Acute Abdomen Flashcards
define acute abdomen
any intra-abdominal disease process that leads to an acute onset of clinical signs
define acute abdomen
any intra abdominal disease process that leads to an acute onset of clinical signs
what is acute abdomen usually caused by?
inflammation of an organ
leakage of fluid from a damaged organ
entrapment of an organ
what are the clinical signs of an acute abdomen?
Increased RR and effort
increased HR
thready or poor PQ
pale and tacky MM with prolongued CRT or injected MM and rapid CRT
hypotension
hypothermic
collapsed or obtunded
hypersalivation and nausea
regurgitation
retching
vomiting
abdominal pain
distended abdomen
arrhythmias
what is indicated by pale and tacky MM and prolonged CRT?
hypovolaemia
what is indicated by injected (red) MM and rapid CRT?
sepsis
what may help to guide possible causes of abdominal pain?
sex
neuter status
breed - deep chested/large dogs
what are the main gastric causes of an acute abdomen?
GDV
FB
gastric ulceration or perforation
intussusception
what are the main abdominal causes of an acute abdomen?
septic peritonitis
blunt or penetrating abdominal trauma
mesenteric volulus
what are the main hepatic / pancreatic causes of an acute abdomen?
acute hepatitis
biliary obstruction or rupture
neoplasia
pancreatitis
splenic mass or torsion
what may be caused by a splenic mass?
haemoabdomen following rupture
what are the urogenital causes of an acute abdomen?
AKI
pylonephritis
urethral tear
uroabdomen
pyometra
prostatitis
what are the key signs of GDV?
retching and unproductive vomiting
hypersalivation
what occurs during GDV?
stomach dilates and rotates or twists
is GDV an emergency
obvs you idiot
life threatening
high risk of mortality
what can be seen following GDV if left for 2+ hours?
necrosis and septic peritonitis due to leakage of necrotic fluid
how is necrosis caused by GDV?
reduction in blood flow to GI tract and spleen
what type of shock is very commonly seen with GDV?
hypovolaemic
what CV effects are seen with GDV?
reduced cardiac output
systemic hypotension
why does GDV result in reduced cardiac output and systemic hypotension?
reduced venous flow due to compression of the vena cava by distended stomach
why are GDV patients in shock?
severely hypoperfused
what types of shock can be seen with GDV?
all 4
distributive
hypovolaemic
cardiogenic
obstructive
why are GDV patients in hypovolaemic shock?
reduced circulating volume leading to reduced venous return and so reduced SV and CO
why are GDV patients in distributive shock?
cytokine release causes vasodilation
this leads to leaky vessels and activation of coagulation
reduced venous return and so reduced SV and CO
what can distributive shock lead to?
SIRS and sepsis
what does SIRS stand for?
systemic inflammatory response syndrome
what is indicated by a GDV patient with SIRS or sepsis?
poor prognosis
why are GDV patients in cardiogenic shock?
reduction in venous return so reduced preload
stomach applies pressure to heart and lungs
reduction in contractility and so CO
why are GDV patients in obstructive shock
physical impediment of blood flow in vessels as they are collapsed due to the pressure from the stomach
reduced venous return and so SV/CO
what is the overall effect of all types of shock?
reduction in CO leading to poor perfusion and hypoxaemia
what is involved in stabilisation of GDV patients?
O2
IV
analgesia
IVFT
bloods
may need catecholamines
regular TPR and reevaluation
recording on hospital sheet
what is critical about IV placement in GDV patients?
as big as possible and preferably 2
no saphenous unless desperate
why are IVs in saphenous veins less useful in patients with shock?
peripheral vasoconstriction means reduction in perfusion of HL
drugs take longer to ave effect / reach site of action
what are the analgesia considerations for GDV patients?
opioids
avoid NSAIDs due to risk of AKI and gastic ulceration
what fluids can be used for fluid resuscitation?
hartmanns fine
hypertonic also ok for initial bolus
what is the main Hartmanns does range for fluid resuscitation?
