Approach to Distended Abdomen PDF 2024

APPROACH TO… THE DISTENDED ABDOMEN PRIYA SHARP LEARNING OBJECTIVES State the potential causes if distended abdomen in companion animals Outline the diagnostic approach to the disease Recognise the limitations and complications associated with various diagnostic techn...

APPROACH TO… THE DISTENDED ABDOMEN PRIYA SHARP LEARNING OBJECTIVES State the potential causes if distended abdomen in companion animals Outline the diagnostic approach to the disease Recognise the limitations and complications associated with various diagnostic techniques Describe the process for abdominocentesis Identify signs associated with ‘gastric dilatation / volvulus’ syndrome, the pathogenesis or disease and outline and therapeutic approach ABDOMINAL DISTENSION What can cause distension? ABDOMINAL DISTENSION What can cause distension? Rupture of the abdominal wall Abdominal muscle rupture Apparent distension Prepubic tendon rupture Weakness of the abdominal wall Hyperadrenocorticism Diabetes mellitus ABDOMINAL DISTENSION What can cause distension? ABDOMINAL DISTENSION What can cause distension? ABDOMINAL DISTENSION What can cause distension? Pneumoperitoneum Obesity Abdominal Cavity Neoplasia TRUE distension Ascites Transudate Exudate Chyle Blood Urine Bile ABDOMINAL DISTENSION What can cause distension?  ABDOMINAL DISTENSION Liver Bladder Drug induced Obstruction Disease induced Neoplasia Stomach Kidney Dilation / volvulus Hydronephrosis Distension Neoplasia Organomegaly Uterus Pregnancy Spleen Intestine Pyometra Neoplasia Dilation / volvulus Neoplasia Drugs Obstipation ABDOMINAL DISTENSION What can cause distension? ABDOMINAL DISTENSION What can cause distension? ABDOMINAL DISTENSION What can cause distension? APPROACH TO DIAGNOSIS What signs? Appetite / thirst V/D, constipation Urination Demeanour Duration? History of trauma? Medical history? Diet? Reproductive history (female) APPROACH TO DIAGNOSIS Signalment Species / breed / age / sex Body condition score Cardiovascular Jugular distension Mucous membrane colour (pallor, jaundice) Respiratory rate and effort Abdominal palpation Palpate and identify individual organs Ballottement – ‘fluid thrill’ Percussion - gas APPROACH TO DIAGNOSIS Laboratory Investigation Haematology PCV, RBC, WBC Biochemistry Liver TP, Albumin, ALT, ALP Bilirubin Kidney / Bladder Creatinine, Urea Serum Albumin If 15 g/l – perform abdominocentesis for lab analysis, cytology and culture ABDOMINAL DISTENSION Radiography ABDOMINAL DISTENSION Radiography ABDOMINAL DISTENSION Ultrasonography APPROACH TO DIAGNOSIS Abdominocentesis Usually following diagnosis of ascites on ultrasonography Ascites: ‘a pathological accumulation of free fluid within the abdominal cavity’ Quick and easy procedure which is minimally invasive. Contraindications Coagulopathy Marked distension of abdominal viscus Severe organomegaly ABDOMINOCENTESIS Clip and prepare for an aseptic procedure Local anaesthetic / sedation usually unnecessary Patient in right lateral recumbency Technique Insert needle / over-the-top catheter midline caudal to umbilicus Insert needle with syringe to maintain sterility Large dog 20G, 1.5’’ Medium dog 21G, 1’’ Small dog/cat 23G, ¾ ‘’ Sample 1-5ml sufficient Sterile plain and EDTA tubes Don’t drain abdomen unless respiratory compromise APPROACH TO DIAGNOSTICS Fluid analysis Fluid Type Appearance Causes Transudate Clear and colourless Liver failure, PLE, PLN (Hypoalbuminaemia) Modified transudate Yellow or blood tinged, can be Portal hypertension, Right turbid sided CHF, Cardiac tamponade Exudate (Sterile) Turbid FIP, pancreatitis, neoplasia Exudate (Septic) Turbid (can be blood stained) GIT perforation, penetrating wound, ruptured pyometra Bile Yellow/brown/green Rupture of gall bladder Blood Red, sanguinous Coagulopathy, ruptured mass, trauma Chyle Cloudy white, cream Cardiomyopathy, trauma? APPROACH TO DIAGNOSTICS Fluid analysis APPROACH TO DIAGNOSIS Fine needle aspirate Ultrasound guided Useful for liver, spleen, prostate (kidney) Percutaneous core biopsy Liver, renal cortex, superficial mass ‘Trucut’ needle Surgical biopsy Consideration for liver biopsy Coagulation profile General anaesthesia Risk haemorrhage If hypoalbuminaemic – wound healing may be impaired G A S T R I C D I L AT I O N / V O LV U LU S Gastric Dilation (GD) = Dramatic distension of the stomach with air Gastric dilation and volvulus (GDV) = Stomach twists on its axis Aetiology Giant and large breed dog Familial history Multi factorial – post prandial exercise, overeating, excessive water intake, aerophagia Stretching gastro hepatic ligament (?with age) G A S T R I C D I L AT I O N / V O LV U LU S Stomach rotates in a clockwise direction Pylorus moves dorsally to left of midline Fundus moves ventrally to right Dilation = air in fundus in right lateral radiograph Volvulus = air in fundus ventrally and pylorus dorsally in right lateral radiograph. Separated by soft tissue band. G D / G D V PAT H O G E N E S I S Gastric Distension complications Increased intragastric pressure Compression small blood vessels = decreased perfusion = necrosis gastric mucosa Oesophageal sphincter occluded – exacerbates the situation Vena cava occluded = impaired venous return to the heart = hypovolaemic shock Impaired diaphragmatic function = affects respiration / oxygenation Splenic torsion can accompany Variable acid-base and electrolyte disturbances = metabolic acidosis (hypoperfusion = lactic acid) GD / GDV CLINICAL SIGNS Clinical Signs Unproductive retching and salivation Abdominal distension Respiratory distress, ,increased rate and effort Hypo perfusion Pallor Tachycardia Weak pulses SHOCK! Diagnosis Signalment and clinical signs Radiography – to differentiate dilation from volvulus May defer until stable G D / G D V I N I T I A L S TA B I L I S AT I O N Decompression Analgesia Stomach tube Intravenous opioid analgesia Trocharization / Percutaneous gastrocentesis (18G) Laboratory work Minimum database Intravenous Fluids Often metabolic acidosis 2 cephalic catheters Serum lactate as marker for gastric 20ml/kg bolus every 20 minutes necrosis ECG for cardiac arrhythmia GDV SURGERY Surgery Emergency – don’t’ delay Laparotomy as soon as patient stable Goals Re-positioning and de-rotation stomach Assessment of gastric and splenic ischaemia Prevention of recurrence - gastropexy SUMMARY Abdominal distension can be a consequence of gas, fluid or ‘solid’ distension Is a symptom of underlying disease Radiography, ultrasonography and abdominocentesis most common diagnostic methods Fluid analysis in ascites can aid diagnosis GDV is a life-threatening disease which requires urgent intervention