Abdominal pain Flashcards
What is an acute abdominal crisis?
An animal presented as an emergency, in a more or less severe critical state, and for which medical and possible surgical treatment will be necessary. The term is often used to describe cases in which some degree of uncertainty remains in regard to the diagnosis.”
When is abdominal pain an emergency?
- hypovolaemic shock
- septic shock
What are differentials for an acute abdominal crisis?
- abomasal volvulus
- abomasal displacement
- haemorrhagic jejunitis
- caecal torsion
- primary/secondary bloat
- intestinal torsion/intussusception
- mesenteric torsion
- peritonitis
Non-GI
- uroliths
- uterine torsion
- pyelonephritis
What should you include in your clinical exam?
Cardio
* Heart rate
* Increased
* Mucous membrane
* tacky
* Capillary refill time
* Prolonged
* Dehydration (skin tent)
* prolonged
Abdominal distension
* Rear and side
* Abdominal distension
* Back position
* flat or arched
Abdominal exam
* Auscultation
* Rumen contractility
* Reduced
* Percussion
* “pings”
* Abnormal
* Succussion
* “splashing”
Signs of pain
* Bruxism
* Abducted elbows
* Reluctance to dip on withers pinch
* Cranial abdominal pain
Rectal palpation
* Viscera
* Normal
* Distended
* Turgid
* Temp
- rectal sweep
Faeces
* Faecal output
* Reduced
* Appearance
* Frank blood
* Melena
* Fibrin and mucus
What ancillary diagnostic tests can you undertake?
- Abdominocentesis & peritoneal fluid analysis
- Colour
- Volume (shouldn’t have very much in normal cow)
- Turbidity
- Odour
- Protein content
- Imaging - Ultrasonography
- 7.5MHz transrectal probe has its uses…
- 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
What causes peritonitis? What is the clinical presentation?
Aetiology
Primary: associated with systemic infection
Secondary: after abdominal surgery
Clinical signs
Acute: abdominal discomfort, pyrexia +/- toxaemia, altered faecal output
Chronic: non-specific clinical signs
What are diffuse and local causes of peritonitis?
Diffuse
* Urethral obstruction
* Acute acidosis/rumenitits
* Toxic mastitis
* Postpartum metritis
* Perforated abomasal ulcer
Local
* LDA/RDA
* Caecal torsion
* TRP
* Uterine torsion/rupture, dystocia, caesarean, vaginal tear
* Intestinal onstruction, volvulus, strangulation, intussusception, perforation
* Splenic/hepatic/umbilical abscess
* Fat necrosis
How would you diagnose acute peritonitis?
Withers test: may be reluctant to dip and may produce audible grunt (indicating abdominal pain)
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.
How would you treat peritonitis?
Immediate and conservative:
* Fluid therapy
* Nsaids
* Antimicrobials
* B lactam or tetracycline
* Long course (think licensing)
Surgical
Debridement, lavage and drainage
Cows wall off infections well
Prognosis?
What causes caecal torsion? How are they treated?
Signalment: usually early lactation dairy cows
Aetiology: poorly understood (increased VFA in intestines -> atony?)
Presentation: dilation>torsion
Treatment
* Surgical - Right flank laparotomy, externalise and empty caecum using purse string suture, reposition
* Oral fluids
* Calcium borogluconate
* NSAIDs (2 days, i.e. ketoprofen), antibiotics (3 days, Procaine benzylpenicillin)
* Treatment dilatation: surgical or conservative:
* Calcium borogluconate
* NSAIDs
What causes haemorrhagic jejunitis? What is the clinical presentation? How is it treated?
- usually early lactation
- unknown aetiology - link with Clostridium perfrigens type A?
- clots -> obstruction -> colic
- red - dark black blood in faeces
- often fatal
- surgical treatment
- supportive (NSAIDs, fluids…)
What pain relief can we give cows with abdominal pain?
NSAIDs in anorexic patients can induce ulcers
NSAIDs may impact on clinical signs used for decision making
Choice based on:
- Experience, cost , legislation etc
