Exam 4 - Hemoabdomen Flashcards
what are the 2 general categories of causes of hemoabdomen?
spontaneous & traumatic
what animals are typically affected by neoplastic hemoabdomens?
older/larger animals that have waxing & waning signs - chronic with acute decompensation
what animals are typically more commonly affected by acquired coagulopathy causing hemoabdomen?
younger animals & wanderers - subacute to acute decompensation (completely normal prior to the last 24 hours)
what is this? what does it mean?
cullen’s sign - internal bleeding
what are the common sources for traumatic hemoabdomen?
spleen > liver > kidney
T/F: 37% of dogs with pelvic fractures also will have concurrent intraabdominal injuries
true - hemoabdomen, uroabdomen, septic abdomen
what is the pathophysiology of acute traumatic coagulopathy?
result of trauma - massive activation of protein C
inhibits factors V & VIII, plasminogen activator inhibitor-1
animal becomes hypercoagulable & hyperfibrinolytic
what is the pathophysiology of resuscitation-induced coagulopathy?
dilutional coagulopathy - high volumes of crystalloids/colloids
temperature of fluid products - hypothermia
animal becomes hypocoagulable
what is the rule regarding bleeding splenic masses?
50% of splenic masses are malignant
& of the 50% - 50-75% of malignant splenic tumors are hemangiosarcomas (others are lymphoma, histiocytic sarcoma)
what is the most common cause of acquired coagulopathy leading to hemoabdomen?
anticoagulant rodenticide
what is the most common anticoagulant rodenticide coagulopathy we see?
2nd generation
what is the mechanism of action of anticoagulant rodenticide?
inhibits vitamin K1 epoxide reductase - can’t activate vitamin k dependent clotting factors
irreversible
what diagnostics should you run in an animal presenting with a hemoabdomen?
abdominal imaging - FAST scan, rads, CT
abdominocentesis
platelet count
clotting times
blood type & cross match
how much fluid must be in the abdomen for it to be visible on rads & for the animal to have a palpable fluid wave?
rads - 8.8ml/kg
fluid wave - 40ml/kg
what is the goal of abdominocentesis in a patient presenting with a suspected hemoabdomen? what should you do with the fluid sample?
goal is diagnostic not therapeutic
compare it to peripheral blood - if PCV & total solids are increased compared to peripheral blood, supportive of hemoabdomen
why is a platelet count necessary in a patient with a hemoabdomen?
while thrombocytopenia/thrombocytopathia is unlikely to cause cavitary bleeding, it does contribute to progressive hemorrhage
why are clotting times necessary in a patient with a hemoabdomen?
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
if you have a PT/PTT time come back for >300 seconds, what should be on your list for differentials?
- anticoagulant rodenticide - signalment & history
- neoplasia - signalment & history
- hypofibrinogenemia - signalment, history, chem panel
- envenomation - history & clinical signs
- user error - non-hemorrhagic patient
what are some general therapy plans for treating a patient with hemoabdomen?
IV fluids, blood products (allogenic or autotransfusion), surgery, fibrinolysis inhibitors, & abdominal compression wrap
what treatment is indicated for any hemoabdomen patient with signs of shock? what should you be cautious with?
iv fluids - isotonic, hypertonic, synthetic & blood products
be cautious with volume - can causes resuscitation induced coagulopathy
what is the low volume resuscitation strategy?
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
what is the low pressure resuscitation strategy?
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
what is the definitive treatment for inherited or acquired coagulopathies resulting in bleeding?
plasma!!
frozen plasma for anticoagulant rodenticide
fresh frozen plasma for inherited coagulopathies
what criteria is met for a confirmed bleeding patient with refractory shock that is unresponsive to fluids?
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
what are the ideal patients for autotransfusions?
inherited or acquired coagulopathy patients
autotransfusions for hemoabdomens are controversial in what patients?
neoplastic causes of bleeding
what is an important consideration when performing an autotransfusion?
in traumatic cases - ensure no contamination
what is an autotransfusion? when is it indicated?
only provides red blood cells - need to supplement plasma
acute hemorrhage only
when is surgery indicated for hemoabdomen patients?
neoplastic hemoabdomens - may require advanced imaging for surgical planning, particularly in extra-splenic causes
T/F: traumatic hemoabdomen is not often surgical
true
what are the indications for surgery in a traumatic hemoabdomen?
decreases in PCV/TS despite medical management & progressive effusion despite medical management
when is surgery never indicated in a hemoabdomen patient?
acquired coagulopathies - rarely ever in inherited
treat medically first always
when are fibrinolysis inhibitors indicated?
acute traumatic coagulopathy - CRASH trial, within 3 hours
can consider in neoplastic hemoabdomens
when should you not use fibrinolysis inhibitors?
acquired & inherited coagulopathies
what is the dosing used for aminocaproic acid as a fibrinolysis inhibitor?
100-150 mg/kg every 8 hours IV or 15 mg/kg/hr
what is the dosing used for tranexamic acid as a fibrinolysis inhibitor?
10 mg/kg IV followed by 1 mg/kg/hr