20 ml/kg boluses
up to 80 ml/kg total
what is the consideration if hypertonic saline used?
less needed but fluid must be replaced with isotonic as soon as possible
how could hypertonic saline be included into fluid rescusitation?
initial dose with hypertonic
isotonic from then on
what patients is hypertonic saline not appropriate in?
dehydrated as will remove even more fluid from the tissues and worsen signs
what type of blood sample is ideal for GDV patients?
arterial
what analysis will be performed on blood samples of GDV patients?
blood gas
blood type
coags
PCV and TS
lactate
urea:creatinine
what is indicated by PCV and TS?
dehydration (increased PCV if deh)
what is indicated by lactate levels?
prognosis
high levels show high level of anaerobic activity
why may catecholamines be used in GDV patients?
increase vascular resistance and so cardiac output
what is seen on a GDV xray?
pylorus cranial and dorsal
what is US used for in GDV assessment?
POCUS for gas filled space or haemoabdomen
what is xray used for in GDV assessment?
confirmation of GD or GDV
assessment of thorax for aspiration pneumonia
why may GDV patients be at risk of aspiration pneumonia?
regurgitation
what must be done before gastric decompression begins?
fluid rescusitation must be underway
what is the aim of gastric decompression?
removal of fluid and gas from the stomach
what can happen to the patient as the stomach is decompressed?
become more ‘shocky’
why may patients become more ‘shocky’ as the stomach is decompressed?
sudden toxin release as pressure is reduced and blood flow is normalised
what can be caused by sudden toxin release following gastric decompression?
SIRS
sepsis
what is SIRS?
exaggerated defense response of the body to a noxious stressor
how do SIRS and sepsis differ?
sepsis is SIRS which has a known infectious cause
can have SIRS without sepsis but nor sepsis without SIRS
what are the main ways of decompressing the stomach?
percutaneous
oro-gastric
what is involved in percutaneous gastric decompression?
insertion of large catheter into area where stomach is most distended in order to release air
what is involved in oro-gastric gastric decompression?
stomach tube placed once patient under GA
tube held as low as possible to allow contents to escape
what should you do if resistance is felt which the stomach tube is being advanced?
stop passing the tube
how rapidly will patients be taken to surgery for GDV?
depends on patient
some may be stabilised more before
others will have only a short period of stabilisation
what is needed in theatre for GDV surgery?
crash kit
flush
stomach tubes
suction unit
warm fluids for lavage
monitoring equipment
large surgical kit
spare kit
self retaining retractors
table which will tilt or trough
scrub nurse
circulating nurse
what may be done with crash drugs before GDV surgery?
calculated and drawn up
what are the main anaesthesia considerations for GDV patients?
hypotension
hypoxia
hypoxaemia
metabolic acidosis
hypothermia
arrhythmias
regurge
what is hypoxia?
low O2 in body tissues
what is hypoxaemia?
low O2 in blood
what tests may indicate metabolic acidosis?
lactate
acid base
base excess
what may be used to correct metabolic acidosis?
spiked fluids
how can risk of regurge be managed?
head up induction
prophylactic gastro protectants
cuff ET tube
have suction ready
regular checking of ET tube cuff
what arrhythmias are commonly seen with GDV?
VPCs
VT
how many VPCs in a row indicate VT?
4 or more
what treatment would be started if more than 4 VPCs were seen in a row?
lidocaine bolus
then CRI
what should be done with all GDV patients prior to induction?
pre-oxygenation
what pre-med would be used for GDV patients?
opioid only
why would the premed used for a GDV patient be opioid only?
ACP and dex/medetomidine cause too much CVS compromise
what are the CVS effects of ACP?
vasodilation
need to assist patient to maintain BP anyway as shock
what are the CVS effects of dex/medetomidine?
vasoconstriction - worsening of hypoperfusion
what may influence choice of induction agent?
alfax can cause VT which may worsen arrhythmias
what induction agent would be used for GDV patients?
co induction
midazolam and propofol or alfaxalone
what is the aim of coinduction?
reduction of required induction agent
how may patients with GDV be maintained?
iso/sevo
fentanyl CRI
local block
what must be monitored in GDV patients post op?
