Acute abdo/GDV Flashcards by Caitlin Holcombe

what is an acute abdomen?

any intra-abdominal disease process that leads to an acute onset of clinical signs

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why might a patient develop an acute abdomen?

inflammation of an organ

leakage of fluid from a damaged organ

entrapment of an organ

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what respiratory and cardiac changes might be seen in patients with an acute abdomen?

increased resp rate and effort

increased heart rate, ‘thready’/poor pulses, arrhythmias

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how might an acute. abdomen affect mm/CRT?

pale, tacky mm and prolonged CRT
or
injected (bright red) mm and rapid CRT

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what might it mean if a patient has injected mucous membranes and a rapid CRT?

sepsis

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how does an acute abdomen affect patient temperature

often hypothermic

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what mentation is likely to be seen in patients with an acute abdomen?

collapsed or obtunded

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what GI signs accompany an acute abdomen?

hypersalivation and nausea

regurgitation, retching

abdominal pain

distended abdomen

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what are the GI differentials for an acute abdomen?

GDV

foreign body

gastric ulceration or perforation

intussusception

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what are the abdominal differentials for an acute abdmen?

septic peritonitis

blunt/penetrating abdominal trauma

mesenteric volvulus

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what are the abdominal organ-related differentials for an acute abdomen?

acute hepatitis

biliary obstruction/rupture

neoplasia

pancreatitis

splenic mass/torsion

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what are the urinary-related differentials for an acute abdomen?

acute kidney injury

pyelonephritis

urethral tear

uroabdomen

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what are the reproductive-related differentials for an acute abdomen?

pyometra

prostatitis

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what is GDV?

a condition where the stomach dilates and rotates/twists

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how does GDV lead to necrosis and septic peritonitis?

due to reduced blood flow to the GI tract and spleen

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what can a reduction in blood flow to the GI tract and spleen lead to in GDV?

necrosis of the affected organs and septic peritonitis

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which body systems can be affected by GDV?

CVS

respiratory

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why does GDV result in reduced cardiac output and systemic hypotension?

reduced venous return due to compression of caudal vena cava

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which type of shock does GDV cause?

hypovolaemic

distributive

cardiogenic

obstructive

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how does GDV cause hypovolaemic shock?

decreased circulating volume –> decreased venous return –> decreased stroke volume and cardiac output

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how does GDV cause distributive shock?

vasodilation, leaky vessels and activation of coagulation –> decreased venous return –> decreased stroke volume and cardiac output

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how does GDV cause cardiogenic shock?

heart is unable to pump –> lower contractility –> decreased cardiac output

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how does GDV cause obstructive shock?

physical impediment to blood flow in vessels –> reduced venous return, stroke volume and cardiac output

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what does development of SIRS/sepsis indicate in GDV?

poor prognosis

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why does cariogenic shock occur in GDV?

there is pressure being exerted on the heart from the massively distended stomach

what are the main steps in stabilising a patient who has presented with GDV?

administer oxygen therapy place wide bore catheter (2 if possible), shock rate IV fluids/bolus pain relief blood sample consider drugs e.g. catecholamines

why should we avoid placement of the IV catheters in the hindlimbs of a patient with GDV?

systemic hypotension leads to peripheral vasoconstriction

what type of analgesia is helpful in stabilisation of GDV patients?

opioids - can also help reduce stress

what type of analgesia should we avoid in patients with GDV? why?

NSAIDs - renal protection under hypotension

why might we want a blood sample from a patient with GDV?

blood gas analysis basic emergency database blood type, coagulation factors

why might we give catecholamines to a patient with GDV?

help with hypotension by increasing vascular resistance

what is the shock rate for GDV fluid resuscitation?

no more than 80-90ml/kg

what other type of fluid therapy might be useful in stabilisation of GDV patients?

hypertonic saline - minimal amount required and can be given quickly

what do we need to remember when considering hypertonic saline for GDV patients?

cannot be given to dehydrated patients fluid lost must be replaced by isotonic saline once stable

how can we diagnose GDV?

pocus can confirm gas-filled space radiographs can confirm GD vs GDV

why might we take thoracic radiographs of a GDV patient?

to check for regurgitation/aspiration signs

what must occur before gastric decompression in GDV patients?

fluid resuscitation must have already started

at what rate should the stomach be decompressed in GDV patients?

slowly

why should the stomach be decompressed slowly in GDV patients?

