Acute abdo/GDV Flashcards
what is an acute abdomen?
any intra-abdominal disease process that leads to an acute onset of clinical signs
why might a patient develop an acute abdomen?
inflammation of an organ
leakage of fluid from a damaged organ
entrapment of an organ
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
how might an acute. abdomen affect mm/CRT?
pale, tacky mm and prolonged CRT
or
injected (bright red) mm and rapid CRT
what might it mean if a patient has injected mucous membranes and a rapid CRT?
sepsis
how does an acute abdomen affect patient temperature
often hypothermic
what mentation is likely to be seen in patients with an acute abdomen?
collapsed or obtunded
what GI signs accompany an acute abdomen?
hypersalivation and nausea
regurgitation, retching
abdominal pain
distended abdomen
what are the GI differentials for an acute abdomen?
GDV
foreign body
gastric ulceration or perforation
intussusception
what are the abdominal differentials for an acute abdmen?
septic peritonitis
blunt/penetrating abdominal trauma
mesenteric volvulus
what are the abdominal organ-related differentials for an acute abdomen?
acute hepatitis
biliary obstruction/rupture
neoplasia
pancreatitis
splenic mass/torsion
what are the urinary-related differentials for an acute abdomen?
acute kidney injury
pyelonephritis
urethral tear
uroabdomen
what are the reproductive-related differentials for an acute abdomen?
pyometra
prostatitis
what is GDV?
a condition where the stomach dilates and rotates/twists
how does GDV lead to necrosis and septic peritonitis?
due to reduced blood flow to the GI tract and spleen
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
which body systems can be affected by GDV?
CVS
respiratory
GI
why does GDV result in reduced cardiac output and systemic hypotension?
reduced venous return due to compression of caudal vena cava
which type of shock does GDV cause?
hypovolaemic
distributive
cardiogenic
obstructive
how does GDV cause hypovolaemic shock?
decreased circulating volume –> decreased venous return –> decreased stroke volume and cardiac output
how does GDV cause distributive shock?
vasodilation, leaky vessels and activation of coagulation –> decreased venous return –> decreased stroke volume and cardiac output
how does GDV cause cardiogenic shock?
heart is unable to pump –> lower contractility –> decreased cardiac output
how does GDV cause obstructive shock?
physical impediment to blood flow in vessels –> reduced venous return, stroke volume and cardiac output
what does development of SIRS/sepsis indicate in GDV?
poor prognosis
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
