3 Emergency Stabilization of the Acute Abdomen Patient

       Nyssa Levy and Matthew Beal

       Michigan State University, College of Veterinary Medicine, East Lansing, MI, USA

Introduction

      Animals with acute abdomen suffer from sudden‐onset abdominal pain, often with concurrent systemic signs including, but not limited to vomiting, diarrhea, fever, and lethargy. While the underlying causes of acute abdomen are varied and extensive, all can have serious negative effects on major body systems and overall patient stability. The first goal of emergency stabilization is to identify and address any life‐threatening abnormalities before initiation of surgical or medical management to maximize treatment success and minimize complications. Initial stabilization of the acute abdomen patient focuses on a systematic approach to evaluation and management of major body system (cardiovascular, respiratory, and central nervous system) abnormalities. This is followed by, or performed concurrently with, an in‐depth evaluation of the abdomen, management of abdominal pain, and a diagnostic workup to identify the underlying cause of acute abdomen. This chapter details the approach to initial recognition, stabilization and diagnostics for the acute abdomen patient.

Pathophysiology of Acute Abdomen

      Pain receptors, or nociceptors, are located throughout the abdomen and are responsible for the detection and transmission of pain signals. These receptors are found throughout visceral layers and the peritoneal lining, and are activated by organ distension, capsule stretch, inflammation, ischemia, and rupture [1]. It is important to keep in mind that animals that are presented with a decreased level of consciousness (i.e., depressed, dull, or obtunded mentation) may not exhibit signs of pain until they are adequately resuscitated. It is also important to consider the potential presence of extra‐abdominal diseases, which can mimic and often be mistaken for abdominal pain, such as intervertebral disk disease and other causes of spinal pain including, but not limited to, discospondylitis, neoplasia, and spinal fracture/instability.

Differential Diagnoses

There are many diseases that can lead to the development of acute abdomen, with associated major body system abnormalities and patient instability. Table 3.1 lists many of the common causes organized by primary organ or body system, with diseases requiring, or that may require, surgical intervention designated by an asterisk [2].

      Historical information collected at the time of presentation can be useful in narrowing down the list of differential diagnoses. Information including presenting complaint, when the patient was last normal, progression of clinical signs, systemic manifestations of disease, current medications, and past medical history should be collected. Additional specific information regarding known trauma, known ingestion of foreign material, and exposure to toxins, toxicants or medications can direct the early clinical diagnostic and treatment choices.

Primary Assessment

A focused yet complete physical examination for acute abdomen patients is critical for early identification and initiation of treatment for potentially life‐threatening problems. Primary patient assessment should follow the ABC method of evaluating the patient's airway, breathing, and circulation status. The ABC evaluation should be followed by examination of the major body systems, palpation of the abdomen, and a complete physical examination. For a complete discussion of initial triage, see Chapter 1.

Table 3.1 Etiologies of acute abdomen.

      Source: Adapted from Beal [2].