patients can quickly decompensate sudden release of endotoxins can lead to sepsis/SIRS

what is percutaneous decompression?

placement of a needle/catheter through the body wall into the stomach to release gas (doesn't release fluid)

what is oro-gastric decompression?

stomach tube placed down oesophagus to remove fluid from stomach

what equipment will we need to get ready if there is a suspected GDV coming into practice?

crash kit stomach tubes suction unit IV fluids - warmed monitoring equipment large surgical kit, lap swabs self-retaining retractors scrubbed assistant and float nurse

what are our major anaesthetic concerns for a patient with GDV?

hypotension hypothermia hypoxia,hypoxaemia metabolic acidosis arrhythmias regurgitation

how many ventricular premature complexes are considered ventricular tachycardia?

>4 VPCs

what pre-medication is appropriate for a patient with GDV?

methadone and midazolam

which premedicants are inappropriate for GDV cases?

ACP and medetomidine - cause too much CVS compromise

what is an appropriate induction technique for GDV cases?

co-induction of midazolam with propofol or alfaxalone

what perioperative analgesia may be appropriate for GDV cases?

fentanyl CRI lidocaine (can help with arrhythmias)

what is our most important perioperative concern with GDV patients?

management of blood pressure above 60mmHg MAP

what drugs can be given to help with vagally mediated bradycardia in GDV cases?

anticholinergics - atropine of glycopyrrolate

which bpm is appropriate for which anticholinergic?

<40 = atropine 40-60 = glycopyrrolate

what can anticholinergics help with in GDV cases?

vagally mediated bradycardia

what is important to monitor post-op in GDV patients?

HR, RR mm, CRT, hydration status blood database, ECG, blood pressure UOP signs of sepsis/SIRS/DIC

why do we want to monitor ECG post-op in GDV patients?

poor perfusion and hypoxia can cause arrhythmias

what else might we consider post-op for GDV patients?

fluid therapy analgesia placement of a feeding tube? reduce stress as much as possible - may need to go home to improve recovery

what other surgical procedure may be performed alongside derotation of the stomach? why?

gastropexy - reduce chance of recurrence from 70-80% to 4-10%

what feeding advice can we give to owners about GDV?

smaller portions multiple times a day wet and dry mixed increases risk use go slow bowls no raised feeding

what temperature/HR/RR could indicate sepsis in a dog?

temp <37.2 >39.4 HR >120 RR >24

what temperature/HR/RR could indicate sepsis in a cat?

temp <27.2 >39.4 HR <140 >220 RR >40

what white blood cell count (x10^3) could indicate sepsis in a dog?

<6 >16

what white blood cell count (x10^3) could indicate sepsis in a cat?

<6 >20

what is septic peritonitis?

release of chemicals into the bloodstream to fight off infection - inappropriate and unregulated response to these chemicals triggers changes that can damage multiple organ systems

how should septic peritonitis be managed if suspected?

collect samples of fluid to send for C&S start broad-spectrum abs until culture is back

why do we start antibiotics early if septic peritonitis is suspected?

reduces risk of endotoxaemia

how can we reduce risk of endotoxaemia due to septic peritonitis?

start broad spectrum antibiotics early

what is haemoabdomen?

accumulation of blood within the peritoneal cavity

which species gets haemoabdomen more commonly?

dogs

how does haemoabdomen occur?

traumatic (e.g. RTA) or spontaneous (e.g. ruptured splenic/liver mass)

how will a patient with acute haemoabdomen present?

collapsed and hypovolaemic

how will a patient with chronic haemoabdomen present?

general history of lethargy and anaemia

what should we prepare for suspected haemoabdomen?

equipment for blood transfusion

do patients with haemoabdomen have a low PCV/TS?

acute bleed - normal PCV/TS - once rehydrated, both will drop

why should care be taken with venepuncture in haemoabdomen patients?

might have reduced clotting, especially if they have been used up in a bleed

how does uroabdomen occur?

associated with a rupture/leak within the urinary tract - may be due to trauma

how do patients with uroabdomen present?

collapsed and hypovolaemic

what are our main concerns with uroabdomen patients?

often have acid-base imbalances, esp hyperkalaemia - can lead to arrhythmias uraemic acids can cause metabolic acidosis

how can we treat hyperkalaemia due to uroabdomen?

IVFT with calcium - only lasts 20 mins can give glucose +/- insulin CRI (pushes potassium back into cells)

which condition can be associated with uroabdomen?

acute kidney injury