Devising a Plan

Question 1

• Bow is an eight year old entire female Springer Spaniel owned by an elderly client Mrs Lamont
• She is brought to the practice by Mrs Lamont’s son, who can tell you only that his mother is concerned because the dog’s tummy is getting bigger
• Write a list of the questions you need to ask

Answer 1

• Is Bow generally well or unwell?
• appetite?
• thirst?
• vomiting?
• appearance and consistency of stool
• Has the change in body shape happened suddenly?
• Will she still go for walks?
• When was she last in season?

There are more questions to ask but this is a start…..getting an idea as soon as you can of whether you are dealing with an acute or chronic problem and a sick or a basically well dog is very important.

Question 2

What are the 5 broad categories of abdominal distension?

Answer 2

• Tissue
• Fluid
• Gas
• Faeces/ingesta
• Abdominal muscle weakness

Question 3

Name 4 tissue causes of abdominal enlargement (5)

Answer 3

• organ enlargement
  
  • e.g. liver, spleen, kidney, prostate in a male dog
• uterine enlargement (Bow is an entire female)
  
  • pregnancy
  • pyometra/hydrometra/mucometra
• fat
  
  • obesity
  • hyperadrenocorticism (body fat redistributes to the abdomen)
• neoplasia
  
  • focal organ masses (eg renal adenocarcinoma, splenic haemangiosacroma)
  • infiltrating neoplasia (eg GI lymphoma, carcinomatosis)
• granulomatous disease (rare in the UK but can occur with fungal disease, or in cats with FIP)

Question 4

Name 2 causes of fluid abdominal distension (3)

Answer 4

• free fluid in the abdomen…more on this in week 8!
• trapped in organs
  
  • urinary system: bladder, hydronephrosis
  • uterus: pyometra or mucometra
  • GI tract: associated with physical obstruction, functional ileus or severe enteritis/bloat
• cysts filled with fluid
  
  • perinephric cyst
  • polycystic kidney disease
  • polycystic liver disease
  • paraprostatic cysts in male dogs

Question 5

Name 2 gas/air causes of abdominal distension (3)

Answer 5

• in the gastrointestinal tract associated with
  
  • GDV/gastric dilation
  • physical obstruction or functional ileus
• free gas in the abdomen
  
  • almost always associated with life threatening perforation of the GI tract +/- gas forming organisms
  • perforated gastric or duodenal ulcer
  • ruptured bowel associated with a FB or tumour
  • can persist for 10-14 days post laparotomy
  • not usually distended in this situation but air is still present
  • post trauma and abdominal wall rupture
• trapped within diseased organs (not always a cause of distension)
  
  • emphysematous cystitis (sometimes associated with severe UTI)
  • gas forming bacteria in the liver or gall bladder

Question 6

Name a cause of faeces/ingesta causing abdominal distension (2)

Answer 6

• constipation or obstipation
• dietary scavenging

Question 7

Name an abdominal muscle weakness cause of abdominal distension (2)

Answer 7

• associated with hyperadrenocorticism (ie combination of redistribution of body fat and weak muscle)
• iatrogenic steroid myopathy-(think back to your muscle disease SDL)

Question 8

Create a problem list:

• BCS 1.5/5
• Respiration
• rate 40/min
• shallow breathing pattern
• MM slightly pale?
• Muffled heart sounds
• Palpation and ballottement of the abdomen suggests a “fluid thrill” ie abdominal fluid

Answer 8

• Abdominal enlargement
• probably due to free fluid
• Poor body condition
• Tachypnoea
• restrictive breathing pattern?
• possible pleural fluid?
• Pale mm
• Muffled heart sounds

Question 9

Create a diagnostic plan:

• Abdominal enlargement
• probably due to free fluid
• Poor body condition
• Tachypnoea
• restrictive breathing pattern?
• possible pleural fluid?
• Pale mm
• Muffled heart sounds

Answer 9

• Confirm presence of abdominal &/or pleural fluid
• with diagnostic imaging
• abdominal/thoracic radiograph?
• ultrasound?
• by blind thoracocentesis or abdominocentesis
• sometimes justified in an emergency situation to drain large volume pleural fluid if diagnostic imaging is likely to cause unacceptable stress
• might give rapid confirmation of a major abdominal bleed
• potential to do harm!
• Blood sample (think about what these tests might tell you….they should not be considered just as “routine”!)
• haematology
• biochemistry
• Urinalysis (stix, SG, sediment examination)
• Collect a sample of abdominal/pleural fluid
• visual assessment (clear, cloudy, colour?)
• fluid analysis:
• cell count and cell types
• microscopy
• in house lab?
• external lab?
• both?
• protein content

Question 10

What is this?

Answer 10

Ultrasound confirmed the presence of free fluid in the abdomen

Question 11

• Abdominal fluid analysis showed:
• clear and colourless fluid
• SG 1.013
• protein 15g/l
• very few cells seen (occasional macrophages and neutrophils)
• What type of fluid is this?

Answer 11

• Transudate
• Modified transudate
• Exudate
• septic
• non-septic
• Blood
• Urine
• Bile
• Chyle

Question 12

Why may you have abdominal fluid and might have pleural fluid?

Answer 12

Modified transudates are a type of effusion whose cell count and protein content are intermediate between a transudate and an exudate. In some cases, modified transudates may represent a transitional stage before the development of an exudate (as with uroabdomen, which begins as a modified transudate but develops into a chemical exudative peritonitis over time). Modified transudates arise as a result of disruptions to the endothelium or imbalances in the Starling forces. Common causes include:

• Increased vascular hydrostatic pressure resulting from inappropriate activation of the renin-angiotensin-aldosterone system (RAAS) in portal hypertension or congestive heart failure.
• Vasculitis, caused by feline infectious peritonitis virus (FIPV) or neoplasia. (Further discussion of the effusion encountered with FIP.)
• Strangulation of abdominal or thoracic organs may lead to the production of a modified transudate (which will develop into an exudate if untreated). This may occur with lung lobe torsion, torsion of the spleen or of a liver lobe or if part of the liver becomes strangulated within a diaphragmatic rupture.
• Chylous effusions are sometimes considered to be a type of modified transudate.