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.
Why is 50% dextrose administered in certain types of hyperkalemia veterinary patients (such as urinary obstruction)?
K 6.5- <8 mEq/L
- 0,5 ml/kg 50% dextrose (dilute 1:4 NaCl)
K >8 mEq/L, +/- changes in the ECG
- 1ml/kg 50% dextrose (dilute 1:4 NaCl) + insulin 0.25 U/kg IV.
This treatment works through an indirect mechanism to temporarily shift potassium from the bloodstream into cells, thereby lowering serum potassium concentrations and reducing the risk of life-threatening complications like cardiac arrhythmias.
Glucose -> insulin -> promotes the uptake of glucose into cells, but it also facilitates the movement of potassium into cells via sodium-potassium ATPase pumps.
Analgesia and anesthesia for feline urinary obstruction cases.
Analgesia and premedication:
Butorphanol (0,1 – 0,4 mg/kg)
- Moderate to good sedation
- Short duration (60 – 90 min)
- Not good for analgesia
Methadone (0,05 – 0.6 mg/kg)
- Moderate sedation
- Duration 2-4h
- Good analgesia
Sedation and muscle relaxation
- Midazolam (0.05 – 0.2 mg/kg)
Induction
- Propofol (4 – 8 mg/kg) IV
Treatment of urinary obstruction.
Catheterization!
Treatment after catheterization –
hospital/stationary treatment.
Catheterization and hospitalization
reduces the risk for recurrence.
Cats, who were sent home after
catheterization were 3.7 times more
likely to develop urinary obstruction
again.
Finding out the cause and treating it is the main thing!
Describe Fluid therapy in feline urinary obstruction during hospital treatment (so not initial therapy).
Fluid therapy varies in patients, evaluate according to the situation. Recheck every 2-4h!
Take into account maintenance, dehydration and ongoing losses due to
post-obstructive diuresis.
- Happens in 46% of cats
Be aware of fluid overload!
UOP (urine output)
Cats 0,5 – 1 ml/kg/h
Dogs 1 – 2 ml/kg/h
Check UOP, emptying of the bladder, weight, closed system collection bags, RR rate.
What exactly is post-obstructive diuresis?
refers to the excessive production of urine that occurs after the relief of a urinary obstruction. It is a compensatory response by the body following the restoration of urine flow after a period of urinary blockage.
Osmotic Diuresis: The accumulated waste products (e.g., urea) create an osmotic gradient in the renal tubules, drawing water into the urine and further increasing urine output.
UOP (urine output)
Cats
Dogs
Cats 0,5 – 1 ml/kg/h
Dogs 1 – 2 ml/kg/h
Analgesia in urinary obstruction.
Opioids
- Buprenorphine, methadone, fentanyl
- Smallest dosage that ensures analgesia and relaxation of the urethral sphincter.
NSAID
- Meloxicam (0.05 – 0.1 mg/kg SC, PO q24h).
- Only if the patient is stabilized, euvolemic and kidney values have become
normal.
Tamsulosin
Gabapentin, pregabalin
What is tamsulosin?
is an alpha-1 adrenergic receptor antagonist (alpha-blocker) that relaxes the smooth muscles in the urinary tract, particularly the bladder neck and prostate. It is primarily used to improve urine flow in conditions where obstruction or spasm of the urinary tract is present.
indicated for Benign Prostatic Hyperplasia and urinary retention etc.
Describe pregabalin in vet med?
Pregabalin is an anticonvulsant and neuropathic pain medication used in veterinary medicine primarily for managing chronic pain, particularly neuropathic pain. It is also used in certain cases for seizure control and to treat anxiety in animals.
Pregabalin works by binding to the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system (CNS). This reduces the release of excitatory neurotransmitters (such as glutamate, norepinephrine, and substance P), which are involved in pain transmission and seizure activity.
Describe Antibiotics in urinary obstruction cases.
Bacterial lower urinary tract infections are rare.
If the urine culture is negative, there is no reason to start with AB.
Rare occasions if there is prior catheterization in history.
UTI is rare in sterile catheterization
Urine sample for culture when catheter is removed.
Always favor cystocentesis for UA.
In dogs, the standard pregnancy lasts for
57 – 72 days
In cats with induced ovulation, the standard pregnancy lasts for
63 – 65 days
Pyometra primarily affects older intact bitches and queens.
