Acute Abdomen Flashcards
acute abdomen
presenting to ER with acute abdominal pain
OR
has an unstable condition due to abdominal disease
what are the 3 steps to approaching an acute abdomen case
- does patient require immediate stabilization
- does the patient need emergency surgery
- what diagnostics are needed to find the source of pain or diagnose a surgical condition
assessing need for stabilization
- airway
- breathing
- circulation
- disability/dysfunction
perfusion parameters
- mentation
- MM color
- CRT
- HR
- pulse quality
- extremity temperature
shock stabilization steps
- O2 supplementation
- IV catheter placement (large bore)
- IV fluid bolus
- +/- dextrose
- analgesia
- +/- antibiotics
guidelines for fluid resuscitation
LRS or plasmalyte
dogs: 80-90 ml/kg
cats: 40-50 ml/kg
goal is to achieve resuscitation within 15 MINUTES
administer 1/4 shock dose boluses over 5 min and reassess perfusion parameters after each
what analgesia should be provided immediately in acute abdomen patients
opioids - full mu agonists
hydromorphone, methadone
what are the 4 mechanisms of pain in the abdomen
- distention
- traction
- ischemia
- inflammation
what are the 7 indications for emergency surgery
- organ displacement, torsion, or obstruction (hollow organs)
- free peritoneal air
- intra-abdominal abscess or pyometra
- septic peritonitis
- bile peritonitis
- uncontrollable abdominal pain (if advanced diagnostics not available)
- penetrating abdominal injury (if penetrating object has risk of bacterial inoculation)
hemoabdomen
free blood in the abdomen that does not clot
characterized by the PCV of abdominal fluid > PCV of peripheral blood
causes of hemoabdomen
- trauma
- coagulopathy
- ruptured viscera
- torn blood vessels
indications for taking hemoabdomen to surgery
- unable to medically stabilize (fluids, transfusion)
- surgery is required for the underlying disease (bleeding liver, splenic mass)
what diagnostics should be performed on acute abdomen patients
- bloodwork - ICU panel, PCV/TP
- abdominal imaging
- radiographs: GDV, obstruction, free fluid/air
- POCUS: highly sensitive for free fluid - always sample for cytology and analysis - fluid analysis
what fluid analysis values indicate uroabdomen
fluid creatinine > 2x serum
fluid potassium > 1.4x serum
what fluid analysis values indicate bile peritonitis
fluid bilirubin > 2x serum
