Abdominal Pain In Small Animals

Question 1

How severe is the problem likely to be if an animal presents with abdominal pain?

Answer 1

Not all are emergencies by MOST ARE

Question 2

What is meant by the term ‘acute abdomen’?

What does this indicate about future treatment?

Answer 2

Dog/cat with acute marked abdominal pain

Patient requires emergency stabilisation

Surgery may or may not be necessary

Question 3

What information should be gathered from an EMERGENCY patient?

Answer 3

Capsule history:
Signalment, primary problem, duration
Eating/drinking/urinating/ defaecating
Any drugs administered?

MBS assessment
CVRS
neuro

— MAKE SURE PATIENT IS STABILISED —

Question 4

What should you do following your emergency assessment if the patient is stable?

Answer 4

Take a full history 
Appetite/diet
Vomiting
Diarrhoea
Lethargy/behaviour/gait 
Scavenger/drug administration/ toxin access
Urination/defaecation 
Vaccination/anthelmintic treatment 
Neutering status/last season

Question 5

Why might it be important to ask about the diet in a patient with abdominal pain?

Answer 5

Raw food - bones

Question 6

What is the goal of abdominal palpation?

Answer 6

Pain - localised or generalised

Masses - organomegaly or foreign body

Fluid thrill

Tympani

Question 7

What can be palpated cranially in the abdomen?

Answer 7

Liver, Spleen

Potentially stomach and kidneys

Question 8

What can be palpated in the mid-abdomen?

Answer 8

Intestinal loops

Question 9

What can be palpated in the caudal abdomen?

Answer 9

Bladder
Prostate
Colon

Question 10

What might generalised abdominal pain suggest?

Answer 10

Inflamed peritoneum

Question 11

What can be confused with masses upon palpation?

Answer 11

Faeces

Cat’s kidneys

Question 12

How could you tell whether you had palpated a mass or faeces?

Answer 12

If you compress the faeces, they stay compressed.

Question 13

What is fluid thrill?

Answer 13

Push on one side of the abdomen and feel reverberation on the other

Question 14

What is tympany?

Answer 14

Gas filled area

Feels taught like a drum,

Generally associated with a GI issue

Question 15

What might you look for during an oral examination?

Answer 15

Foreign body under tongue

Ulcers

Ptyalism

Icterus

Pallor

Question 16

What is meant by the term ptyalism?

Answer 16

Excess salivation

Question 17

What should be checked for in oral examination of cats?

Answer 17

Linear foreign bodies - STRING

Often anchored to tongue

Question 18

What other type of pain is typically confused with abdominal pain?

Answer 18

Spinal pain

Also, respiratory distress and stress

Question 19

How could you differentiate between spinal and abdominal pain?

Answer 19

Push down on spine

Question 20

How can you assess the reproductive system of a small animal?

Answer 20

Observe external genitalia

Perform rectal examination

Question 21

What would you expect to palpate during a small animal rectal exam?

Answer 21

Prostate (male)
Uterus (female)
Urethra (runs ventrally)
Sublumbar lymph nodes 
Faeces 
Foreign material

Question 22

Why might it be important to palpate the uterus?

Answer 22

Check for pyrometra

Question 23

Why might it be important to palpate the urethra?

Answer 23

Check for obstructions

Question 24

Why might it be important to palpate the sublumbar lymph nodes?

Answer 24

Neoplasia

Question 25

What mechanisms can cause abdominal pain? How can these come about?

Answer 25

Distension of an organ /capsule (dilation) Traction - twisting/pulling (torsion) Ischaemia - Infarction/necrosis Inflammation - Gastroenteritis

Question 26

What can cause Intra-abdominal pain?

