Abdominal pain in Small animals

Question 1

causes

Answer 1

Distension of hollow viscous or organ capsule
Inflammation
ischaemia
Traction

Question 2

DDx - stomach

Answer 2

obstruction, rupture, gastric dilation, GDV, ulceration, gastritis, intoxication, neoplasia

Question 3

DDx - small intestine

Answer 3

obstruction, intussusception, rupture, torsion, inflammation, neoplasia

Question 4

DDx - large intestine

Answer 4

obstruction, perforation, severe inflammation or infection, neoplasia

Question 5

DDx - peritoneum

Answer 5

septic peritonitis, uroabdomen, bile peritonitis

Question 6

DDx - pancreas

Answer 6

acute pancreatitis

Question 7

DDx - liver/biliary tract

Answer 7

bile peritonitis, bile duct obstruction, live lobe torsion, hepatitis, neoplasia

Question 8

DDx - spleen

Answer 8

torsion, thrombosis, ruptured neoplasm

Question 9

DDx - kindneys

Answer 9

acute injury (toxins, pyelonephritis, obstrucion, trauma, vascular events)

Question 10

DDx - ureter/prostate/bladder/urethra

Answer 10

calculi (obstruction), ruptured bladder, prostate abscess, prostitis, neoplasia

Question 11

DDx - ovaries/uterus

Answer 11

pyometra, cysts, neoplasia

Question 12

DDx - testicles

Answer 12

torsion, abscess, inflammation, neoplasia

Question 13

surgical emergencies

Answer 13

Intestinal obstruction (complete or partial)
Pyometra – usually less urgent if open
Dystocia if medical management ineffective or contraindicated
Gastric dilatation ± volvulus (GDV)
Septic peritonitis, e.g. due to: Gastrointestinal tract
rupture/perforation, Dehiscence of surgical GIT wound, Uterine rupture, Prostatic abscess rupture
Intussusception
Penetrating abdominal wound
Abdominal bite injury/crush injury
Uroabdomen
Urethral obstruction if catheterisation unsuccessful
Bile peritonitis
Splenic torsion
Strangulated hernia
Intractable haemorrhage
Mesenteric torsion

Question 14

medical disorders

Answer 14

Pancreatitis
Gastroenteritis, especially - Haemorrhagic gastroenteritis (HGE) + Parvoviral enteritis
Gastrointestinal ulceration without perforation
Ileus
Acute hepatitis/cholangiohepatitis
Pyelonephritis
Hypoadrenocorticism (Addison’s)

Question 15

what looks similar to abdominal pain?

Answer 15

spinal pain

Question 16

history

Answer 16

“prayer position”
gruting/groaning
pain when being handled by owners

Question 17

physical exam

Answer 17

Physiological changes may be present
pain detected during ultrasonography?
If absent initially, reassess regularly
Generally harder to detect in cats

Question 18

classifying pain

Answer 18

Severity
Location:
Diffuse/generalised often associated with peritonitis – primary cause?
Focal/localised

Question 19

palpation limitations

Answer 19

limited by recumbency

unremarkable abdominal palpation doesnt exclude potentially severe disease

Question 20

free fluid scanning

Answer 20

Manual palpation insensitive + false positives
Radiography better but not great
Ultrasonography - Much more sensitive and patient-friendly, Perform in ALL patients with suspected
abdominal pain
Aspirate and analyse

Question 21

Patient management – Priorities

Answer 21

Address life-threatening problems
stabilize major body systems - acute abdominal presentation often have cardio compromise
analgesia

Question 22

signalment

Answer 22

Young animals e.g. Foreign body ingestion, Infectious disease
Female intact animals: pyometra
Cats - String foreign body, Acute cholangitis/cholangiohepatitis
Middle-aged, obese female dogs: acute pancreatitis

Question 23

history - important questions

Answer 23

ingestion of foreign bodies/toxins
other animals affected
vaccines
other medical conditions + medication
general demeanor
duration of clinical signs

Question 24

things to look out for an radiograph

Answer 24

foreign bodies, obstruction, loss of serosal detail, pancreatitis, masses, neoplasia, peritoneal gas