Approach to acute abdomen Flashcards
What is an acute abdomen?
= acute onset of abdominal pain
- vomiting commonly seen
- collapse
- shock
What are the 4 quadrants you can find abdominal pain?
- cranial
- caudal
- dorsal
- ventral
Cranial abdominal pain - which organs could be affected?
- liver
- stomach
- pancreas
- peritoneum
- oesophagus
- diaphragm
- spleen
- duodenum
- spine
Dorsal abdominal pain - which organs could be affected?
- kidneys
- spine
- colon
- spleen
- adrenals
- (stomach)
Caudal abdominal pain - which organs could be affected?
- bladder
- colon
- uterus
- prostate
- spine
Ventral abdominal pain - which organs could be affected?
- spleen
- umbilicus
- intestines (primarily jejunum, ileum also)
- mammary glands
- muscle
- fluid i.e. blood (pro-inflammatory mediator so causes pain) - localised peritonitis
- spine
Distributive shock CS
- increased temp
- red mm
- shortened CRT
- tachypnoea
- tachycardia
- bounding peripheral pulses: big difference between systolic and diastolic pressure but MAP poor/decreased, so also considered to be a poor pulse
Hypovolaemic shock CS
- decreased temp
- pale mm
- prolonged CRT
- tachypnoea: metabolic acidosis -> reduces oxygen to tissues so more anaerobic respiration so lactic acid production, so compensate but breathing out more CO2
- tachycardia (but cats can sometimes have a bradycardic response -> can maintain high vagal tone in the face of severe dz)
- poor pulse
Cardiogenic shock (e.g. DCM) CS
- decreased temp
- pale mm
- prolonged CRT
- tachypnoea
- tachycardia
- poor pulses
Obstructive shock CS
- decreased temp
- pale mm
- prolonged CRT
- tachypnoea
- tachycardia
- poor pulses
Organ vs free fluid
- organ fluid usually circular whereas free fluid tends to create angles
How to differentiate
- POCUS: allows to find problems quickly within the abdomen
If POCUS is inconclusive
- radiography: good for obstructive GI dz e.g. FB
- if still inconclusive: US (full abdo scan)
Lab work - point of care
PCV / TP
- TP will change with acute bleeding (drops)
- use PCV to check that the fluid taken from abdomen is actually blood
Blood gas
- metabolic acidosis vs alkalosis
- most likely to be acidotic due to lactic acid being produced
- alkalosis rare but can be due to v+ -> everything is coming up likely due to FB or obstruction of the pylorus or duodenum
Blood smear
Slide agglutination
Urinalysis
- useful for AKI
Glucose
- useful for spotting diabetic pts
Lactate
- tells you about perfusion
- gives a target as readily changeable i.e. should drop well with good tx
BP
- + lactate gives target for fluid therapy
Electrolytes
- Na/K -> AKI, addison’s
Lab work - lengthy (i.e. takes >15mins to get results)
C&ST of tap
Microscopy
Haematology
- clue for really sick pt is WBCc
– neutrophilia/paenia -> toxic change, left shift)
Biochemistry
- liver enzymes
- urea/creatinine for kidney
Basal cortisol
- for Addison’s
Coagulation
- pT
- aPTT
- TEG/VCM
Which organs will be damaged in the short term / quickly by hypoxia? How can you monitor these organs?
Brain
- mentation: Glasgow coma scale
Kidney
- urinalysis
- biochem
- urine output
Heart
- ECG
- POCUS already told us about the mechanical aspect of the heart
Lungs
- SpO2
- PaO2
