Acute abdomen

Question 1

What characterizes an acute abdomen?

Answer 1

• Sudden onset of abdominal pain

- May be accompanied by vomiting, diarrhea, fever, shock, and can lead to death

Question 2

How urgent are acute abdomens?

Answer 2

• Need to be treated as an emergency

- Be aggressive

Question 3

Ddx (etiology) for acute abdomen, and which require surgery to resolve?

Answer 3

1. Complete obstruction*
2. Perforation*
3. Volvulus/torsion*
4. Herniation/strangulation*
5. Abscess/infection*
6. Necrosis/ischemia*
7. Severe inflammation (e.g. severe pancreatitis

Question 4

Organ systems potentially involved with acute abdomen

Answer 4

• GIT
• Liver
• GB/biliary tract
• Spleen
• Pancreas
• Urinary
• Reproductive

Question 5

What should happen if you cannot make a definitive diagnosis to rule out a surgical cause of acute abdomen?

Answer 5

• Surgical explore!

Question 6

Diagnostic plan for acute abdomen, focus on tests that can be done quickly on site, such as?

Answer 6

• PCV/TP, CBC
• Electrolytes
• Blood gas
• BUN
• Lacate
• Coagulation Tests
• USG/UA
• Imaging
• Abdominocentesis if abdominal fluids
• Blood glucose

Question 7

In an emergency situation before running a test, what should you ask yourself?

Answer 7

• Will doing this test further compromise my patient or will the test result change my treatment plan?

Question 8

Should you do chest rads to look for mets in a dog wit ha perforated bowel suspected to be secodnary to neoplasia, and why?

Answer 8

• Yes, because if mets are present, the prognosis is grave and surgery may thus not be indicated

Question 9

In a dog suspected to have GDV based on signalment, hx, and PE findings, does it make sense to restrain the dog for abdominal rads before treating with fluids and decompressing the stomach? Why or why not?

Answer 9

• No, because positioning is likely to further incrase compression of the diaphragm, caudal vena cava, and portal vein by the dilated stomach

Question 10

Common pre-op treatments for patient with acute abdomen

Answer 10

• Oxygen
• IVF at shock rate
• Correct glucose, electrolytes, acid/base
• IVF
• nalgesia (opioids); stay away from NSAIDs
• Also GI meds like gastroprotectants and motility modifiers

Question 11

Why no NSAIDs in acute abdomen patients?

Answer 11

• often dehydrated and may have compromise to GIT, liver, and/or kidney function already

Question 12

FB variety of signs

Answer 12

• Can cause acute or intermittent vomiting depending on location and degree of obstruction
• Intermittent signs are sometimes seen with gastric FB that intermittently moves in to block the pylorus, then moves back into a larger luminal area of the stomach

Question 13

Which pennies are made made of copper/zinc?

Answer 13

• Before 1983 is copper

- After 1983 are Zinc

Question 14

What can zinc cause?

Answer 14

• Hemolysis and lead to V/D, red urine, anemia, icterus, hepatocellular degeneration, and renal tubule necrosis

Question 15

What is the reflex called when local intestinal dilation in response to contact between mucosa and sharp FB?

Answer 15

• Not sure - find it in the notes somewhere

Question 16

When removing a FB, what do you need to explore?

Answer 16

• The entire GIT so you don’t miss other FBs that weren’t detected on imaging

Question 17

How current should images be for sx?

Answer 17

• Base it on CURRENT IMAGES

Question 18

What is a linear foreign body?

Answer 18

• String or thread or many objects interlocked together like rubber bands

Question 19

What happens with a linear foreign body?

Answer 19

• Knot or clump of the linear foreign body gets trapped while the more linear portion continues aboradly down the GIT
• The intestine dutifully continues peristalsis in an attempt to advance the material
• However, since the LFB is anchored, this results in the intestine bunching up on itself

Question 20

Where is the most common site of anchorage of LFB in a cat?

Answer 20

• Under the tongue

Question 21

Where is the most common site of anchorage of LFB in a dog?

Answer 21

• Pylorus

Question 22

What happens as hte bowel bunches up on itself, what happens?

Answer 22

• Obstruction is more and more complete

Question 23

Where does the LFB end up getting pulled along, and what is the ultimate consequence?

