Chapter 186 - Abdominocentesis

Question 1

Indication for therapeutic removal of large volumes of abdominal fluids?

Answer 1

• impaired diaphragmatic motion
• increased intra-abdominal pressure impeding blood flow to the visceral organs,
• painful

Question 2

What is a four-quadrant abdominocentesis (blind technique)?

Answer 2

Four open needles are placed simultaneouslyin each quadrant surrounding the umbilicus.
Gravity dependency or changes in transabdominal pressure between the needles may increase the likelihood of obtaining fluid.

Question 3

Procedure for diagnostic peritoneal lavage (DPL)?

Answer 3

• Local anesthetic infusion of 2% lidocaine at the umbilicus or 2–3 cm lateral to it (to avoid the falciform fat).
• 22 mL/kg of warm, sterile 0.9% sodium chloride infused by gravity through a drip set attached to the catheter
• Gently massage abdomen or roll patient without dislodging catheter

Question 4

Comparison of glucose / creatinine / potassium / bilirubine between peritoneal fluid and blood: cut-offs and conclusions

Answer 4

• Glucose difference >20 mg/dL: 100% sensitive/100% specific for septic peritoneal effusion in 18 dogs
• Abdominal fluid bilirubin significantly greater than peripheral bilirubin: bile peritonitis
• Creatinine concentration in the abdominal fluid > twice peripheral blood: highly suggestive of uroabdomen
• Potassium in abdominal fluid > 1.4 x peripheral blood : suggests uroabdomen