

A

Gas distension
Pylorus pivots (180/360 degrees, 90% rotate clockwise)
Space occupying: pressure on vena cava = obstructive shock, gastric vessel occlusion = necrosis, gastric blood supply linked to spleen = spleen engorges and twists)

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41
Q

Type of shock in GDV

A

Obstructive

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42
Q

Treatment of obstructive shock in GDV

A

Oxygen therapy
Analgesia
IVFT bolus in cephalic vein
ECG +/- treat ventricular tachycardia with lidocaine

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43
Q

Reason for IVFT bolus in cephalic vein with GDV

A

No hypovolaemia but no blood returning to heart due to CVC obstruction = hypovolaemia cranially

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44
Q

Why is an ECG required in GDV management?

A

Hypoxic damage to heart = arrhythmias, most commonly ventricular tachycardia

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45
Q

Medical treatment of obstruction in GDV for temporary stabilisation

A

Orogastric (large)/nasograstric (small) tube to decompress stomach
Percutaneous decompression with Trocar/needle/catheter if tube can’t be placed

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46
Q

Anaesthetic considerations in GDV

A

High ASA grading
Avoid alpha 2s (CV compromise)
Methadone for pain
Co-induce with Midazolam and propofol (anaesthetic sparing affect)
Antibiotics? (Long surgery/damage to gastric mucosa)
Monitor lactate/blood gas analysis/ECG (acidosis likely)
Monitor cardiac output (blood pressure)
Monitor perfusion (ventilate, capnography)

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47
Q

Advised surgical technique for GDV

A

Decompress stomach fully
Incisional gastropexy (de-rotate stomach, incise pylorus serosa and abdominal wall, stitch together)
Remove spleen if damaged

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48
Q

Surgical methods for GDV

A

Belt loop
Circocostal version
Tube gastropexy
Incisional gastropexy

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49
Q

Post operative care for GDV

A

Monitor cardiac output for 24-48h as there is risk of repurfusion injury (ECG, blood pressure)
Oxygen therapy?

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50
Q

Radiographic appearance of ‘bloat’ (gastric dilation, no volvulus)?

A

‘Double bubble’/’boxing glove’

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51
Q

How to differentiate between 360 degree rotation of stomach and bloat?

A

Patient with bloat is less critical
Cannot stomach tube patient with volvulus

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52
Q

Surgical management of bloat

A

Gastropexy is indicated as there is a future risk of GDV

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53
Q

Benefits of a prophylactic gastropexy

A

Can be done at same time as castration/spay (reduced cost)

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54
Q

Risks of a prophylactic gastropexy

A

Surgical risk
Surgical time/cost
(Mesenteric torsion)

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55
Q

What could red fluid on abdominal tap be?

A

Blood (haemoabdomen) or serosanguinous

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56
Q

How can you differentiate a serosanguinous abdominal fluid from a haemoabdomen?

A

Very low PCV compared to blood = serosanguinous discharge

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57
Q

How do you determine whether a haemoabdomen is acute or chronic?

A

PCV
Acute = blood
Semi-acute >blood
Chronic <blood

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58
Q

How do you stabilise a neoplastic bleed?

A

Measure perfusion (blood pressure and lactate)
IVFT if necessary
Blood transfusion (auto-transfusion, whole blood or pRBCs)

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59
Q

Treatment of neoplastic bleed

A

Surgery (remove mass)
Chemotherapy(/radiotherapy)
Euthanasia

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60
Q

Causes of haemoabdomen

A

Neoplastic bleed
Blunt force trauma
Penetrating wound trauma
Coagulopathy

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61
Q

Stabilisation of haemoabdomen due to trauma

A

Measure perfusion (blood pressure, lactate)
Fluids or blood transfusion (autotransfusion must be filtered due to microaggregates, whole blood, rRBC with plasma)
Tranexamic acid (fibrinolytic)

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62
Q

Should you operate on patients with haemoabdomen due to trauma?

A

Blunt trauma: avoid operating, will be bleeding from multiple vessels/sources
Penetrating wound: surgery to stop bleeding

63
Q

Most common cause of haemoabdomen due to coagulopathy

A

Warfarin poisoning

64
Q

Stabilisation of patient with a haemoabdomen due to a coagulopathy

A

Measure perfusion (blood pressure, lactate)
Fluids or transfusion (fresh frozen plasma rich in clotting factors, pRBCs, whole blood last choice, no microaggregates in autotransfusion but must give plasma too)

65
Q

Which haemoabdomen patient should you never operate on?

A

Coagulopathy

66
Q

How do you diagnose a uroabdomen?