Answer 23

• LFB ends up being pulled tight along the mesenteric side of the intestinal lumen
• Repeated peristalsis results in the LFB sawing through the mesenteric border wall, ultimately leading to perforation
• Each perforation may be small, but there can be a lot of them along the affected length of intestine, requiring resection of the affected piece of bowel because there are too many little holes to patch or to even see

Question 24

Appearance on radiographs of linear foreign body?

Answer 24

• Plicated bowel

- May see eccentric, comma-shaped intraluminal gas bubbles

Question 25

Usual treatment for linear foreign body?

Answer 25

- Surgery usually required - Release LFB from its anchor point first - If at the base of the tongue, cut the knot there and let the end zing down into the stomach and intestines - If at pylorus, be prepared to do multiple enterotomies so that you can remove the LFB in sections without pulling it tight (which could cut through the mesenteric wall) - May need multiple enterotomies

Question 26

When is conservative treatment possible for LFB?

Answer 26

- In the very limited circumstance where the LFB is accessible to release from its anchor point (e.g. around the tongue), ingestion of LFB was very recent, patient has no signs of peritonitis, and patient can be closely monitored by the DVM

Question 27

What happens during an intussusception?

Answer 27

- One piece of bowel (the intussusceptum) slides up inside the intussuscipiens

Question 28

Which part of the intussusception has obstructed flow of ingesta?

Answer 28

- The intussusceptum

Question 29

What happens to the mesojejunum and jejunal vessels of the intussusceptum?

Answer 29

- Pulled into the intussuscipiens, thus compromising the vasculature of the intussusceptum

Question 30

What are the most common sites for intussusception?

Answer 30

- Ileocolic and jejunojejunal juction

Question 31

Causes of intussusception?

Answer 31

- Enteritis (parasites, infection, dietary indiscretion) - Change in bowel pliability mobility (e.g. foreign body, neoplasia, adhesion, ileus) - Idiopathic (most common)

Question 32

What is the most common cause of intussusception?

Answer 32

- Idiopathic

Question 33

In what % of intussusception cases can you palpate the intussusception?

Answer 33

- 50-70% | - Feels firm

Question 34

History and clinical signs of intussusception

Answer 34

- Intermittent (slides in and out) or constant and obstruction can be partial or complete

Question 35

Rule outs for intussusception

Answer 35

- Abscess - Mass - Neoplasia - High suspicion for intussusception based on signalment, hx, and clinical signs

Question 36

Radiographic appearance of intussusception

Answer 36

- May see tubular shaped bowel mass and signs of obstruction

Question 37

Ultrasound appearance of intussusception

Answer 37

- Target

Question 38

Treatment for intussusception

Answer 38

- Reduce or resection and anastomosis (latter is required in 80% of cases) - Treat underlying causes - +/- Enteroplication

Question 39

What is the risk with intussusception if you haven't treated the underlying cause?

Answer 39

- Recurrence is a big concern

Question 40

Enteroplication

Answer 40

- Intestines are tacked to each other so that one piece cannot telescope into another - Because we know that having an anchored piece of bowel next to an unanchored one can cause intussusception, the entire intestine must be plicated (all or nothing)

Question 41

What is the recurrence rate if no plication is done?

Answer 41

- 20% approximately

Question 42

What is risk of obstruction or loss of blood supply with plication?

Answer 42

- 20% | - Little to no risk of re-intussusception

Question 43

Where do tacking sutures go through?

Answer 43

- Serosa, muscularis, and into the submucosa

Question 44

With complete obstruction of arterial and venous blood supply to a section of bowel, in what time frame do you get blackm aximally distended bowel?

Answer 44

8-12 hours

Question 45

What can happen as early as 1 hr post-strangulation?

Answer 45

- Bowel wall edema with mucosal slough

Question 46

What are other consequences with obstruction of arterial and venous blood supply with strangulation?

Answer 46

- Hemorrhage into the lumen???? | - bacterial translocation

Question 47

Mesenteric volvulus

Answer 47

- Intestine rotates around the root of the mesentery - Blood supply to the small intestine is compromised --> severe, peracute abdominal pain --> rapid progression to shock and death

Question 48

Treatment for mesenteric volvulus?

Answer 48

- Start fluids, oxygen, antibiotics, analgesia, and go to surgery NOW - You cannot stabilize these patients medically - If you take the time to do diagnostics (e.g. imaging, anything other than bedside labwork), the dog will likely be dead before you get to surgery