Devising a Plan Flashcards
- Bow is an eight year old entire female Springer Spaniel owned by an elderly client Mrs Lamont
- She is brought to the practice by Mrs Lamont’s son, who can tell you only that his mother is concerned because the dog’s tummy is getting bigger
- Write a list of the questions you need to ask
- Is Bow generally well or unwell?
- appetite?
- thirst?
- vomiting?
- appearance and consistency of stool
- Has the change in body shape happened suddenly?
- Will she still go for walks?
- When was she last in season?
There are more questions to ask but this is a start…..getting an idea as soon as you can of whether you are dealing with an acute or chronic problem and a sick or a basically well dog is very important.
What are the 5 broad categories of abdominal distension?
- Tissue
- Fluid
- Gas
- Faeces/ingesta
- Abdominal muscle weakness
Name 4 tissue causes of abdominal enlargement (5)
- organ enlargement
- e.g. liver, spleen, kidney, prostate in a male dog
- uterine enlargement (Bow is an entire female)
- pregnancy
- pyometra/hydrometra/mucometra
- fat
- obesity
- hyperadrenocorticism (body fat redistributes to the abdomen)
- neoplasia
- focal organ masses (eg renal adenocarcinoma, splenic haemangiosacroma)
- infiltrating neoplasia (eg GI lymphoma, carcinomatosis)
- granulomatous disease (rare in the UK but can occur with fungal disease, or in cats with FIP)
Name 2 causes of fluid abdominal distension (3)
- free fluid in the abdomen…more on this in week 8!
- trapped in organs
- urinary system: bladder, hydronephrosis
- uterus: pyometra or mucometra
- GI tract: associated with physical obstruction, functional ileus or severe enteritis/bloat
- cysts filled with fluid
- perinephric cyst
- polycystic kidney disease
- polycystic liver disease
- paraprostatic cysts in male dogs
Name 2 gas/air causes of abdominal distension (3)
- in the gastrointestinal tract associated with
- GDV/gastric dilation
- physical obstruction or functional ileus
- free gas in the abdomen
- almost always associated with life threatening perforation of the GI tract +/- gas forming organisms
- perforated gastric or duodenal ulcer
- ruptured bowel associated with a FB or tumour
- can persist for 10-14 days post laparotomy
- not usually distended in this situation but air is still present
- post trauma and abdominal wall rupture
- trapped within diseased organs (not always a cause of distension)
- emphysematous cystitis (sometimes associated with severe UTI)
- gas forming bacteria in the liver or gall bladder
Name a cause of faeces/ingesta causing abdominal distension (2)
- constipation or obstipation
- dietary scavenging
Name an abdominal muscle weakness cause of abdominal distension (2)
- associated with hyperadrenocorticism (ie combination of redistribution of body fat and weak muscle)
- iatrogenic steroid myopathy-(think back to your muscle disease SDL)
Create a problem list:
- BCS 1.5/5
- Respiration
- rate 40/min
- shallow breathing pattern
- MM slightly pale?
- Muffled heart sounds
- Palpation and ballottement of the abdomen suggests a “fluid thrill” ie abdominal fluid
- Abdominal enlargement
- probably due to free fluid
- Poor body condition
- Tachypnoea
- restrictive breathing pattern?
- possible pleural fluid?
- Pale mm
- Muffled heart sounds
Create a diagnostic plan:
- Abdominal enlargement
- probably due to free fluid
- Poor body condition
- Tachypnoea
- restrictive breathing pattern?
- possible pleural fluid?
- Pale mm
- Muffled heart sounds
- Confirm presence of abdominal &/or pleural fluid
- with diagnostic imaging
- abdominal/thoracic radiograph?
- ultrasound?
- by blind thoracocentesis or abdominocentesis
- sometimes justified in an emergency situation to drain large volume pleural fluid if diagnostic imaging is likely to cause unacceptable stress
- might give rapid confirmation of a major abdominal bleed
- potential to do harm!
- Blood sample (think about what these tests might tell you….they should not be considered just as “routine”!)
- haematology
- biochemistry
- Urinalysis (stix, SG, sediment examination)
- Collect a sample of abdominal/pleural fluid
- visual assessment (clear, cloudy, colour?)
- fluid analysis:
- cell count and cell types
- microscopy
- in house lab?
- external lab?
- both?
- protein content
What is this?
Ultrasound confirmed the presence of free fluid in the abdomen
- Abdominal fluid analysis showed:
- clear and colourless fluid
- SG 1.013
- protein 15g/l
- very few cells seen (occasional macrophages and neutrophils)
- What type of fluid is this?
- Transudate
- Modified transudate
- Exudate
- septic
- non-septic
- Blood
- Urine
- Bile
- Chyle
Why may you have abdominal fluid and might have pleural fluid?
Modified transudates are a type of effusion whose cell count and protein content are intermediate between a transudate and an exudate. In some cases, modified transudates may represent a transitional stage before the development of an exudate (as with uroabdomen, which begins as a modified transudate but develops into a chemical exudative peritonitis over time). Modified transudates arise as a result of disruptions to the endothelium or imbalances in the Starling forces. Common causes include:
- Increased vascular hydrostatic pressure resulting from inappropriate activation of the renin-angiotensin-aldosterone system (RAAS) in portal hypertension or congestive heart failure.
- Vasculitis, caused by feline infectious peritonitis virus (FIPV) or neoplasia. (Further discussion of the effusion encountered with FIP.)
- Strangulation of abdominal or thoracic organs may lead to the production of a modified transudate (which will develop into an exudate if untreated). This may occur with lung lobe torsion, torsion of the spleen or of a liver lobe or if part of the liver becomes strangulated within a diaphragmatic rupture.
- Chylous effusions are sometimes considered to be a type of modified transudate.