A

POCUS to identify free fluid
Bubble study US
(Contrast radiograph)
Tap fluid

67
Q

Biochemistry of fluid in uroabdomen

A

Creatinine >2x blood
Potassium >1.4x blood
(Urea may be similar)

68
Q

Why should you use ECG monitoring in patients with uroabdomen?

A

Hyperkalaemia = atrial standstill (no P wave, QRS wide and abnormal/escape complex)

69
Q

Test for hyperkalaemia in uroabdomen

A

Blood gas
(Biochemistry)

70
Q

Treatment of uroabdomen

A

Drain bladder with urinary catheter (allow bladder to rest and inflammation reduce before surgery/may resolve)
Surgery

Stimulate transport of sodium into cells as potassium will be co-transported, preventing hyperkalaemia: glucose bolus (stimulate insulin production), bicarbonate, beta-2 agonist (Salbutamol), Hartmann’s (alkalising)

71
Q

Hernia

A

Protrusion of an organ/part of an organ through a defect in the wall of the anatomical area in which it normally lies, generally consists of a hernial ring or sac

72
Q

How is a rupture different to a hernia?

A

No ring or sac

73
Q

Are all hernias reducible?

A

No, sometimes the ring closes behind the prolapsed tissue

74
Q

Aims of surgical repair of ruptures and hernias

A

Return hernia content to normal location
Secure closure of neck of sac
Obliterate redundant tissue in the sac
Try to use the patients own tissue for repair

75
Q

How is a hernia surgically reduced?

A

Incise over site (ensure adequate exposure)
Breakdown adhesions
Check viability of herniated tissues, resect non-viable tissues

76
Q

Defect closure after surgical hernia reduction

A

Direct opposition
Don’t compromise vasculature
Sufficiently strong suture material (polydioxanone, polypropylene)
Monofilament to avoid sinus formation

77
Q

Type of hernia often found in young animals which is usually congenital due to failed embryogenesis

A

Umbilical

78
Q

Should you breed from an animal that had an umbilical hernia?

A

No, it is thought to be inherited

79
Q

Which condition can an umbilical hernia be associated with?

A

Cryptorchid dogs

80
Q

Typical presentation of umbilical hernia

A

True hernia (lined by peritoneal sac)
Soft, painless swelling at umbilicus
Normally contain fat/omentum, occasionally intestine (V+/D+)

81
Q

What should you check when an animal has an umbilical hernia?

A

Diaphragm and heart

82
Q

How is an umbilical hernia diagnosed?

A

Palpation

83
Q

Management of umbilical hernia

A

May resolve spontaneously or can be corrected at neutering

84
Q

How is an umbilical hernia surgically closed?

A

Reduce, incise over hernia, excise sac, repair muscle edges
Remove skin that has stretched over site
Bunch ligate fat
Don’t debride margins
Close with synthetic, absorbable, monofilament suture (polydioxanone)

85
Q

What hernia develops when surgical closure of a body cavity fails?

A

Incisional hernia

86
Q

Where does an incisional hernia most commonly occur?

A

Linea alba

87
Q

How soon after surgery does an incisional hernia occur?

A

Normally within 7 days, can be chronic

88
Q

Cause of incisional hernia

A

Incorrect technique
Incorrect suture material/pattern
Entrapped fat between wound edges
Infection
Steroids/cushings
Poor post op care

89
Q

Signs of incisional hernia

A

Oedema, inflammation and serosanguinous fluid often pre-empt
Soft painless swelling
Palpable defect
Exposed viscera

90
Q

Investigation of incisional hernia

A

Commonly obvious
Ultrasound, x rays or advanced imaging might be useful

91
Q

Treatment of incisional hernia

A

Repair ASAP, evisceration is an acute abdominal emergency
Lavage
Resect non-viable tissues, anastomose bowel if necessary
Re-open and repair entire wound
Debride edges if infected/non-viable
Suture external sheath of rectus abdominis (strongest holding layer)
Monofilament suture (long lasting, appropriate size)

92
Q

Why might traumatic abdominal rupture be missed?

A

Swelling/bruising

93
Q

How is a traumatic abdominal rupture repaired?

A

Same principles as hernia repair
Lots of lavage and avoid mesh if contaminated
Identify free edge of abdominal wall and reattach to cranial pelvic brim if there is prepubic tendon rupture

94
Q

What might enter subcutaneous space with an inguinal hernia?

A

Most commonly omentum
Intestine, bladder or uterus

95
Q

Cause of inguinal hernia

A

Congenital inguinal ring abnormality or trauma
Can be spontaneous
Can be associated with pregnancy/obesity
Probably inherited, consider neutering

96
Q

Signalment for non-traumatic inguinal hernia

A

Intact female middle aged dogs or male dogs <2y
Small breeds e.g. Cairn/WHWT

97
Q

Is an inguinal hernia usually painful

A

No unless incarcerated contents

98
Q

Treatment of inguinal hernia

A

Surgical closure

99
Q

Are scrotal hernias common or rare?

