Acute Abdomen SA Diseases

Question 1

describe gastric dilation

Answer 1

1. generally self inflicted
   -also referred to as food bloat
2. rads are necessary to ensure everything is in the proper anatomical location
3. treatment:
   -IVF
   -frequent walks so it gets moving
4. CAUTION:
   -sometimes the stomach is so large these patients can also present with signs of obstructive shock

Question 2

describe IVF therapy for gastric dilation

Answer 2

1. euvolemia is first goal
   -assess perfusion parameters
   -isotonic crystalloid bolus
   -10 ml/kg
2. rehydration is second goal:
   -maintenance rate: 40-60ml/kg/day
   -rehydration: BW x %dehydrated X1000 - fluid deficit in mL
   -ongoing losses

Question 3

describe gastric dilation AND volvulus

Answer 3

1. gastric distension and rotation of the stomach on its mesenteric axis
2. signalment: large and giant breeds
   -great dane, st. bernard, bernese, standard poodles
   -guinea pigs!
3. debate on risk factors:
   -large meals, overeating, small kibble
   -lean body condition
   -large drops in environmental temp
   -increasing age
   -STRONGEST ASSOCIATION: a first degree relative with a GDV

Question 4

describe history, PE, and bloodwork of GDV

Answer 4

1. history:
   -abdominal distension and pain
   -retching or non-productive vomiting
   -collapse
   -prayer stance
2. PE:
   -abdominal distension
   -signs associated with obstructive shock
3. bloodwork: marked lactic acidosis
   -an initial lactate of <4mmol/L or a >40% reduction in plasma lactate following fluid resuscitation are associated with increased survival and fewer complications

-an initial lactate of >6mmol/L may be associated with gastric wall necrosis and increased cost of care

Question 5

describe clinical symptoms of GDV and their causes

Answer 5

1. nausea:
   -causes retching, attempts to vomit
2. increased work of breathing:
   -due to gastric distension and displacement of diaphragm
3. increase in intra-abdominal pressure:
   -causes reduced venous return and reduced cardiac output
4. hemoabdomen:
   -due to tearing of short gastric vessels
5. gastric necrosis:
   -due to hypoxic and ischemic injury to gastric wall and release of inflammatory cytokines
6. ventricular arrhythmias

Question 6

describe radiographs and ultrasound of GDV

Answer 6

radiographs
-right lateral view is DIAGNOSTIC
-double bubble
-pop eye arm

ultrasound:
-it’s just going to look like a bunch of air so not generally helpful

Question 7

describe initial stabilization of GDV

Answer 7

1. IVC placement
2. isotonic crystalloid boluses
   -10-20 mL increments
   -reassess prior to repeating
3. analgesia: use a PURE MU OPIOID
   -methadone
   -fentanyl
   -hydromorphone
4. if ventricular arrhythmias:
   -lidocaine bolus then CRI
5. nothing dies in radiology!
   -initial stabilization should be occurring while owners are communication, diagnostics are being performed, and materials are gathered for gastric decompression

Question 8

describe gastric decompression of GDV

Answer 8

1. orogastric tube: patient must be anesthetized and intubated, use special OG tube (lubed up) and have a bucket ready
2. NG tube
3. trocarisation:
   -remember where the spleen is (good to use ultrasound)
   -use a long needle; once stomach deflates you will use your purchase with the gastric wall
   -take a sniff; you’ll know when you’re in!
   -not recommended if just gastric dilation alone since there may be leakage

Question 9

describe the surgical emergency part of GDV

Answer 9

truly a surgical emergency!!

1. stomach needs to be manually derotated
2. gastrectomy may be indicated if areas of perforation or necrosis
3. splenectomy may be indicated
4. gastropexy should NOT be option; will not prevent the GD but will prevent the V
5. place an NG tube during surgery to allow quantification and visualization of gastric contents during recovery AND initiate nutrition when indicated

Question 10

describe pyloric outflow obstruction

Answer 10

1. food cannot pass from stomach to duodenum
2. for an acute abdomen:
   -foreign material
   -tumor
3. clinical signs: regurgitation and/or vomiting
4. imaging: severe gastric distension with visualization of foreign material or mass
5. treatment: surgical intervention or endoscopy

Question 11

describe small intestinal mechanical obstruction

Answer 11

1. ingestion of foreign material is most common cause in dogs and cats
2. intussusception is second most common
3. can be partial or complete
   -partial can have a more chronic history
   -complete will require sx!
4. stabilization and rehydration prior to surgery are key!
5. diagnosis:
   -radiographs: two populations of bowel, intussusception, plication or bunching

-ultrasound: dilated, fluid filled intestine orad to obstruction, hard shadowing at area of FB

Question 12

describe acute pancreatitis

Answer 12

1. inciting cause usually remains unidentified
2. canine mortality rates range from 27-42%
   -can result in respiratory distress, AKI, DIC
   -premature activation of digestive zymogens in the acinar cells leads to cell necrosis and autodigestion

Question 13

describe acute pancreatitis diagnosis

Answer 13

1. bloodwork:
   -hemoconcentration
   -leukocytosis or leukopenia
   -thrombocytopenia
   -increases in hepatic enzymes and total bilirubin
   -azotemia
   -electrolyte abnormalities
2. abdominal radiographs: not sensitive or specific
3. abdominal ultrasound: helpful if trained!
4. CT: 100% sensitivity

Question 14

describe fluid therapy and stabilization for pancreatitis

Answer 14

1. resuscitation, naintenance, rehydration
2. vasopressors: for distributive shock
   -dopamine
   -norepi
3. supplemental oxygen:
   -hypovolemic shock
   -ARDS
   -asp pneumonia
   -pleural effusion
   -PTE

Question 15

describe pancreatitis treatment

Answer 15

1. fluid therapy
2. anti-nausea meds:
   -maropitant
   -ondansetron
3. pain mgmt
4. nutrition:
   -NG, NE, or esophagostomy tube
5. early enteral nutrition (within 24 hours of hospitalization:
   -improved mucosal gut structure
   -decreased bacterial translocation
   -fewer complications than parenteral nutrition