Abdominal Pain - The Acute Abdomen

Question 1

What does “Acute Abdomen” mean?

Answer 1

Term used to describe dog or cat with acute marked abdominal pain

Question 2

What do patients with “acute abdomen” need as far as stabilization goes?

Answer 2

Patient needs ER stabilization +/- surgery

Question 3

What is the best approach to take when palpating the abdomen of an animal with abdominal pain?

Answer 3

BE GENTLE
Cranial to caudal approach to keep consistent

Question 4

What are the organs which you will feel cranially, caudally and mid-abdomen on palpation?

Answer 4

Question 5

Why is it important to check under tongue in cats with abdominal pain?

Answer 5

Linear foreign body

Question 6

What can occur in the intestines which causes abdominal pain?

Answer 6

Distention of organ/capsule - Dilation
Traction - Torsion
Ischemia - Infarction/necrosis
Inflammation - gastroenteritis

Question 7

What can be easily confused with abdominal pain?

Answer 7

Spinal pain
Stress
Respiratory distress

Question 8

What is this condition? How do you know?

Answer 8

Double bubble

Question 9

What is FAST in U/S fast scan? What do you look for in the abdomen during this scan?

Answer 9

Focused Assessment with Sonography for Trauma/Triage/Tracking
Brief examination of abdomen looking for abdominal fluid
- As skills improve you may see more!

Question 10

What are the analgesia options for abdominal pain?

Answer 10

Pure mu opioids - Ex. methadone, fentanyl, morphine
Partial agonist opioids - Ex. buprenorphine
Ketamine infusion
Lidocaine infusion (be careful with cats)

Question 11

Which medication(s) should you avoid in patients with abdominal pain? Why?

Answer 11

NSAIDs - Ex. meloxicam, carprofen
- Risk of GI ulceration, kidney injury
- Patient may need Sx (risk when used with anesthesia due to PG interference - low kidney perfusion)

Question 12

Give some examples of surgical emergencies which cause abdominal pain

Answer 12

Septic peritonitis
Anything which carries risk of causing septic peritonitis
GDV
Metabolic or vascular emergency
Pyometra
Dystocia

Question 13

What is septic peritonitis and what other conditions cause this to occur?

Answer 13

Inflammation or infection of the peritoneal (abdominal) cavity which leads to bacterial infiltration –> production of toxins by gm- bacteria –> toxic shock –> death

Uterine rupture, body wall rupture
Intestinal obstruction, intussusception
Penetrating abdominal wound
Abdominal bite/crushing injury

Question 14

Give an example of a metabolic emergency?

Answer 14

Uroperitoneum

Question 15

What is the difference between open and closed pyometra and which is more urgent?

Answer 15

Open pyometra - draining (able to manage medically if not severe)
Closed pyometra - not draining (unable to manage medically, ER surgical intervention required)

Question 16

Give typical medical management protocol for abdominal pain? What are each of these treatments targeting?

Answer 16

IV fluids - Shock, dehydration
Antiemetics - Maropitant, Metaclopramide, Ondansetron
Gastroprotectants - Omeprazole (H2 blocker), H2 antagonists (Ranitidine, Cimetidine)
Antibiotics - Only if high risk of infection
Nutrition - Enteral (preferred) or parenteral
Toxicities - specific treatment if required

Question 17

Should you generally use abx to treat diarrhea?

Answer 17

No - unless there is a profound infectious bacterial cause