A

Rare

100
Q

What is the main cause of scrotal hernias?

A

Castration in small mammals with large inguinal rings and open methods (guinea pigs)

101
Q

Causes of diaphragmatic rupture

A

RTA
Congenital (hernia)

102
Q

Pathogenesis of diaphragmatic rupture

A

Abdominal pressure and open glottis
Tear usually in muscular part of diaphragm (weakest)
Radial or circumferential tears

103
Q

Clinical signs of diaphragmatic rupture

A

Present shortly after trauma, shocked
Pale/cyanotic
Tachypnoeic/dyspnoeic
Tachycardic
Occasional cardiac arrythmias
Hydrothorax

104
Q

Clinical signs of chronic diaphragmatic rupture

A

Exercise intolerance
Dyspnoea
Vomiting
Weight loss

105
Q

Diagnosis of diaphragmatic hernia

A

Radiograph (can put water soluble contrast in abdomen)
Ultrasonography (especially chronic)

106
Q

Radiographic findings with diaphragmatic hernia

A

Loss of diaphragmatic line
Loss of cardiac silhouette
Gas filled structure in thorax
Atelectasis
Displaced abdominal organs

107
Q

Treatment of diaphragmatic hernia

A

Oxygen/IVFT/warm patient
Prophylactic antibiotics (toxin release from strangulation)
ECG
Surgery (open heart surgery once abdomen opened)

108
Q

Causes of increased mortality in diaphragmatic hernia surgery

A

Surgery performed <24h following injury
Patient >1y

109
Q

What causes this presentation?

A

Perineal hernia

109
Q

Signalment for perineal hernia

A

Normally entire older male dog, occasionally bitch/cat

110
Q

Clinical signs of perineal hernia

A

Bulging perineal hernia
Faecal tenesmus
Dysuria

111
Q

Causes of perineal hernia

A

Progressive weakening of pelvic diaphragm
Hormonal influence
Tenesmus
Congenital/acquired weakness
Colitis/prostatomegaly

112
Q

Muscles that provide lateral support to the anus (bilateral disruption = perineal hernia)

A

Levator ani
Coccygeus
External anal sphincter
(Together referred to as pelvic diaphragm)

113
Q

Diagnosis of a perineal hernia

A

Reducible perineal swelling
Absence of pelvic diaphragm on rectal
Assess sphincter tone
Ultrasound/contrast urethrography to highlight bladder

114
Q

Why is bladder retroflexion an emergency?

A

Stranguria
Hyperkalaemia
Azotaemia
Avascular necrosis

115
Q

Treatment of perineal hernia

A

Cystocentesis through perineum if bladder retroflexed and cannot pass urethral catheter
IVFT (check K+ levels)
Herniorrhaphy (type of muscle repair)
Castrate

116
Q

Complications after perineal hernia surgery

A

Faecal incontinence (poor suture placement/chronic)
Urinary problems
Infection
Rectal prolapse (if continuing to strain after surgery)
Sciatic nerve entrapment
Recurrence (if not castrated, due to excess testosterone)

117
Q

Hernia that is commonly seen in brachycephalic breeds and shar peis

A

Hiatal hernia (congenital defect)

118
Q

What is a hiatal hernia?

A

Abnormal movement of part of the stomach from its normal position in the abdomen into the chest

119
Q

Clinical signs of hiatal hernia

A

Regurgitation
Hypersalivation
Visceral discomfort
Low BCS

120
Q

Diagnosis of hiatal hernia

A

Contrast radiography (soft tissue opacity in dorso-caudal thorax adjacent to diaphragm, swallow barium and take radiograph quickly)
Fluroscopy
Endoscopy

121
Q

What radiographic abnormality is this?

A

Hiatal hernia

122
Q

What is a hiatal hernia clinically similar to?

