Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Farm - GI > Abdominal pain > Flashcards

Abdominal pain Flashcards

1
Q

What is an acute abdominal crisis?

A
  • an animal presented as an emergency, in a more or less severe critical state, and for which medical and possible surgical tx will be necessary
  • term often used to describe cases in which some degree of uncertainty remains in regard to the diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What would be a true emergency?

A
  • probably if either the following:
    – hypovolaemic shock (high hr, slow CRT, pale mm)
    – septic shock
  • note- ruminants are stoic animals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ddx for acute abdominal crisis - GI dz

A
  • Abomasal volvulus
  • Abomasal displacement
  • Haemorrhagic jejunitis
  • Caecal torsion
  • Primary/secondary bloat
  • Intestinal torsion/intussusception
  • Mesenteric torsion
  • Peritonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ddx for acute abdominal crisis - non-GI dz

A
  • Uroliths
  • Uterine torsion (usually at the end of gestation)
  • Pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signalment and history

A
  • Age
  • Sex
  • Breed
  • Stage of production
  • Nutrition
  • Management system
  • Stage in reproductive cycle
  • Previous surgery
  • Previous treatments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical examination - CV status

A
  • Heart rate
    – Increased
  • Mucous membrane
    – tacky
  • Capillary refill time
    – Prolonged
  • Dehydration (skin tent)
    – prolonged
    – skin tent above the eye
    – sunken eyes can also tell us about hydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical exam - abdominal silhouette

A
  • Rear and side
    – Abdominal distension
  • Back position
    – flat or arched (cranioabdominal pain or just generalised abdominal pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical exam - abdominal exam

A
  • Auscultation
    – Rumen contractility
    -> Reduced
  • Percussion
    – “pings” = DA
    – paralumbar fossa
    – can be anywhere from the olecranon to the paralumbar fossa
    -> Abnormal
  • Succussion (ballottement)
    – “splashing”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical exam - signs of pain

A
  • Bruxism (grinding teeth)
  • Abducted elbows
  • Reluctance to dip on withers pinch
    – Cranial abdominal pain
  • Head press, frowned/worried expression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical exam - rectal palpation

A
  • Viscera
    – Normal
    – Distended
    – Turgid
  • Help rule out none GI?
  • Normal RDAs wouldn’t feel on rectal unless really distended
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical exam - faeces

A
  • Faecal output
    – Reduced
  • Appearance
    – Frank blood
    – Melena
    – Fibrin and mucus

Rectal sweep - should have room to move when rectal - if tight and not able to move a lot it can mean straining or the rectal wall doesnt want to move due to fibrin attachment on the other side -> peritonitis (e.g. due to calving issues, poorly done c-sections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ancillary Diagnostic Tests

A

Abdominocentesis & peritoneal fluid analysis
- Colour
- Volume
- Turbidity
- Odour (if it smell really bad it’s really bad news)
- Protein content (on refractometer)

Peritoneal tap - need to avoid the rumen so don’t do on the left side.
Hand back from the diploid on the midline to the mammary vein = good area to go in

Imaging- Ultrasonography
- 7.5MHz transrectal probe has its uses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ultrasonography

A
  • good for scanning reticulum and rumen, esp for tyrewire dz
  • don’t need to clip or coupling gel, just lots of surgical spirit
  • Reticular contractions
    – Located left of midline, caudal to xiphoid
    – U shaped structure
    – Only wall visible (gas mixed into ingesta in lumen)
    – Cranial sac of rumen caudal to reticulum
    – Reticulum = biphasic contractions
    -> Second moves reticulum dorsally
  • Also good for adhesions, abscess, fluid accumulation etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Peritonitis aetiology

A
  • Primary (uncommon): associated with systemic infection
  • Secondary (much more common): after abdominal surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Peritonitis clinical presentation

A
  • Acute: abdominal discomfort, pyrexia +/- toxaemia (check mm), altered faecal output, look awful
  • Chronic: non-specific clinical signs, can be waxing and Maning (around stressors commonly), can just look a bit off
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diffuse peritonitis

A
  • Urethral obstruction (-> bladder rupture -> peritonitis)
  • Acute acidosis/rumenitits
  • Toxic mastitis
  • Postpartum metritis
  • Perforated abomasal ulcer
  • inflammation and infectious everywhere
  • any local cause can easily become diffuse if they spread
17
Q

Local peritonitis

A
  • LDA/RDA
  • Caecal torsion
  • TRP
  • Uterine torsion/rupture, dystocia, caesarean, vaginal tear
  • Intestinal obstruction, volvulus, strangulation, intussusception, perforation
  • Splenic/hepatic/umbilical abscess
    – Umbilical abscess in calves top of ddx
  • Fat necrosis (older, fat animals)
18
Q

Pathophysiology of acute peritonitis

A
  • adhesions (1w-10d in, fibrin + collagen -> to control the infection/keep the infection in)
  • toxaemia
  • shock and haemorrhage
  • pain/tucked up appearance
  • paralytic ileus
  • exudate (lots of WBCs, neutrophils, day 5 deposit of fibrin)
19
Q