Answer 26

``` Stomach/intestines Pancreas Uterus Prostate Kidneys/ureters/bladder Liver Spleen Effusions ```

Question 27

What can cause extra-abdominal pain?

Answer 27

Cutaneous/muscular

Question 28

What are the ddx for stomach/intestinal pain?

Answer 28

``` GDV Mesenteric torsion Infarction Ulceration GIT infection (e.g. parvo, HGE) Foreign body Intussuception Toxin Neoplasia ```

Question 29

What are the ddx for pancreas pain?

Answer 29

Pancreatitis, Abcess, Neoplasia

Question 30

What are the ddx for liver pain?

Answer 30

torsion (rare) Cholangiohepatitis Abcess Biliary obstruction (inflammation, gall bladder mucocoele)

Question 31

What are the ddx for spleen pain?

Answer 31

``` Torsion Infarction Haematoma Abscess Neoplasia ```

Question 32

What are the ddx for cavity pain?

Answer 32

``` Septic peritonitis Uroperitoneum Bile peritonitis Severe distension from transudate/ haemabdomen Abdominal wall trauma ```

Question 33

What are the ddx for renal pain?

Answer 33

``` Infarction Pyelonephritis Neoplasia Nephroliths Ureteric obstruction ```

Question 34

What are the ddx for bladder/urethra pain?

Answer 34

Cystitis, Calculi Urethral obstruction

Question 35

what are the ddx for reproductive pain?

Answer 35

Pyometra Dystocia Prostatic abcess Prostatitis

Question 36

How could you further investigate abdominal pain?

Answer 36

Diagnostic imaging - radiography and ultrasound Cytology of abdominal fluid Blood tests - CBC and biochem, CPLi/Parvo etc

Question 37

What does FAST stand for ?

Answer 37

Focused Assessment with Sonography for Trauma/Triage/Tracking (see if things change)

Question 38

What is a FAST ultrasound?

Answer 38

Brief examination of the abdomen looking for free abdominal fluid

Question 39

How do you conduct a FAST ultrasound?

Answer 39

Four positions: (Start from diaphragm move round clockwise) Diaphragmaticohepatic Spleno-renal Cysto-colic Hepatorenal Score the amount of fluid present from 0-4

Question 40

What are some surgical emergencies associated with abdominal pain?

Answer 40

Septic peritonitis due to: GIT problems, uterine rupture, prostatic abscess rupture, body wall rupture Risk of SP due to: intestinal obstruction, intussusception, penetrating abdominal wound, abdominal bite/crush injury GDV Metabolic emergency - uroperitoneum or bile peritonitis Vascular emergency - splenic torsion, strangulated hernia, mesenteric torsion, intractable haemorrhage Pyometra Dystocia

Question 41

When would a presentation of pyometra be less severe?

Answer 41

If the pyometra is open and pus can drip out of the vulva

Question 42

Name some common antiemetics.

Answer 42

Maropitant Metoclopramide Ondansetron

Question 43

What analgesia should be given to patients with abdominal pain?

Answer 43

Pure opioids (e.g. methadone, morphine, fentanyl) Partial agonist opioid (e.g. buprenorphine) Ketamine infusion Lidocaine infusion

Question 44

What analgesics should NOT be given to patients with abdominal pain? Why?

Answer 44

NSAIDS Risk of GI ulcers Risk of kidney injury May need surgery - contraindicated in anaesthesia

Question 45

How should patients be managed post op?

Answer 45

Monitoring: Physical exam, continuous ECG, PCV TS 24 hours, electrolytes Treatment: IV fluids, Analgesia (methadone), antiemetic (maropitant), gastric protectant (omeprazole), Nutrition

Question 46

Describe an outline of the approach to a patient with acute abdomen.

Answer 46

1. Capsule history and MBS assessment 2. IF STABLE, take full history 3. Physical exam - Abdominal palpation, oral examination, spinal pain?, reproductive system, rectal exam 4. Diagnostic imaging (FAST), Cytology of abdominal fluid and CBC+Biochem +/- CPLi/Parvo 5. Surgical and medical management inc. analgesia 6. Post op care