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SA DX & TX I > Exam 4 - Hemoabdomen > Flashcards

Exam 4 - Hemoabdomen Flashcards

1
Q

what are the 2 general categories of causes of hemoabdomen?

A

spontaneous & traumatic

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2
Q

what animals are typically affected by neoplastic hemoabdomens?

A

older/larger animals that have waxing & waning signs - chronic with acute decompensation

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3
Q

what animals are typically more commonly affected by acquired coagulopathy causing hemoabdomen?

A

younger animals & wanderers - subacute to acute decompensation (completely normal prior to the last 24 hours)

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4
Q

what is this? what does it mean?

A

cullen’s sign - internal bleeding

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5
Q

what are the common sources for traumatic hemoabdomen?

A

spleen > liver > kidney

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6
Q

T/F: 37% of dogs with pelvic fractures also will have concurrent intraabdominal injuries

A

true - hemoabdomen, uroabdomen, septic abdomen

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7
Q

what is the pathophysiology of acute traumatic coagulopathy?

A

result of trauma - massive activation of protein C

inhibits factors V & VIII, plasminogen activator inhibitor-1

animal becomes hypercoagulable & hyperfibrinolytic

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8
Q

what is the pathophysiology of resuscitation-induced coagulopathy?

A

dilutional coagulopathy - high volumes of crystalloids/colloids

temperature of fluid products - hypothermia

animal becomes hypocoagulable

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9
Q

what is the rule regarding bleeding splenic masses?

A

50% of splenic masses are malignant

& of the 50% - 50-75% of malignant splenic tumors are hemangiosarcomas (others are lymphoma, histiocytic sarcoma)

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10
Q

what is the most common cause of acquired coagulopathy leading to hemoabdomen?

A

anticoagulant rodenticide

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11
Q

what is the most common anticoagulant rodenticide coagulopathy we see?

A

2nd generation

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12
Q

what is the mechanism of action of anticoagulant rodenticide?

A

inhibits vitamin K1 epoxide reductase - can’t activate vitamin k dependent clotting factors

irreversible

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13
Q

what diagnostics should you run in an animal presenting with a hemoabdomen?

A

abdominal imaging - FAST scan, rads, CT

abdominocentesis

platelet count

clotting times

blood type & cross match

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14
Q

how much fluid must be in the abdomen for it to be visible on rads & for the animal to have a palpable fluid wave?

A

rads - 8.8ml/kg

fluid wave - 40ml/kg

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15
Q

what is the goal of abdominocentesis in a patient presenting with a suspected hemoabdomen? what should you do with the fluid sample?

A

goal is diagnostic not therapeutic

compare it to peripheral blood - if PCV & total solids are increased compared to peripheral blood, supportive of hemoabdomen

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16
Q

why is a platelet count necessary in a patient with a hemoabdomen?

A

while thrombocytopenia/thrombocytopathia is unlikely to cause cavitary bleeding, it does contribute to progressive hemorrhage

17
Q

why are clotting times necessary in a patient with a hemoabdomen?

A

coagulopathy is associated with causing cavitary bleeding - can be definitive for acquired/inherited coagulopathies

significant abnormalities (>50% prolongation) can be found in massive hemorrhage from trauma or neoplasia

18
Q

if you have a PT/PTT time come back for >300 seconds, what should be on your list for differentials?

A
  1. anticoagulant rodenticide - signalment & history
  2. neoplasia - signalment & history
  3. hypofibrinogenemia - signalment, history, chem panel
  4. envenomation - history & clinical signs
  5. user error - non-hemorrhagic patient
19
Q

what are some general therapy plans for treating a patient with hemoabdomen?

A

IV fluids, blood products (allogenic or autotransfusion), surgery, fibrinolysis inhibitors, & abdominal compression wrap

20
Q

what treatment is indicated for any hemoabdomen patient with signs of shock? what should you be cautious with?

A

iv fluids - isotonic, hypertonic, synthetic & blood products

be cautious with volume - can causes resuscitation induced coagulopathy

21
Q

what is the low volume resuscitation strategy?

A

titrate the lowest volume of fluid to achieve normal perfusion & pressure - typically a combo of crystalloid & colloid products (5ml/kg vetstarch & 3ml/kg hypertonic saline or 5-10 ml/kg isotonic saline & 5 ml/kg vetstarch)

definitive resuscitation

22
Q

what is the low pressure resuscitation strategy?

A

titrate to subnormal blood pressure (MAP 50-60 mmHg) - any product in any dose can be administered as part of the damage control plan

surgery is performed to identify the source of hemorrhage ASAP - after hemorrhage is controlled, patient is resuscitated to normal MAP

23
Q

what is the definitive treatment for inherited or acquired coagulopathies resulting in bleeding?

A

plasma!!

frozen plasma for anticoagulant rodenticide

fresh frozen plasma for inherited coagulopathies

24
Q

what criteria is met for a confirmed bleeding patient with refractory shock that is unresponsive to fluids?

A

3/4 blood volume is administered as fluids with mild improvement but no resuscitation

1/2 of blood volume administered with no improvements

> 20 ml/kg blood removed from a body cavity (canine)

decrease in PCV of >50% with continued signs of shock

25
Q

what are the ideal patients for autotransfusions?

A

inherited or acquired coagulopathy patients

26
Q

autotransfusions for hemoabdomens are controversial in what patients?

A

neoplastic causes of bleeding

27
Q

what is an important consideration when performing an autotransfusion?

A

in traumatic cases - ensure no contamination

28
Q

what is an autotransfusion? when is it indicated?

A

only provides red blood cells - need to supplement plasma

acute hemorrhage only

29
Q

when is surgery indicated for hemoabdomen patients?

A

neoplastic hemoabdomens - may require advanced imaging for surgical planning, particularly in extra-splenic causes

30
Q

T/F: traumatic hemoabdomen is not often surgical

A

true

31
Q

what are the indications for surgery in a traumatic hemoabdomen?

A

decreases in PCV/TS despite medical management & progressive effusion despite medical management

32
Q

when is surgery never indicated in a hemoabdomen patient?

A

acquired coagulopathies - rarely ever in inherited

treat medically first always

33
Q

when are fibrinolysis inhibitors indicated?

A

acute traumatic coagulopathy - CRASH trial, within 3 hours

can consider in neoplastic hemoabdomens

34
Q

when should you not use fibrinolysis inhibitors?

A

acquired & inherited coagulopathies

35
Q

what is the dosing used for aminocaproic acid as a fibrinolysis inhibitor?

A

100-150 mg/kg every 8 hours IV or 15 mg/kg/hr

36
Q

what is the dosing used for tranexamic acid as a fibrinolysis inhibitor?

A

10 mg/kg IV followed by 1 mg/kg/hr

SA DX & TX I (59 decks)

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