BP
what BP must patients be maintained at to ensure organ perfusion?
60 mmHg
how may hypotension be treated?
volume related - IVFT
vagally mediated - anticholinergics
what anticholinergics may be used for vagally mediated bradycardia?
atropine
glycopyrrolate
what is vagally mediated bradycardia?
pressure on vagus nerve causes HR to drop in response which is inappropriate for patient condition
what type of block is seen with profiund bradycardia?
AV block
what level of bradycardia is atropine used for?
severe
what level of bradycardia is glycopyrrolate used for?
milder (40-60 bpm)
how long do patients need to be monitored for following GDV?
24-48 hours close monitoring
what CVS signs can be caused by poor perfusion?
hypoxia and arrhythmias
how can fluid status be assessed?
PCV
TS
MM
CRT
BP
what is involved in post op monitoring of GDV patients?
HR
RR
MM
CRT
hydration
ECG
BP
what analgesia may be used for GDV patients post op?
paracetamol
CRI
how may nutrition be managed for GDV patients post op?
TTE
TPN
feeding tube
what is normal UOP?
2ml/kg/hr
what complications are you looking for following GDV surgery?
sepsis
SIRS
DIC
aspiration pneumonia
peritonitis
what signs may suggest sepsis, SIRS or DIC?
oedema
bleeding
sudden deterioration
what is the chance of GDV recurrence without gastropexy?
70-80%
what is the chance of GDV recurrence with gastropexy?
4-10%
how can GDV be prevented?
owner education
how can owners avoid GDV?
low stress
small, frequent meals
avoid wet and dry mix
go slow bowls
prophylactic gastropexy
what temperature may suggest sepsis in dogs?
<37.2
>39.4
what temperature may suggest sepsis in cats?
<37.2
>39.4
what HR may suggest sepsis in dogs?
> 120
what HR may suggest sepsis in cats?
<140
>220
what RR may suggest sepsis in cats?
> 40
what RR may suggest sepsis in dogs?
> 24
what WBC count may suggest sepsis in cats?
<6
>20
what WBC count may suggest sepsis in dogs?
<6
>16
10% banded neutrophils
what is sepsis?
release of chemicals (cytokines) into the blood stream to fight infection
inappropriate and unregulated response to these chemicals triggers changes which damage MOS
how is sepsis caused by release of chemicals (cytokines) into the blood stream?
inappropriate and unregulated response leading to organ damage
what samples should be collected from patients with oedema/suspected sepsis?
culture and sensitivity
if sepsis is suspected how should patients be treated?
broad spectrum antibiotics until culture back
then targeted
what is the benefit of starting antibiotics early if patients have sepsis?
reduction in risk of endotoxaemia
what is haemoabdomen?
accumulation of blood within peritoneal cavity
what animals is haemoabdomen more common in?
dogs
what can haemoabdomen be caused by?
trauma
spontaneous (splenic mass rupture)
how will patients with acute haemoabdomen present?
collapsed
hypovolaemia
how will patients with chronic haemoabdomen present?
lethargy and aneamia
what is PCV and TS like in acute haemoabdomen patients?
normal
will then drop when they are rehydrated
what other blood factors may have been affected by bleeding?
clotting factors
what treatment may haemoabdomen patients need?
blood transfusion
what is uroabdomen associated with?
rupture or leak within urinary tract caused by damage to the bladder or other area along the tract
how will patients with uroabdomen present?
collapsed
hypovolaemic
what is the most common electrolyte imbalance seen with uroabdomen patients?
hyperkalaemia
what can be caused by hyperkalaemia?
arrhythmias
what is seen on EGC with hyperkalaemia?
spiked T waves
how is hyperkalaemia treated?
IVFT with calcium for 20 mins
glucose or insulin CRI
why are glucose or insulin CRIs used to manage hyperkalaemia?
force potassium back into cells and reduce blood conc
what can cause metabolic acidosis in uroabdomen?
uraemic acids
what can uraemic acids cause?
metabolic acidosis
what injury can be associated with uroabdomen?
AKI
