Acute Abdomen SA Flashcards
describe clinical signs of acute abdomen
nonspecific!!
- vomiting/regurgitation
- diarrhea
- lethargy
- anorexia/hyporexia
- abdominal pain
how do you break down the anatomy with acute abdomen?
GI
1. stomach
2. small intestine
3. large intestine
extra-GI
1. pancreas
2. hepatobiliary
3. renal/urinary
4. reproductive
5. spleen
6. peritoneum (peritonitis always secondary to something else!!)
look-alikes (non-abdominal diseases)
1. neuro/back pain (when palpate abdomen, can translate as abdominal pain)
2. cardiac: arrhythmias/CHF
what are 4 causes of visceral pain in the GI tract? ON EXAM
- distension
-functional
-mechanical - inflammation
- traction
- ischemia
what are the more common causes of visceral pain for the stomach?
- distension
-functional: gastric dilation (food bloat)
-mechanical: gastric dilation and volvulus, pyloric outflow obstruction (foreign body or mass) - inflammation
-gastritis; infectious vs noninfectious - traction
- ischemia
-thromboembolic disease (less common for a clot to go to the abdomen first!)
-consequence of GDV (more common ischemic cause!!)
what are the more common causes of visceral pain of the small intestine?
- distension:
-functional ileus: can be secondary to anything! (AKI, pancreatitis, drugs, etc.)
-mechanical: FB obstruction, intussusception, obstructive neoplasia - inflammation:
-gastroenteritis: infectious vs noninfectious
-acute hemorrhagic diarrhea syndrome (AHDS) - ischemia:
-thromboembolic disease - traction:
-mesenteric torsion
what are common causes of visceral pain in the large intestines?
- distension
- inflammation
- ischemia
- traction: torsion; generally most common cause of acute abdomen in LI of small animals!
-most common in larger dogs
LI not super important in small animals for acute abdomen
-if something can make it through the ICJ, it can make it through the colon pretty easy
what are common causes of visceral pain, extra-GI?
pancreas: acute hepatitis
hepatobiliary:
-gallbladder mucocele (bile peritonitis)
-hepatic abscess
-hepatitis
-cholangiohepatitis
-liver lobe torsion (more in rabbits)
-neoplasia (acute?)
renal/urinary:
-urethral obstruction
-pyelonephritis
repro:
-pyometra
-prostatitis
-prostatic abscess
spleen:
-splenic torsion
-splenic infarct
-neoplasia (acute?)
peritoneum: always secondary!
-septic abdomen
-uroabdomen
-hemoabdomen
describe common causes of acute abdomen by signalment
young:
-infectious diseases: parasitic, viral
-eat stupid things
old:
-neoplasia
-degenerative
altered vs intact:
-infectious
-neoplasia
species:
-cats eat string
-dogs eat socks
describe important aspects of history taking for acute abdomen
- vomiting versus regurgitation
-frequency
-consistency
-color
-relationship to meals - diarrhea:
-frequency
-consistency
-color - dietary indiscretion
-take into account time of year and if there are children in the house - access to toxins?
- other animals in house? are they affected?
- history of any medical problems? medications? vx history?
- when was patient last normal?
- what and when was the first clinical sign noted?
- how have the clinical signs progressed since then?
*chronic abdominal pain that is static is not usually an emergency, but acute deterioration of a chronic issue or an acute issue WARRANTS IMMEDIATE ASSESSMENT
give some clinical signs of abdominal pain
GI:
-vomiting
-retching
-regurgitation
-painful defecation
-diarrhea
cardiorespiratory:
-panting
-lethargy
-collapse
abdominal manifestations:
-distension
-tenderness
miscellaneous
-anorexia
-praying position/tucked posture
-restlessness, vocalizing, reluctance to move
after initial stabilization, what is the most important part of the physical exam for acute abdomen?
abdominal palpation!!
-cranial abdominal pain: pancreatitis
-very distended stomach
describe specific physical exam findings for a patient with acute abdomen
- abdominal distension
-cranial organomegaly: should be able to slide fingers under ribcage in normal, if not, some distension
-space-occupying mass
-fluid (ascites) - abdominal fluid wave
- rectal exam (dogs): but check thermometer for poop color and consistency in small dogs and cats!!
what type of shock do we see in patients with acute abdomen?
- hypovolemic:
-GI losses
-renal losses
-severe dehydration (10-12%) leading to fluid shifts (fluids from intravascular space shift to interstitial space)
-hemoabdomen is most common hypovolemic cause! - obstructive:
-GDV (decrease in preload, body responds as if hypovolemic)
-veins are weenies!! eensy beensy - distributive:
-septic peritonitis
-acute pancreatitis - cardiogenic
describe step one, or initial stabilization, of an acute abdomen patient
- vascular access:
-peripheral, large bore catheter
-may need multiples based on patient needs - analgesia (injectable)
-opioids
-ketamine
-lidocaine - fluid resuscitation:
-crystalloids
-colloids
describe initial diagnostics (step 2) of the acute abdomen patient
- blood pressure
- electrocardiogram
- point of care bloodwork
-PCV/TS
-blood glucose
-lactate
-blood gas
-electrolytes - AFAST
-abdominal focused assessment with sonography for trauma
