Abdominal Pain In Small Animals Flashcards
How severe is the problem likely to be if an animal presents with abdominal pain?
Not all are emergencies by MOST ARE
What is meant by the term ‘acute abdomen’?
What does this indicate about future treatment?
Dog/cat with acute marked abdominal pain
Patient requires emergency stabilisation
Surgery may or may not be necessary
What information should be gathered from an EMERGENCY patient?
Capsule history:
Signalment, primary problem, duration
Eating/drinking/urinating/ defaecating
Any drugs administered?
MBS assessment
CVRS
neuro
— MAKE SURE PATIENT IS STABILISED —
What should you do following your emergency assessment if the patient is stable?
Take a full history Appetite/diet Vomiting Diarrhoea Lethargy/behaviour/gait Scavenger/drug administration/ toxin access Urination/defaecation Vaccination/anthelmintic treatment Neutering status/last season
Why might it be important to ask about the diet in a patient with abdominal pain?
Raw food - bones
What is the goal of abdominal palpation?
Pain - localised or generalised
Masses - organomegaly or foreign body
Fluid thrill
Tympani
What can be palpated cranially in the abdomen?
Liver, Spleen
Potentially stomach and kidneys
What can be palpated in the mid-abdomen?
Intestinal loops
What can be palpated in the caudal abdomen?
Bladder
Prostate
Colon
What might generalised abdominal pain suggest?
Inflamed peritoneum
What can be confused with masses upon palpation?
Faeces
Cat’s kidneys
How could you tell whether you had palpated a mass or faeces?
If you compress the faeces, they stay compressed.
What is fluid thrill?
Push on one side of the abdomen and feel reverberation on the other
What is tympany?
Gas filled area
Feels taught like a drum,
Generally associated with a GI issue
What might you look for during an oral examination?
Foreign body under tongue
Ulcers
Ptyalism
Icterus
Pallor
What is meant by the term ptyalism?
Excess salivation
What should be checked for in oral examination of cats?
Linear foreign bodies - STRING
Often anchored to tongue
What other type of pain is typically confused with abdominal pain?
Spinal pain
Also, respiratory distress and stress
How could you differentiate between spinal and abdominal pain?
Push down on spine
How can you assess the reproductive system of a small animal?
Observe external genitalia
Perform rectal examination
What would you expect to palpate during a small animal rectal exam?
Prostate (male) Uterus (female) Urethra (runs ventrally) Sublumbar lymph nodes Faeces Foreign material
Why might it be important to palpate the uterus?
Check for pyrometra
Why might it be important to palpate the urethra?
Check for obstructions
Why might it be important to palpate the sublumbar lymph nodes?
Neoplasia
What mechanisms can cause abdominal pain? How can these come about?
Distension of an organ /capsule (dilation)
Traction - twisting/pulling (torsion)
Ischaemia - Infarction/necrosis
Inflammation - Gastroenteritis
What can cause Intra-abdominal pain?
Stomach/intestines Pancreas Uterus Prostate Kidneys/ureters/bladder Liver Spleen Effusions
What can cause extra-abdominal pain?
Cutaneous/muscular
What are the ddx for stomach/intestinal pain?
GDV Mesenteric torsion Infarction Ulceration GIT infection (e.g. parvo, HGE) Foreign body Intussuception Toxin Neoplasia
What are the ddx for pancreas pain?
Pancreatitis,
Abcess,
Neoplasia
What are the ddx for liver pain?
torsion (rare)
Cholangiohepatitis
Abcess
Biliary obstruction (inflammation, gall bladder mucocoele)
What are the ddx for spleen pain?
Torsion Infarction Haematoma Abscess Neoplasia
What are the ddx for cavity pain?
Septic peritonitis Uroperitoneum Bile peritonitis Severe distension from transudate/ haemabdomen Abdominal wall trauma
What are the ddx for renal pain?
Infarction Pyelonephritis Neoplasia Nephroliths Ureteric obstruction
What are the ddx for bladder/urethra pain?
Cystitis,
Calculi
Urethral obstruction
what are the ddx for reproductive pain?
Pyometra
Dystocia
Prostatic abcess
Prostatitis
How could you further investigate abdominal pain?
Diagnostic imaging - radiography and ultrasound
Cytology of abdominal fluid
Blood tests - CBC and biochem, CPLi/Parvo etc
What does FAST stand for ?
Focused
Assessment with
Sonography for
Trauma/Triage/Tracking (see if things change)
What is a FAST ultrasound?
Brief examination of the abdomen looking for free abdominal fluid
How do you conduct a FAST ultrasound?
Four positions:
(Start from diaphragm move round clockwise)
Diaphragmaticohepatic
Spleno-renal
Cysto-colic
Hepatorenal
Score the amount of fluid present from 0-4
What are some surgical emergencies associated with abdominal pain?
Septic peritonitis due to: GIT problems, uterine rupture, prostatic abscess rupture, body wall rupture
Risk of SP due to: intestinal obstruction, intussusception, penetrating abdominal wound, abdominal bite/crush injury
GDV
Metabolic emergency - uroperitoneum or bile peritonitis
Vascular emergency - splenic torsion, strangulated hernia, mesenteric torsion, intractable haemorrhage
Pyometra
Dystocia
When would a presentation of pyometra be less severe?
If the pyometra is open and pus can drip out of the vulva
Name some common antiemetics.
Maropitant
Metoclopramide
Ondansetron
What analgesia should be given to patients with abdominal pain?
Pure opioids (e.g. methadone, morphine, fentanyl)
Partial agonist opioid (e.g. buprenorphine)
Ketamine infusion
Lidocaine infusion
What analgesics should NOT be given to patients with abdominal pain?
Why?
NSAIDS
Risk of GI ulcers
Risk of kidney injury
May need surgery - contraindicated in anaesthesia
How should patients be managed post op?
Monitoring: Physical exam, continuous ECG, PCV TS 24 hours, electrolytes
Treatment: IV fluids, Analgesia (methadone), antiemetic (maropitant), gastric protectant (omeprazole), Nutrition
Describe an outline of the approach to a patient with acute abdomen.
- Capsule history and MBS assessment
- IF STABLE, take full history
- Physical exam - Abdominal palpation, oral examination, spinal pain?, reproductive system, rectal exam
- Diagnostic imaging (FAST), Cytology of abdominal fluid and CBC+Biochem +/- CPLi/Parvo
- Surgical and medical management inc. analgesia
- Post op care
