Acute abdomen Flashcards
What characterizes an acute abdomen?
- Sudden onset of abdominal pain
- May be accompanied by vomiting, diarrhea, fever, shock, and can lead to death
How urgent are acute abdomens?
- Need to be treated as an emergency
- Be aggressive
Ddx (etiology) for acute abdomen, and which require surgery to resolve?
- Complete obstruction*
- Perforation*
- Volvulus/torsion*
- Herniation/strangulation*
- Abscess/infection*
- Necrosis/ischemia*
- Severe inflammation (e.g. severe pancreatitis
Organ systems potentially involved with acute abdomen
- GIT
- Liver
- GB/biliary tract
- Spleen
- Pancreas
- Urinary
- Reproductive
What should happen if you cannot make a definitive diagnosis to rule out a surgical cause of acute abdomen?
- Surgical explore!
Diagnostic plan for acute abdomen, focus on tests that can be done quickly on site, such as?
- PCV/TP, CBC
- Electrolytes
- Blood gas
- BUN
- Lacate
- Coagulation Tests
- USG/UA
- Imaging
- Abdominocentesis if abdominal fluids
- Blood glucose
In an emergency situation before running a test, what should you ask yourself?
- Will doing this test further compromise my patient or will the test result change my treatment plan?
Should you do chest rads to look for mets in a dog wit ha perforated bowel suspected to be secodnary to neoplasia, and why?
- Yes, because if mets are present, the prognosis is grave and surgery may thus not be indicated
In a dog suspected to have GDV based on signalment, hx, and PE findings, does it make sense to restrain the dog for abdominal rads before treating with fluids and decompressing the stomach? Why or why not?
- No, because positioning is likely to further incrase compression of the diaphragm, caudal vena cava, and portal vein by the dilated stomach
Common pre-op treatments for patient with acute abdomen
- Oxygen
- IVF at shock rate
- Correct glucose, electrolytes, acid/base
- IVF
- nalgesia (opioids); stay away from NSAIDs
- Also GI meds like gastroprotectants and motility modifiers
Why no NSAIDs in acute abdomen patients?
- often dehydrated and may have compromise to GIT, liver, and/or kidney function already
FB variety of signs
- Can cause acute or intermittent vomiting depending on location and degree of obstruction
- Intermittent signs are sometimes seen with gastric FB that intermittently moves in to block the pylorus, then moves back into a larger luminal area of the stomach
Which pennies are made made of copper/zinc?
- Before 1983 is copper
- After 1983 are Zinc
What can zinc cause?
- Hemolysis and lead to V/D, red urine, anemia, icterus, hepatocellular degeneration, and renal tubule necrosis
What is the reflex called when local intestinal dilation in response to contact between mucosa and sharp FB?
- Not sure - find it in the notes somewhere
When removing a FB, what do you need to explore?
- The entire GIT so you don’t miss other FBs that weren’t detected on imaging
How current should images be for sx?
- Base it on CURRENT IMAGES
What is a linear foreign body?
- String or thread or many objects interlocked together like rubber bands
What happens with a linear foreign body?
- Knot or clump of the linear foreign body gets trapped while the more linear portion continues aboradly down the GIT
- The intestine dutifully continues peristalsis in an attempt to advance the material
- However, since the LFB is anchored, this results in the intestine bunching up on itself
Where is the most common site of anchorage of LFB in a cat?
- Under the tongue
Where is the most common site of anchorage of LFB in a dog?
- Pylorus
What happens as hte bowel bunches up on itself, what happens?
- Obstruction is more and more complete
Where does the LFB end up getting pulled along, and what is the ultimate consequence?
- LFB ends up being pulled tight along the mesenteric side of the intestinal lumen
- Repeated peristalsis results in the LFB sawing through the mesenteric border wall, ultimately leading to perforation
- Each perforation may be small, but there can be a lot of them along the affected length of intestine, requiring resection of the affected piece of bowel because there are too many little holes to patch or to even see
Appearance on radiographs of linear foreign body?
- Plicated bowel
- May see eccentric, comma-shaped intraluminal gas bubbles
Usual treatment for linear foreign body?
- Surgery usually required
- Release LFB from its anchor point first
- If at the base of the tongue, cut the knot there and let the end zing down into the stomach and intestines
- If at pylorus, be prepared to do multiple enterotomies so that you can remove the LFB in sections without pulling it tight (which could cut through the mesenteric wall)
- May need multiple enterotomies
When is conservative treatment possible for LFB?
- In the very limited circumstance where the LFB is accessible to release from its anchor point (e.g. around the tongue), ingestion of LFB was very recent, patient has no signs of peritonitis, and patient can be closely monitored by the DVM
What happens during an intussusception?
- One piece of bowel (the intussusceptum) slides up inside the intussuscipiens
Which part of the intussusception has obstructed flow of ingesta?
- The intussusceptum
What happens to the mesojejunum and jejunal vessels of the intussusceptum?
- Pulled into the intussuscipiens, thus compromising the vasculature of the intussusceptum
What are the most common sites for intussusception?
- Ileocolic and jejunojejunal juction
Causes of intussusception?
- Enteritis (parasites, infection, dietary indiscretion)
- Change in bowel pliability mobility (e.g. foreign body, neoplasia, adhesion, ileus)
- Idiopathic (most common)
What is the most common cause of intussusception?
- Idiopathic
In what % of intussusception cases can you palpate the intussusception?
- 50-70%
- Feels firm
History and clinical signs of intussusception
- Intermittent (slides in and out) or constant and obstruction can be partial or complete
Rule outs for intussusception
- Abscess
- Mass
- Neoplasia
- High suspicion for intussusception based on signalment, hx, and clinical signs
Radiographic appearance of intussusception
- May see tubular shaped bowel mass and signs of obstruction
Ultrasound appearance of intussusception
- Target
Treatment for intussusception
- Reduce or resection and anastomosis (latter is required in 80% of cases)
- Treat underlying causes
- +/- Enteroplication
What is the risk with intussusception if you haven’t treated the underlying cause?
- Recurrence is a big concern
Enteroplication
- Intestines are tacked to each other so that one piece cannot telescope into another
- Because we know that having an anchored piece of bowel next to an unanchored one can cause intussusception, the entire intestine must be plicated (all or nothing)
What is the recurrence rate if no plication is done?
- 20% approximately
What is risk of obstruction or loss of blood supply with plication?
- 20%
- Little to no risk of re-intussusception
Where do tacking sutures go through?
- Serosa, muscularis, and into the submucosa
With complete obstruction of arterial and venous blood supply to a section of bowel, in what time frame do you get blackm aximally distended bowel?
8-12 hours
What can happen as early as 1 hr post-strangulation?
- Bowel wall edema with mucosal slough
What are other consequences with obstruction of arterial and venous blood supply with strangulation?
- Hemorrhage into the lumen????
- bacterial translocation
Mesenteric volvulus
- Intestine rotates around the root of the mesentery
- Blood supply to the small intestine is compromised –> severe, peracute abdominal pain –> rapid progression to shock and death
Treatment for mesenteric volvulus?
- Start fluids, oxygen, antibiotics, analgesia, and go to surgery NOW
- You cannot stabilize these patients medically
- If you take the time to do diagnostics (e.g. imaging, anything other than bedside labwork), the dog will likely be dead before you get to surgery
