The Acute Abdomen: When to Do Surgery

The acute abdomen defined is acute abdominal pain associated with vomiting, abdomi- nal distention, postural changes, lethargy, anorexia, shock, or collapse. pain results from visceral, parietal, or referred areas from tension, or stretching, inflammation, or ischemia. Sources of the pain may be hepatobiliary, gastrointestinal, splenic, peritoneal, or extraperitoneal sites. Signalment is important when considering sources of pain (e.g. GDV versus biliary mucocele) as is the reproductive status. timing of the problem is also important as is the prior history, medical conditions, and environment (possibility of dietary indiscretion, toxin ingestion, and drug history). a good, general physical exami- nation should be done immediately, i like to look for “what will kill the patient first” and the examination should be repeated often, as you should evaluate for new clinical signs and response to therapy (therapy is often performed at the same time as the physical examination and initial diagnostic testing). abdominal evaluation should include per- cussion, palpation, auscultation, testing for a fluid wave, and depending on the history it may require clipping hair to evaluate for wounds. rectal examination should also be performed to evaluate the prostate and helps in evaluating the uterus or uterine stump. Clipping the hair also facilitates a faSt scan using ultrasound.

Differential diagnoses are Many for acute abdominal pain. Quick tests should include pCV, tp, Bun, glucose, and a platelet count or estimate. Electrolytes and lactate are read- ily available on a minipanel (noVa). Coagulation tests should be based on physical find- ings (petechiae, ecchymoses). [...]