Risk factors: (4)
Increasing age
Nulliparity
Breed
Administration of exogenous estrogen or progesterone.
- Administration of medroxyprogesterone acetate increased prevalence of pyometra by 45%.
Describe pyometra Pathogenesis.
Occurs typically during diestrus.
- Progesterone stimulates endometrial growth and glandular secretory activity.
- It also reduces myometrial contractility and maintains cervical closure.
- Diminishes immune function.
- Increases endometrial bacterial adherence.
Often cystic endometrial hyperplasia (CEF) precedes pyometra, but not always.
Many bitches have concurrent urinary tract infections.
- E.coli is the most common bacteria.
Pyometra patient history typically…?
Clinical signs? (6)
History
- Around 30 days after proestrus
- Use of exogenous progesterone
- Infertility
Clinical signs:
- Vaginal discharge (can do cytology)
- Fever
- PU/PD
- Anorexia
- Dehydration
- Signs of sepsis
Diagnostics for pyometra?
Imaging:
- U/S – most sensitive
- Xray
+ Blood samples
Blood samples in pyometra cases may reveal: (6)
Neutrophilia – band neutrophils
Up to 70% anemia of chronic disease
hyperproteinemia/ hyperglobulinemia due to dehydration and inflammation
Hypoalbuminemia due to sepsis
Elevated kidney and liver enzymes
Electrolyte imbalances: especially glucose (hyper-), hyperkalemia
(canine pyometra cases typically exhibit hyperkalemia due to factors like renal dysfunction, dehydration, and metabolic acidosis)
Treatment of pyometra.
Surgical
- OHE (Treatment of choice)
- Prior stabilization
- Use of aglepristone (P4 blocker)
Medical
- Used in valuable breeding dogs
- Has different protocols
Prognosis for pyometra surgery or medical management.
Survival rate 92%
Most common complication is peritonitis.
Recurrence in medical treatment 20-77% within 1 – 2 years.
40 – 90% of bitches whelp a normal litter after medical management
Possible causes of Vaginal / uterine prolapse and ddx.
Vaginal / uterine prolapse is rare,
Poss causes:
Stretching / laxity of the pelvic muscles
Uterine atony
Traumas
Dystocia
DDx:
Tumors of the uterus, vagina and
urethra
Metritis
Pelvic prolapse / edema
Treatment of Uterine prolapse.
Manual reponation (restoration)
The prolapsed part of the uterus is rinsed with physiological solution and lubricated
with a water-absorbing lubricant.
Reinsertion of the uterus is carried out through the vagina, for which continuous
manipulations are performed through the abdominal wall.
Manual vaginal inspection and abdominal palpation are necessary to confirm
position.
Once the partial reinsertion is done, a laparotomy is performed for further
reinsertion and, if necessary, an ovariohysterectomy.
It is also possible to consider pefroming a pexy, where the uterus is attached to
the ventrolateral abdominal wall.
If vaginal reinsertion is not possible: amputation of the uterus.
Causes of penile prolapse. (4)
Narrowing of the opening of the foreskin (paraphimosis)
Hypoplasia of the foreskin
Weak muscles of the foreskin
Penis enlargement (priapism)
- Caused by trauma, neoplasia, drying, or hair retention on the penile mucosa.
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.
Describe Penile prolapse.
A very painful condition
Xray of the penile bone should be taken to rule out a fracture of the penile bone, neoplasia, and the presence of a foreign body.
Palpation of the prostate gland and foreskin.
Vascularity check – foreskin color, CRT and temperature.
Lighter ulcers must be cleaned and should heal well with conservative treatment.
In case of large and deep ulcers, surgical intervention is necessary.
Depending on the findings, the necessary diagnostic examinations (US, contrast
urethrography, CT, biopsy, etc.) will be decided.
Conservative treatment: local treatment (wound), oral antibiotics, NSAIDs, temporary catheter.
GDV is?
+ risk factors?
Gastric dilatation and volvulus (GDV) is a life-threatening condition.
Risk factors:
Deep chest
Age
Fast eating/feeding once a day
Dry food
Nervous / fearful temperament
Looseness or agenesis of the gastric ligaments
Cardiovascular changes GDV causes: (4)
Compression of the portal vein and caudal vena cava
Venous blood return to the heart is inhibited, blood pressure lowers
Compression of the portal vein causes swelling and distension of the GI system; the volume of blood in the vessel decreases.
