Page 1063 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

1038 CHAPTER 9

VetBooks.ir 9.42 9.43

Fig. 9.43 Splenic laceration in a foal (arrow), caused
by a kick.
Fig. 9.42 Ultrasonographic appearance of a normal
spleen.

ataxia or unconsciousness, while loss of 50% of blood examination of the abdomen should be performed.
volume usually results in death. The volume and character of the abdominal fluid
should be examined. Free blood is typically homoge-
Clinical presentation neously hyperechoic, with a swirling character. The
Clinical signs will depend on the amount of haemor- spleen should be examined carefully for changes in
rhage that has occurred. Mild bleeding may be inap- architecture as well as the presence of masses; how-
parent or interpreted as mild colic. In more severe ever, the site of trauma is not usually identified.
cases, tachycardia, tachypnoea, weakness, pale Other abdominal organs should be examined as
mucous membranes, cold extremities and abdomi- possible sources of blood loss. Abdominocentesis is
nal distension may be observed as a consequence used to confirm the presence of blood in the abdo-
of haemorrhagic shock. A systolic haemodynamic men. Ultrasonographic guidance is useful to avoid
heart murmur may be present. While signs similar splenic puncture and misinterpretation of results. If
to those of colic may be observed, the degree of pain only a small volume of blood is obtained on abdomi-
does not correspond with the severity of other clini- nocentesis and ultrasonography has not been per-
cal signs, especially the elevation in heart rate. formed, the possibility of laceration of a body wall
blood vessel or splenic puncture should be consid-
Differential diagnosis ered, as opposed to haemoabdomen. Cytological
Colic of GI origin, peritonitis, septicaemia, endo- analysis is not usually able to differentiate blood
toxaemia and a variety of intoxications should be contamination from haemoabdomen after acute
considered. haemorrhage. Centrifugation of the sample may be
useful because plasma will often be haemolysed with
Diagnosis haemoabdomen but not with blood contamination.
Physical examination findings may be non-specific Haematology is not useful in acute haemorrhage
unless gross abdominal distension is apparent. because blood, protein and fluid are lost concur-
Evidence of hypovolaemic/haemorrhagic shock of rently. Over time, anaemia and hypoproteinae-
unknown origin, particularly with a history of recent mia will be present, particularly if fluid therapy is
trauma, suggests splenic rupture. Ultrasonographic provided.