Page 437 - Small Animal Internal Medicine, 6th Edition

CHAPTER 26 Clinical Manifestations of Gastrointestinal Disorders 409

Quick history/physical examination
VetBooks.ir Animal in shock Neither of these Gastric dilation/volvulus

First treat and stabilize Treat shock and decompress stomach

Thorough history/physical examination

Find localizing Do not find
problems (e.g., mass) localizing problems

Proceed appropriately Abdominal radiographs
Abdominal ultrasound
cPLI

Surgery not needed Not sure whether Obviously needs Abdominal
(pancreatitis, pyelonephritis) surgery needed or not surgery or biopsy fluid
(Intestinal obstruction,
abdominal mass, foreign
object, spontaneous Fluid analysis
pneumoperitoneum)

Septic Nonseptic

Clinical pathology Surgery and/or biopsy See Chapter 34
(CBC, serum chemistry after initial stabilization
profile, urinalysis,
coagulation profile)

Still not obvious whether Obviously needs
surgery needed or not surgery

Treat symptomatically/supportively
and monitor

Improvement No improvement
or condition deteriorates...

FIG 26.6
General diagnostic approach to acute abdomen in the dog and cat. CBC, Complete
blood count; PLI, pancreatic lipase immunoreactivity.

there is abdominal enlargement until good cause is found to failure). Fine-needle aspiration is typically safe, although
believe otherwise. There are six main causes of abdominal leakage of septic contents or implantation of neoplastic cells
distention (Box 26.20). may rarely occur. Ultrasonography helps determine poten-
The first concern is whether an acute abdomen is present tial for hemorrhage or leakage (e.g., cyst, mass with ultraso-
(e.g., GDV, septic peritonitis, hemoabdomen plus shock). nographic characteristics of hemangiosarcoma). Finding
After an acute abdomen is ruled out, it should be possible to spontaneous pneumoperitoneum suggests alimentary tract
classify enlargement on the basis of physical examination rupture or septic peritonitis and is usually an indication for
and abdominal imaging (i.e., radiography or ultrasonogra- prompt surgical exploration. A hollow viscus dilated with
phy), according to the criteria in Box 26.20. Obesity and gas may indicate obstruction (i.e., gastric dilation, intestinal
pregnancy should be obvious. Specimens of free abdominal obstruction) or physiologic ileus (see p. 420 and pp. 467-468;
fluid should be obtained and analyzed as described in Figs. 27.5 and 30.3. Surgery is indicated if an obstruction
Chapter 34. Biopsy should be performed on abdominal seems likely. If abdominal musculature weakness is sus-
masses and enlarged organs, unless there is a reason not to pected, hyperadrenocorticism may be considered. Results of
(e.g., hepatomegaly caused by severe right-sided heart a CBC, serum biochemistry panel, and urinalysis are used to