Acute Abdomen SA

Question 1

Define acute abdomen

Answer 1

Condition of severe abdomenal pain caused by acute disease or injury to internal organs

Question 2

What are the 3 stages to treating acute abdomen?

Answer 2

• Identify problem
  > Diagnostic plan
  > Treatment plan
  > Follow up plan

Question 3

What 4 physiological problems may cause pain in the abdo?

Answer 3

• Distension
• Inflammation
• Ischaemia
• Traction

Question 4

How may physiological disturbances be remembered?

Answer 4

Vitamin D
V - cascular (thrombosis/heamorrhage) 
I - Infection/inflammation/immune mediated
T - toxin/trauma
A - Anomalous
M - Metabolic
I - Iatrogenic/idiopathic
N - Neoplasia/nutrition
D - Degenerative

Question 5

Give DDx for stomach/intestine related pain

Answer 5

• GDV
• Mesenteric torsion
• Infarction
• Ulceration
• GIT infection (parva, HGE)
• FB
• Intussescpetion
• Toxin
• Neoplasia

Question 6

Give DDx for pancreatic related pain

Answer 6

Pancreatitis, abscess, neoplasia

Question 7

Give DDx for liver related pain

Answer 7

Torsion
Cholangiohepatitis
Abscess
Bile obstruction

Question 8

Give DDx for spleen related pain

Answer 8

• Torsion
• Infarction
• Haematoma
• Abscess
• neoplasia

Question 9

Give DDx for peritoneal and retroperitoneal cavity related pain

Answer 9

Peritoneal: septic peritonitis (GIT, repro, external) Uroperitoneum, bile peritonitis [rare] severe distension from transudate/haemabdomen, abdo wall trauma
Retroperitoneal: renal infarctino, pyelonephritis due to UTI, neoplasia

Question 10

Give DDx for bladder related pain

Answer 10

Cystitis, calculi, urethral obstruction

Question 11

Give DDx for repro related pain

Answer 11

Pyometra, dystocia, prostatic abscess, prostatitis

Question 12

What pay be confused for abdominal pain?

Answer 12

• Spinal pain
• Nervousness -> flinching
• Respiratory problems (compression of abdo -> compression of thorax)
• Hyperaesthesia (eg. cannabis consumption)

Question 13

What diagnostic tests are usually carried out for acute abdomen?

Answer 13

• History/PE
• PCV/TS/blood smear—> CHEAP, QUICK, EASY
• Blood glucose —————–^
• Abdo ultrasound for free fluid
• Abdomenocentesis (U/S or blind)
• Diagnostic peritoneal lavage
• Abdo radiographs (VD, R lateral for GDV, L lateral for pylorus, check fluid/obstruction/free gas, contrast studies)
• CT, heam/biochem
• Ex lap

Question 14

What CV problem is commonly seen in dogs with GVD?

Answer 14

Ventricular premature complexes and tachycardia

Question 15

What pathology may lead to hypoglycaemia?

Answer 15

Septic peritonitis

Question 16

Which diagnoses are classified as surgical emergencies?

Answer 16

• Gastric dilation ± volvulus (GVD)

- Septic peritonitis (GIT/uterine rupture/prostatic abscess rupture)

Question 17

Which diagnoses may emergency surgery be considered?

Answer 17

- Risk of septic peritonitis
> Partial/complete obstruction 
> Intussusception 
> Penetrating abdo wound
> Abdo bite/crush injury

Question 18

What diagnoses may be classed as procedural or surgical emergencies?

Answer 18

• Metabolic emergency (uroperitoneum [drain peritoneum -> v azotaemia], urethral obstruction, bile peritonitis)
• Vascular emergency (splenic torsion, strangulated hernia, mesenteric torsion, intractable haemorrhage (replacing entire blood volume)

Question 19

When should nutritional supplements/feeding assistance be provided?

Answer 19

Anorexia >3d

Question 20

Give 4 anagesia options for dealing with acute abdomen. Which is generally contraindicated?

Answer 20

1. Pure opioids (methadone, morphine, fentanyl)
   2 .Partial agonist opioid (buprenorphine)
2. NSAIDs (meloxicam, carprofen) CARE Renal and GIT toxicity esp if poorly perfused
3. Multimodal (ketamine CRI, lidocaine CRI)