Diagnosis of acute peritonitis

A

Withers test: may be reluctant to dip and may produce audible grunt (indicating abdominal pain). ~30% sensitive

Eric Williams test: A quiet grunt may be heard just before the ruminal A wave contraction, due to the pain from the biphasic reticular contraction

Rectal palpation: adhesions may elicit discomfort or a pain response and may be palpated within the abdominal cavity per rectum (particularly in chronic peritonitis)

Clinical pathology: leukopenia and degenerative left shift (increase in immature neutrophils), increased levels of plasma fibrinogens and low plasma proteins to fibrinogen ratio

Abdominocentesis: increased turbidity, increased leukocyte count, increased total protein levels (>3g/dl) +/- bacteria (can be difficult)

Exploratory laparotomy:may allow for identification of the cause of peritonitis and possible correction of the condition is possible.

Gluto-aldehyde test:
Binds to fibrinogen if in blood and will form a blot. if clots within 3 mins it’s a fairly accurate indicator there’s fibrinogen. decent cow side test. for more chronic cases

20
Q

Treatment of peritonitis

A

Immediate and conservative:
- Fluid therapy (IV fluids, hypertonic 3-5L, then pump orally)
- NSAIDs (ideally into the vein)
- Antimicrobials (B lactam or tetracycline, Long course (going to be off licence, duration: 2w+)) (procaine penicillin, amoxicillin, oxytet (given IV depending on product))

Surgical:
Debridement, lavage and drainage (don’t have suction in the field so debridement, lavage, draining difficult)
Cows wall off infections well
Localised peritonitis - flushing would spread it and make it diffuse so leave it

Prognosis
Dependent on cause, tx, type, so guarded

21
Q

Caecal Torsion signalment

A
  • usually early lactation dairy cows
22
Q

Caecal Torsion aetiology

A
  • poorly understood (increased VFA in intestines -> atony?)
    (concentrate heavy diet increases VFAs)
23
Q

Caecal Torsion presentation

A
  • caecal atony may cause dilatation
  • if free end kinds over dilatation -> torsion

Drain fluid into bucket as it’s a prognostic indicator -> >30L poorer prognosis

24
Q

Caecal torsion tx

A
  • Right flank laparotomy, externalise and empty caecum using purse string suture, reposition
  • Oral fluids
  • Calcium borogluconate (helps contractions of the mucosal wall, give into the vein)
  • NSAIDs (2 days, i.e. ketoprofen), antibiotics (3 days, Procaine benzylpenicillin)
  • Fibre to reduce VFAs in diet
25
Q

Caecal dilatation tx

A
  • Calcium borogluconate (helps contractions of the mucosal wall, give into the vein)
  • NSAIDs
  • Fibre to reduce VFAs in diet
26
Q

Haemorrhagic jejunitis

A

= haemorrhagic bowel syndrome

27
Q

Haemorrhagic jejunitis signalment

A
  • Usually (but not always) early lactation
28
Q

Haemorrhagic jejunitis aetiology

A
  • Unknown. Link with Clostridium perfringens type A? Links to Salmonella also?
29
Q

Haemorrhagic jejunitis presentation

A
  • clots -> obstruction -> colic
  • red - dark black blood in faeces
  • often fatal
30
Q

Haemorrhagic jejunitis tx

A
  • surgery?
  • supportive (NSAIDs, fluids, etc), but isn’t usually enough as need something to move the clot along
  • massaging the clot through is a potential option
31
Q

Other intestinal issues

A
  • Strangulation: rare
    – Prolapse of SI through mesenteric tear
    – Persistent urachus
  • Volvulus: rare
    – Torsion of root of mesentery
  • Intussusception: rare
  • Intestinal obstructions: rare

aetiology unknown

32
Q

Other intestinal issues - clinical presentation

A

Severe abdominal pain, circulatory compromise, abdominal bloat _ death in hours

33
Q

Other intestinal issues - diagnosis

A
  • rectal palpation
  • ex lap
  • US in calves can find intussusceptions
34
Q

Other intestinal issues - surgical tx

A
  • Right flank approach
  • Principles as for other species
35
Q

Traumatic Reticulopericarditis

A
  • Pericardium and reticulum are anatomically closely located
  • FB is ingested into rumen -> drops into reticulum -> penetrates reticular wall = reticulitis
  • Penetrates further to pericardial sac (through diaphragm) = pericarditis
36
Q

Analgesia in acute abdominal crisis

A
  • Pain = GI hypomotility
  • GI pain = ↑ sympathetic tone = GIT inhibition
  • Peritoneal inflammation = involved in ileus initiation in several species

BUT
- NSAIDs in anorexic patients can induce ulcers
- NSAIDs may impact on clinical signs used for decision making

Choice based on:
- Experience, cost , legislation etc

But benefit of giving pain relief (and NSAID only real class we have) outweighs risk, also usually 7d course rather than extended over weeks and weeks.

Ensure can give into the vein as most appropriate/useful for the v sick animal.

Y4 Farm - GI (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions