Gastrointestinal emergencies Flashcards
An acute abdomen can be caused by: (2)
Abdominal pain
Pain in the lumbar and / or sacrum region
Describe AHDS.
Haemorrhagic gastroenteritis / acute haemorrhagic diarrhea syndrome (AHDS)
Very acute bloody diarrhea, +/- bloody vomiting
Often accompanied by severe hypovolemic shock
Small breeds have a predisposition
Blood analysis during AHDS may show: (3)
Strong haemoconcentration
Low TP
Increased LAC
Treatment of AHDS should include: (5)
Fluid therapy, shock boluses if necessary
Antiemetics
Gastroprotectants
+/- antibiotics
Feeding
Describe Parvovirus cases
Infectious disease (unvaccinated animals)
Acute vomiting / diarrhea
Blood samples typically see:
- Neutropenia
- Hypoalbuminemia
Severe hypovolemic shock / dehydration
Rapid test Parvo antigen to diagnose
treat with Antiemetics, gastroprotectants, antibiotics
Feeding
Pancreatitis clinical signs
Clinical symptoms are non-specific
Vomiting
Painful abdomen
Inappetence
+/- diarrhea
History often includes a change in diet or fatty food.
Do diagnostic imaging.
Blood analysis of Pancreatitis cases typically see: (5)
Dehydration
ALT, ALP, CHOL, TBIL
Pre-renal azotemia
Specific snap tests
Neutrophilia
Describe xray imaging for pancreatitis. (3)
Opacity of the cranial abdominal region.
Enlargement of the pyloric and
duodenal angle.
Displacement of the stomach to the
left
Describe ultrasound for pancreatitis. (3)
Peritoneal fluid around the pancreas
Hyperechoic peri-pancreatic region
Hypoechoic pancreas
Treatment of pancreatitis.
In uncomplicated cases, clinical improvement will be seen in 48h.
Fluid therapy
Antiemetics
+/- antibiotics
Feeding, feeding tube if necessary
NB! Cats prone to “triaditis”
- IBD
- Hepatitis
- Pancreatitis
Describe Foreign bodies In the esophagus -cases
May present with Regurgitation, vomiting, coughing, breathing difficulties.
Risk of esophageal perforation
- Spasm of the muscle layer of the esophagus, necrosis of the mucosa.
Complications
- Mediastinitis and pleuritis
- Pyothorax
Endoscopy preferred
Surgery may be required case dependent
Describe Foreign bodies In the stomach / intestinal tract -cases
Anamnesis: Is foreign body likely, is some toy or object missing / has been chewed up etc.?
Diagnostics
- Xray, +/- contrast
- Ultrasound
Treatment either surgical or endoscopic.
What is Intussuseption?
Typical types?
Typical patient?
Invagination of a portion of the intestinal tract into the lumen of the adjacent section
of the bowel.
Typical types: ileocolic in dogs and jejunojejunal in cats.
Generally <1y of age.
Possible causes of intussusception: (7)
motility disorder,
enteritis,
infection (virus, bacterial, parasitic),
foreign bodies,
prior surgery,
adhesions,
neoplasia
Describe a suspected intussusception patient/case.
Diagnosis made by?
History: anorexia, vomiting, diarrhea
Physical examination: dehydration, tachycardia, abdominal pain, mass in abdomen, thickness of intestinal wall, signs of shock.
Diagnosis is made usually based on ultrasound.
Other diagnostics are also necessary for evaluation of the patient.
Initial stabilization of an intussusception case.
First aim: resolution of dehydration.
- Bolus of crystalloid 15 – 20 ml/kg/h for 20min then reassessment.
If hemodynamically stable, then correction of dehydration and electrolyte imbalances.
Antiemetics
Analgesia- opioids
If we suspect sepsis – antibiotics
Minimal database: PCV, TP, GLU, LAC, LYTE4
Describe surgery of intussusception.
Only After initial stabilization
Diagnostic laparotomy:
- Check the GI tract fully
- Often there is more than one intussusception place.
Manual reduction: is often not possible so
Intestine resection and anastomosis is required.
Afterwards perform Enteroplication so that it would not repeat.
Prognosis after intussusception surgery.
Recurrence 3 – 27%. Usually within 3 days.
Recurrence more common if
enteroplication is not performed.
AKI can be categorized as…
IRIS acute kidney injury Grade I-V
AKI Grade allocated based on blood creatinine and clinical description.
Grade I: < 1.6 mg/dl CREA, nonazotemic AKI (see image)
and so on
AKI are mostly what type?
Ischemic/inflammatory 58%
Infectious 8%
Toxic 6%
Septic some smaller %
& In up to 50% of AKI cases, the underlying
cause is not known.
Clinical signs of AKI.
Apathy
Vomiting
Anorexia
Polyuria, oliguria, anuria
Halitosis, necrosis of the tip of the tongue, peripheral edema (uremia).
Why would necrosis of the tip of the tongue be seen in animals with acute kidney injury?
uremia causes damage to various tissues, including the oral mucosa, which can lead to ulceration and necrosis of soft tissues such as the tongue.
Kidney dysfunction can also lead to vascular abnormalities, such as vasculitis (inflammation of blood vessels) or microthrombi.
urinalysis in AKI may see: (3)
Isosthenuria
Stix: glycosuria, proteinuria, bilirubinuria
pH acidic
hematology in AKI may see: (3)
Hemoconcentration or low PCV
Leukocytosis – infectious
Leptospirosis / borreliosis
x-ray / ultrasound in AKI may see: (2)
Normal or enlarged kidneys
Free fluid and omental reaction around the kidneys.
