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Applied Clinical Veterinary Nursing > Acute abdo/GDV > Flashcards

Acute abdo/GDV Flashcards

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1
Q

what is an acute abdomen?

A

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

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2
Q

why might a patient develop an acute abdomen?

A

inflammation of an organ

leakage of fluid from a damaged organ

entrapment of an organ

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3
Q

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

A

increased resp rate and effort

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

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4
Q

how might an acute. abdomen affect mm/CRT?

A

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

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5
Q

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

A

sepsis

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6
Q

how does an acute abdomen affect patient temperature

A

often hypothermic

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7
Q

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

A

collapsed or obtunded

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8
Q

what GI signs accompany an acute abdomen?

A

hypersalivation and nausea

regurgitation, retching

abdominal pain

distended abdomen

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9
Q

what are the GI differentials for an acute abdomen?

A

GDV

foreign body

gastric ulceration or perforation

intussusception

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10
Q

what are the abdominal differentials for an acute abdmen?

A

septic peritonitis

blunt/penetrating abdominal trauma

mesenteric volvulus

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11
Q

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

A

acute hepatitis

biliary obstruction/rupture

neoplasia

pancreatitis

splenic mass/torsion

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12
Q

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

A

acute kidney injury

pyelonephritis

urethral tear

uroabdomen

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13
Q

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

A

pyometra

prostatitis

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14
Q

what is GDV?

A

a condition where the stomach dilates and rotates/twists

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15
Q

how does GDV lead to necrosis and septic peritonitis?

A

due to reduced blood flow to the GI tract and spleen

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16
Q

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

A

necrosis of the affected organs and septic peritonitis

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17
Q

which body systems can be affected by GDV?

A

CVS

respiratory

GI

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18
Q

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

A

reduced venous return due to compression of caudal vena cava

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19
Q

which type of shock does GDV cause?

A

hypovolaemic

distributive

cardiogenic

obstructive

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20
Q

how does GDV cause hypovolaemic shock?

A

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

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21
Q

how does GDV cause distributive shock?

A

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

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22
Q

how does GDV cause cardiogenic shock?

A

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

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23
Q

how does GDV cause obstructive shock?

A

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

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24
Q

what does development of SIRS/sepsis indicate in GDV?

A

poor prognosis

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25
Q

why does cariogenic shock occur in GDV?

A

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

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26
Q

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

A

administer oxygen therapy

place wide bore catheter (2 if possible), shock rate IV fluids/bolus

pain relief

blood sample

consider drugs e.g. catecholamines

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27
Q

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

A

systemic hypotension leads to peripheral vasoconstriction

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28
Q

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

A

opioids - can also help reduce stress

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29
Q

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

A

NSAIDs - renal protection under hypotension

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30
Q

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

A

blood gas analysis
basic emergency database

blood type, coagulation factors

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31
Q

why might we give catecholamines to a patient with GDV?

A

help with hypotension by increasing vascular resistance

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32
Q

what is the shock rate for GDV fluid resuscitation?

A

no more than 80-90ml/kg

33
Q

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

A

hypertonic saline - minimal amount required and can be given quickly

34
Q

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

A

cannot be given to dehydrated patients

fluid lost must be replaced by isotonic saline once stable

35
Q

how can we diagnose GDV?

A

pocus can confirm gas-filled space

radiographs can confirm GD vs GDV

36
Q

why might we take thoracic radiographs of a GDV patient?

A

to check for regurgitation/aspiration signs

37
Q

what must occur before gastric decompression in GDV patients?

A

fluid resuscitation must have already started

38
Q

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

A

slowly

39
Q

why should the stomach be decompressed slowly in GDV patients?

A

patients can quickly decompensate

sudden release of endotoxins can lead to sepsis/SIRS

40
Q

what is percutaneous decompression?

A

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

41
Q

what is oro-gastric decompression?

A

stomach tube placed down oesophagus to remove fluid from stomach

42
Q

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

A

crash kit

stomach tubes

suction unit

IV fluids - warmed

monitoring equipment

large surgical kit, lap swabs

self-retaining retractors

scrubbed assistant and float nurse

43
Q

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

A

hypotension

hypothermia

hypoxia,hypoxaemia

metabolic acidosis

arrhythmias

regurgitation

44
Q

how many ventricular premature complexes are considered ventricular tachycardia?

A

> 4 VPCs

45
Q

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

A

methadone and midazolam

46
Q

which premedicants are inappropriate for GDV cases?

A

ACP and medetomidine - cause too much CVS compromise

47
Q

what is an appropriate induction technique for GDV cases?

A

co-induction of midazolam with propofol or alfaxalone

48
Q

what perioperative analgesia may be appropriate for GDV cases?

A

fentanyl CRI

lidocaine (can help with arrhythmias)

49
Q

what is our most important perioperative concern with GDV patients?

A

management of blood pressure above 60mmHg MAP

50
Q

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

A

anticholinergics - atropine of glycopyrrolate

51
Q

which bpm is appropriate for which anticholinergic?

A

<40 = atropine

40-60 = glycopyrrolate

52
Q

what can anticholinergics help with in GDV cases?

A

vagally mediated bradycardia

53
Q

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

A

HR, RR mm, CRT, hydration status

blood database, ECG, blood pressure

UOP

signs of sepsis/SIRS/DIC

54
Q

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

A

poor perfusion and hypoxia can cause arrhythmias

55
Q

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

A

fluid therapy

analgesia

placement of a feeding tube?

reduce stress as much as possible - may need to go home to improve recovery

56
Q

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

A

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

57
Q

what feeding advice can we give to owners about GDV?

A

smaller portions multiple times a day

wet and dry mixed increases risk

use go slow bowls

no raised feeding

58
Q

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

A

temp <37.2 >39.4

HR >120

RR >24

59
Q

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

A

temp <27.2 >39.4

HR <140 >220

RR >40

60
Q

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

A

<6 >16

61
Q

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

A

<6 >20

62
Q

what is septic peritonitis?

A

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

63
Q

how should septic peritonitis be managed if suspected?

A

collect samples of fluid to send for C&S

start broad-spectrum abs until culture is back

64
Q

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

A

reduces risk of endotoxaemia

65
Q

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

A

start broad spectrum antibiotics early

66
Q

what is haemoabdomen?

A

accumulation of blood within the peritoneal cavity

67
Q

which species gets haemoabdomen more commonly?

A

dogs

68
Q

how does haemoabdomen occur?

A

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

69
Q

how will a patient with acute haemoabdomen present?

A

collapsed and hypovolaemic

70
Q

how will a patient with chronic haemoabdomen present?

A

general history of lethargy and anaemia

71
Q

what should we prepare for suspected haemoabdomen?

A

equipment for blood transfusion

72
Q

do patients with haemoabdomen have a low PCV/TS?

A

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

73
Q

why should care be taken with venepuncture in haemoabdomen patients?

A

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

74
Q

how does uroabdomen occur?

A

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

75
Q

how do patients with uroabdomen present?

A

collapsed and hypovolaemic

76
Q

what are our main concerns with uroabdomen patients?

A

often have acid-base imbalances, esp hyperkalaemia - can lead to arrhythmias

uraemic acids can cause metabolic acidosis

77
Q

how can we treat hyperkalaemia due to uroabdomen?

A

IVFT with calcium - only lasts 20 mins

can give glucose +/- insulin CRI (pushes potassium back into cells)

78
Q

which condition can be associated with uroabdomen?

A

acute kidney injury

79
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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