Oxygen supply decreases
Toxemic changes caused by GDV: (4)
Bacterial translocalization
Production of free radicals – direct toxic damage to tissues
Tissue hypoxemia and death
Lactic acid production – anaerobic metabolism
Diagnosis of GDV based on: (3)
Anamnesis
Xrays
- Capture Thorax as well to check for aspiration pneumonia.
Lactate
- ≤ 6 mmol/L – 99% survival
- ≥ 6 mmol/L – 58 % survival
- ≥ 9 mmol/L – 1% survival
The decrease in lactate levels post-op is more important though.
If the drop is more than 50%, then the prognosis is good.
Lactate levels in GDV can tell you what?
Prognostic indicator
Lactate
- ≤ 6 mmol/L – 99% survival
- ≥ 6 mmol/L – 58 % survival
- ≥ 9 mmol/L – 1% survival
The decrease in lactate levels post-op is more important though.
If the drop is more than 50% from pre-op, then the prognosis is good.
The type of shock in GDV.
Hypovolemic,
Obstructive &
Distributive
Points of Stabilization of GDV patient. (7)
Hypotension treatment with:
- Dopamine 3 – 10 μg/kg min CRI
- Dobutamine 5 – 15 μg/kg min CRI
Antibiotics
- Broadspectrum
- Prior to surgery
- Cefazolin 20 – 22 mg/kg IV
Antiarrhythmics
- Ventricular arrhythmias
- Start prior to surgery
- Lidocaine 1 – 2 mg/kg IV
Analgesia
- Methadone
- Fentanyl
- FLK
Antiemetics
Gastric lavage if possible with a tube
Decreasing the bloat (Biggest IV catheters as trocar)
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.
Post – op GDV care. (9)
Monitor hydration, BP
Vasopressors / positive inotropes if necessary
MAP above 60 mmHg
Oxygen therapy
Monitoring for arrhythmias – intervention if necessary
Analgesia (FLK / methadone)
Do not use NSAIDs
Do use Gastroprotectants
Feeding is important as well
Normal gestation in dogs lasts
57 – 72 days (65 d)
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.
uteroverdin is
the green pigment of the dog’s placenta
Clinical examination and diagnostics for a potential dystocia dam. (5)
General examination
Vaginal examination
Mammary glands
Xray (Number, position, size of fetuses)
Ultrasound (HR and movement of fetus)
Blood samples from dystocia dam. (6)
Ca
Glu
PCV/PP
UREA, CREA
WBC
RBC
Obstructive dystocia is
Secondary to reasons caused by the mother or the fetus – the fetus is either in the wrong position, too big, dead, or the mother’s birth canal is not wide enough.
Non – obstructive dystocia is due to
Primary uterine inertia +/- atony
Primary uterine atony is treated with
Exogenous oxytocin (0.25 U/ per animal, SC/IM. Max doose 4U/per animal)
Calcium gluconate (proper ECG monitoring required)
Consider the clinical condition of the dam and the number of fetuses (If the dam is tired and there are still many puppies to come, a C-section is indicated)
Review causes of dystocia.
Review causes of functional and obstructive dystocia in dogs.
What is tocodynamometry?
The pressure-sensitive contraction transducer, called a tocodynamometer or TOCO for short, records the pressure force produced by the contorting abdomen during uterine contractions.
When a patient goes into labor or is experiencing contractions, a TOCO, which resembles a belt, is placed on the abdomen of the patient.
Indications for cesarean section. (11)
What is the physiological mechanism behind body temperature drop in females dogs going into labor?
Progesterone has a thermogenic effect, meaning it helps to maintain the body’s basal temperature at a slightly elevated level.
As labor approaches, progesterone levels sharply decline.
The drop in progesterone is typically triggered by the production of prostaglandins from the fetal membranes and the uterus. Prostaglandins cause the regression of the corpus luteum.
With the drop in progesterone, the thermogenic effect is lost. This leads to a drop in the dog’s core body temperature.
After the temperature drop, labor usually starts within 12 to 24 hours. The drop in progesterone not only affects body temperature but also facilitates uterine contractions and cervical dilation, key processes for the birthing of puppies.
Critical limit for fetal heart rate
normal fetal heart rate approx. 200-220 beats per minute
critical lower limit is approx. 160 bpm
(if you can count the heart rate then its too low)