A

Oesophagitis

123
Q

Treatment of oesophagitis in hiatal herniation

A

Antacid
Sucralfate
Prokinetic (peristalsis from cranial to caudal end)
Antibiotics (aspiration pneumonia)

124
Q

Surgical approach to hiatal hernia

A

Ventral midline coeliotomy
Reduce hernia at oesophageal hiatus and close
Pexy oesophagus to diaphragm
Pexy stomach to body wall

125
Q

Congenital communication between pericardial sac and abdomen

A

Peritoneopericardial diaphragmatic hernia (PPDH)

126
Q

Clinical signs of peritoneopericardial diaphragmatic hernia

A

Asymptomatic
GI/respiratory signs (V+/D+, anorexia, weight loss, wheezing, dyspnoea)

127
Q

Aetiology of peritoneopericardial diaphragmatic hernia

A

Faulty development of septum transversum
Often associated cardiac/sternal deformity

128
Q

Signalment of peritoneopericardial diaphragmatic hernia

A

Weimaraner/Cocker Spaniel

129
Q

Diagnosis of peritneopericardial diaphragmatic hernia

A

Radiography +/- contrast (enlarged cardiac silhouette, dorsally displaced trachea, gas opacities in pericardial sac, contrast radiography)
Ultrasound

130
Q

Surgical management of peritoneopericardial diaphragmatic hernia

A

Ventral midline coeliotomy
Incise sternum if necessary
Reduce viscera
Suture diaphragm (no need to close pericardium)

131
Q

Causes of septic peritonitis

A

GI perforation
Hematogenous (GI disease)
External penetration
Iatrogenic
Ascending urinary tract infection (prostatitis/prostatic abscess)

132
Q

Causes of aseptic peritonitis

A

Inflammatory disease in abdomen (hepatitis, nephritis, cholangitis, pancreatitis, splenic abscess)
Abdominal fluid (bile, blood, gastric perforation, urine)

133
Q

When is a gastric perforation not aseptic?

A

Treatment with omeprazole (neutralisation of stomach acid)

134
Q

Important history considerations for septic peritonitis

A

Distributive disease
Foreign body (GI perforation)/external penetration
Recent surgery
Urinary issues (reduced volume, increased frequency, stranguria/dysuria, haematuria, pain)

135
Q

Important history considerations with aseptic peritonitis

A

Localised pain, vomiting and PUPD may indicate acute abdomen/organ inflammation
Bile is very painful in short term (chronic biliary disease e.g. weight loss/inappatence, jaundice = obstruction, no jaundice = traumatic)
Gastric perforation (painful, sudden lack of pain with rupture, then increasing pain as peritonitis is stimulated)

136
Q

Investigation of peritonitis

A

POCUS (free fluid)
Tap fluid (if not enough fluid then do diagnostic peritoneal lavage with saline)

137
Q

How can you differentiate a septic or aseptic cause of abdominal fluid in peritonitis?

A

Colour may indicate issue (yellow = neutrophils)
Bacteria respiring using glucose = glucose lower than blood
Bacteria respiring producing lactate = lactate higher than blood
Smear/cytology for intracellular bacteria

138
Q

Medical management of peritonitis

A

Remove fluid
Fluid therapy
Analgesia

139
Q

When would you opt for surgical management in peritonitis?

A

Remove the problem (source control)
Surgical closure (GI perforations) or surgical removal (when appropriate)

140
Q

What structure should not be surgically removed even if it is causing peritonitis? What is the alternative?

A

Pancreas
Place abdominal drain +/- lavage

141
Q

When should antibiotics be administered in peritonitis?

A

Septic peritonitis (start as soon as possible then switch based on C&S) although technically not needed with good source control

142
Q

Antibiotic choices for treating septic peritonitis

A

Amoxicillin clavulanate or metranidazole (if GI origin) and marbofloxacin (fluroquinolone)

143
Q

Characteristics of a good contrast media

A

Not toxic/harmful
Quickly eliminated from body (but slow enough to image)
Coat lining of organ

144
Q

Substances commonly used as contrast media

A

Barium (+, liquid or on spear, can be mixed with food)
Iodine (+, IV or in bladder, tastes bad, draws liquid into GI tract = diluted)
Air (-)

145
Q

Uses of contrast media

A

Highlight structures
Differentiate between soft tissue and fluid
Identify blockages/obstruction
Identify perforation/rupture
Assess blood supply (IV contrast)
Transit time

146
Q

Which structure is being outlined by the contrast medium and which contrast material was used?

A

Renal pelvis
IV (iodine) urethrogram

147
Q

Which structure is being outlined by the contrast medium and which contrast material was used?

A

Bladder
Air up urinary catheter (pneumocystogram)

148
Q

Which structure is being outlined by the contrast medium and which contrast material was used?

A

Bladder
Iodine and air (urinary catheter, air first)

149
Q

Which structure is being outlined by the contrast medium and which contrast material was used?

A

Stomach/SI
Barium impregnated polythene spheres (BIPS)

150
Q

Which structure is being outlined by the contrast medium and which contrast material was used?

A

Caudal colon/rectum
Barium
Per rectum/enema

151
Q

Functions of endoscopy

A

Visual examination
Minimally invasive biopsy
Minimally invasive interventions

152
Q

What type of gastropexy is this?

A

Incisional

Small Animal (Poppy) (20 decks)

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