Approach to the patient with abdominal pain
1. Define the problem
2. History and physical exam
3. Consider differential diagnoses
4. Further diagnostic evaluation
5. Decision making
6. Appropriate treatment
What can also present similarly to abdominal pain?
Back pain from diseases like intervertebral disc disease or discospondylitis.
Why is it important to distinguish back pain from abdominal pain?
The investigations will be totally different, and working up the wrong problem will be costly financially and medically.
Clinical signs of abdominal pain
Grunting or groaning
Splinting of the abdominal musculature
Altered behavior (unpredictability)
Reasons for abdominal pain
1. Distention of a hollow viscous or organ capsule
4. Traction (pulling or tugging in abdomen)
Name some differential diagnoses for the stomach.
GD (gastric dilatation)
GDV (gastric dilatation volvulus)
Name some differential diagnoses for the intestine.
Name some differential diagnoses for the large intestine.
Severe inflammation or infection
Name some differential diagnoses for the peritoneum.
Name some differential diagnoses for the pancreas.
Name some differential diagnoses for the liver/biliary tract.
Bile Duct obstruction
Liver lobe torsion
Name some differential diagnoses for the spleen.
Name some differential diagnoses for the kidneys.
Acute renal failure (caused by toxins, pyelonephritis, obstruction, trauma, vascular events)
Name some differential diagnoses for the ureter/urinary bladder/urethra/prostate.
Name some differential diagnoses for the ovaries/uterus.
Pyometra (1st thought with intact female with abdominal pain)
Name some differential diagnoses for the testicles.
Most important diagnostic tools in evaluating a patient with abdominal pain
Thorough abdominal palpation
Rectal exam (if possible)
Common Dx in young animals with abdominal pain
Foreign body ingestion
Common dx in female intact animals with abdominal pain
Pyometra until proven otherwise!
Common dx in cats with abdominal pain
String foreign body
Common dx in middle-aged, obese female dogs with abdominal pain
Important questions to ask when taking a history of an animal with abdominal pain.
1. When was the patient last normal
2. Progression of clinical signs
Helpful to put a timeline on clinical signs!
Should abdominal radiographs be taken in an animal with abdominal pain?
Things to look for on an abdominal radiograph
Evidence of intestinal obstruction (segmental gas or fluid distention)
Loss of serosal detail (free abdominal fluid)
What are you looking for with an abdominal ultrasound?
Abnormalities in serosal thickness
Free abdominal fluid
Can be blind or with ultrasound guidance
Patient is in left lateral recumbency (most effective to avoid the spleen)
Manual or chemical restraint
Use open or closed needle technique
Closed needle abdominocentesis
20-22 gauge needle attached to 5ml syringe, insert needle cranial quadrant caudal to liver.
Open needle abdominocentesis
Needle alone is inserted, which may help prevent occlusion of needle (fibrin can occlude if present in fluid). Possible to see free gas on radiographs after this procedure.
Four quadrant adbominocentesis technique
4 needles are placed simultaneously centered around the umbilicus, will increase chance of obtaining fluid.
Diagnostic peritoneal lavage
Indicated if free abdominal fluid is suspected to be present but not obtained or visualized by previous methods.
Diagnostic peritoneal lavage technique
Use 14-16 gauge needle, aseptic technique, restraint as necessary.
Local anesthetic infiltration.
Stab incision through skin prior to catheter placement.
Instill 22 ml/kg of warm saline by gravity and distribute fluid through the abdomen. Remove for cytological exam.
Canine Pancreatic Lipase Immunoassay
What type of analgesia do you use first when treating patient with abdominal pain?
Opioids initially, avoid NSAIDs.