Treatment of AKI.
Treatment is generally supportive treatment.
Fluid therapy
- Ins/OUTs
- Monitor for fluid overload
Antiemetics
Analgesia
Diuretics
Dialysis
Prognosis: Mortality 45 – 60%
typical Feline urinary obstruction patient:
usually castrated male cats, 2-6 years old
Possible causes of Feline urinary obstruction
Physical resistance:
- Bladder stones, mucous plugs
- Strictures and neoplasia – less common
Idiopathic (FIC)
- More than 53% of cases
- Environment, diet, behavioral factors, stress.
Specific Clinical signs of Feline urinary obstruction vs less or non-specific signs.
Specific
- Pollakisuria (frequent, abnormal urination)
- Stranguria (painful urination)
- Dysuria (abnormal urination)
- Hematuria
- Inappropriate urination
- Vocalization
- Large bladder, pain
Less specific
- Inappetence
- Apathy
- Nausea
- Vomiting
- Respiratory signs: tachypnea, open-mouth
breathing
- Cardiovascular: bradycardia, dysarrythmias
Diagnostics for feline urinary obstruction.
Clinical examination
Blood samples:
- Electrolytes
- Biochemistry (kidney enzymes)
- CBC
Further diagnostics (after initial stabilization)
- Urine sample (sediment + culture)
- Xray
- Abdominal ultrasound
First line stabilization for feline urinary obstruction. (6)
IV catheter – collection of blood samples
- Opioid or sedation if necessary in angry animals
ECG
Fluid therapy
Analgesia / muscle relaxation
Sedation / anesthesia
Urinary bladder catheterization
Describe Fluid therapy in feline urinary obstruction upon presentation.
Evaluate the cardiovascular system
- HR
- Rhythm
- Perfusion (pulse, mucous membranes, CRT)
- ECG
Ri-Lac usually first choice (faster resolution of metabolic acidosis)
- Dosages
Shock boluses – ¼ - 1/3 of shock dose 15 – 20 min, repeat if necessary
If the patient is cardiovascularly stable, then decide the dosages based on
dehydration and maintenance.
What main biochemical change may be seen in feline urinary obstruction cases?
And what does the change cause?
Hyperkalemia: Potassium, normally excreted by the kidneys, accumulates in the blood when the obstruction prevents urine flow.
Clinical signs may be unspecific.
- Muscle tremors
- Lethargy
- Arrhythmias
Changes in the ECG may occur.
Hyperkalemia treatment
Fluid therapy and catheterization.
Decompressive cystocentesis if needed.
K < 6.5 mEq/L
- Fluid therapy
K 6.5- <8 mEq/L
- 0,5 ml/kg 50% dextrose (dilute 1:4 NaCl)
K >8 mEq/L, +/- changes in the ECG
- 0,5 – 1 ml/kg 10% calcium gluconate IV supports and protects the heart.
- 1ml/kg 50% dextrose (dilute 1:4 NaCl) + insulin 0.25 U/kg IV.
Diagnostics for pyometra?
Imaging:
- U/S – most sensitive
- Xray
+ Blood samples
Treatment of penile prolapse.
Ingrown/misdirected hairs that are stuck to the penis or foreskin mucosa should be removed immediately, as they prevent normal blood supply.
Swelling reduction: cold compress, local hyperosmolar solution (e.g. 50% dextrose).
Immediate release of the foreskin from pinching/ tightening.
Penile aspiration (removal of excess fluid from the corpus spongiosum of the penis).
The penis should be placed back into the foreskin to prevent further injury.
Surgery
If there is an injury or obstruction to the urethra, before dealing with penile trauma, the obstruction must be removed or urine diversion (e.g catheter) should be ensured and the resulting hyperkalemic state stabilized.
What is The gastric invagination technique?
Gastric Invagination for GDV Induced Necrosis is a surgical technique.
The necrotic area of stomach, instead of being removed by partial gastrectomy, was pushed into the stomach lumen and over sewn with inverting suture patterns. The devitalized tissue was left to be digested by the stomach enzymes allowing the healthy tissue to heal.
Belt-loop gastropexy is a simple and commonly used method.
Create a 3- to 4-cm-long by 3- to 4-cm-wide seromuscular flap in the pyloric antrum. Incorporate one or two branches of the right gastroepiploic artery into the flap.
Using atraumatic forceps or a stay suture, pass the seromuscular flap in a caudal to cranial direction through the “belt loop” in the abdominal wall.
Suture the seromuscular flap back into its original position by using a 3-0 absorbable monofilament suture with a simple interrupted suture pattern.
Labor indicators in dogs (2)
Body temperature drops below 37.6’C, Labor will start in 12 – 24h.
Progesterone drops below 2 ng/ml.
The fetal expulsion stage of labor can last how long in dogs?
abdominal contractions and clear vaginal discharge may last 12-24 hours
the first puppy should be delivered in 2-4 hours from onset of contractions
Placenta should be expelled how long after fetal expulsion
10-25 min after each puppy
Criteria for examination of a potential dystocia dam (9)
Prolonged gestation without signs of labor
Body temperature decrease below 37.6 for 12 – 24h, without signs of labor
Body temperature increase for prolonged time
Vaginal discharge for more than 2 -3 h
Labor activity stops for more than 8h
Active and strong abdominal contractions for 30min, without expulsion of a puppy.
Labor stage 2 lasting for more than 12h.
Abnormal discharge
Signs of systemic illness
Vaginal discharge differentials based on appearance of discharge.
Review causes of dystocia.
Review causes of functional and obstructive dystocia in dogs.
Indications for cesarean section. (11)
