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What are triage findings with an acute abdomen? (4)
- pain (caused by distension, ischemia, traction, and/ or inflammation)
- distension
- fluid wave/ ballottement
- tympanism
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________ should be a rule out for abdominal pain because they can appear similarly.
Spinal pain
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How can you determine if an animal has abdominal pain? (4)
reluctance to move, praying position, does not rest abdomen on floor, grunts/ bites when abdomen is palpated
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When palpating the abdomen and localizing pain, focal suggests __________, regional pain suggests __________, diffuse pain suggests _____(2)_____.
FB; pancreatitis; peritonitis, enteritis
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What is the rule of thumb for severity of abdominal pain?
- the more encapsulated an organ is, the more painful distention will be
- Ex. kidneys are very encapsulated and therefore very painful when enlarged; liver is not encapsulated and can have a huge mass with no pain
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What are the 4 general causes for abdominal pain?
- distention of hollow viscus or organ capsule
- traction (intestinal FB)
- ischemia (volvulus, thrombus)
- inflammation (parvo,pancreatitis)
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What diagnostics will help you in the initial work up of an acute abdomen? (9)
- Shock work-up: PCV-TP, BP/ECG, glucose, lactate, electrolytes, blood gas
- Abdomen work-up: abdominal FAST, abdominocentesis, fluid analysis
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What information with CBC/Chem/UA can help you work up an acute abdomen?
- CBC: eval red cells, platelet count, inflammatory status
- Chem: metabolic status of patient, organ dysfunction
- UA: renal function, urinary tract abnormalities
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What are the advantages of using radiographs in cases of acute abdomen? (3)
- Great for evaluating:
- presence of air or air/gas distention
- metallic or mineral FB
- +/- size of organs
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What are the advantages of using ultrasound in cases of acute abdomen? (3)
- Great for evaluating:
- detection of fluid
- helps with FNA or belly tap
- aspect of the organs (gall bladder)
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What are the anatomic locations for an abdominal FAST scan?
- diaphragmatic- hepatic
- cysto-colic
- hepato-renal (right)
- spleno-renal (left)
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What parameters should you analyze when performing fluid analysis from abdominal fluid? (5)
- PCV/ TP
- total nucleated cell count (TNCC)
- SG
- cytology
- +/- others
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Describe a transudate.
- clear/ colorless
- TP < 2.5
- TNCC < 1,000
- Cells are mononuclear
- SG < 1.018
- hypoalbuminemia, portal vein obstruction, R-CHF
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Describe a modified transudate.
- variable color
- TP 2.5-7.5
- TNCC 1,000- 10,000
- Cells are variable inflammatory cells
- SG is variable
- HWD, neoplasia, liver disease
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Describe an exudate.
- Cloudy
- TP > 3.0
- TNCC > 10,000
- Cells vary with cause and species
- SG > 1.018
- septic vs. non-septic, neoplastic
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Describe the fluid analysis results from a tap of septic peritonitis.
- inflammatory cells
- intracellular bacteria
- paired glucose/ lactate: blood glucose >20 higher than abdominal glucose; abdominal effusion lactate < 2 higher than blood lactate
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Describe the fluid analysis results from a uroabdomen.
- creatinine 2x greater in effusion than peripheral blood
- potassium conc is 1.5 (dogs)- 2(cats)x higher in effusion than peripheral blood
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__________ is a poor marker for uroabdomen because it quickly equilibrates across the peritoneum.
BUN
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Describe the fluid analysis results for bile peritonitis.
- phagocytosed bile pigment on cytology
- effusion bilirubin is 2-3x higher than peripheral blood
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Describe the fluid analysis results from hemoabdomen.
- clotting versus non-clotting blood (non-clotting means active hemoabdomen)
- effusion PCV > 10% consistent with hemoabdomen
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Most cases of acute abdomen are ___________.
surgical emergencies (except pencreatitis)
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What are the mainstays of general treatment of acute abdomen? (3)
- [definitive therapy depends on cause]
- Analgesia- opioids (AVOID NSAIDS)
- IV Fluids- correct shock
- Nutrition- consider placing feeding tube if unable to eat
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___________ is a good prognosticator in GDV for necrosis of stomach.
Lactate clearance (lactate clearance of >50% in 12 hours is correlated with survival)
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