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ABDOMINAL DISTENTION

Definition:
o A sudden or gradual increase in the size of the abdomen.
o May be:
a] intermittent or persistent
b] Asymptomatic or painful
o May be due to either FLUID or NONFLUID causes.
Causes of Abdominal Distension
I. FLUID CAUSES OF ABDOMINAL DISTENSION
o Ascites is an abnormal accumulation of fluid transudate or modified transudate
in the peritoneal cavity.
EXUDATES
 Associated signs :
Vomiting
abdominal pain
Diarrhea
polydipsia
Edema

polyuria
polyphagia

CAUSES OF ABDOMINAL EFFUSION (ASCITES)
I. HIGH PROTEIN ( > 2.5g/dl ) ascites
A. EXUDATE
o CHON(g/dl) > 3.5
o Cells/mm
>30,000

Inflammatory
 BACTERIAL (SEPTIC)
-Bowel rupture
- Penetrating wounds
- Leakage of bile/ urine
 CHEMICAL
- Intraperitoneal drug
- Ruptured abscess
- Pancreatitis
 CIRCULATORY COMPROMISE
- Thrombosis
- Torsion
- Intussusceptions
 PHYSICAL INJURY
- Post surgical manipulation
- Trauma

B. MODIFIED TRANSUDATE
o
CHON(g/dl) 2.5 – 6.0
o
Cells/mm
250 – 20,000

      Cardiac o Right-sided Congestive heart failure o Intracardiac tumors o Cardiomyopathy (Dog) Neoplasia in abdomen Obstruction of hepatic Vein /thoracic caudal Vena cava o Thrombosis o Stricture o Vascular anomaly Thrombosis of hepatic vein / thoracic caudal vena cava Chyle o Lymphadenitis o Ruptured lymphatic Inflammatory Feline Infectious Peritonitis II. LOW PROTEIN ( < 2. TWO GENERAL GROUPS: 1] The primary event The Escape of plasma into tissue spaces with resultant hypovolemia and secondary renal retention of water and electrolytes.8 g/dl) o Glomerular disease o Hepatic insufficiency o GI loss (diarrhea) o Chronic Starvation Sustained Portal Hypertension o Cirrhosis o Chronic Active Hepatitis o Chronic cholangio-Hepatitis o Abdominal or wall hepatic neoplasia with sustained portal hypertension and/or hypoalbuminemia PATHOPHYSIOLOGY of FLUID CAUSES Pathophysiologic mechanisms of ascites are similar of those of expansion of extracellular fluid elsewhere in the body (edema). 2] The primary disturbance The Excessive renal retention of electrolytes and water. .5 o Cells/mm < 1. leading to ECF expansion and transudation of fluid from plasma into tissue spaces. TRANSUDATE o CHON(g/dl) < 2.000   Hypoalbuminemia (<0.5g/dl ) ascites A.

the abdomen “tucked up”.GENERAL MECHANISMS OF ASCITES FORMATION include: 1] Increased capillary hydrostatic pressure 2] Increased capillary permeability 3] Decreased colloid osmotic pressure of plasma (hypoalbuminemia) 4] Obstruction of lymph flow 5] Excessive renal retention of sodium and water. History and physical examination A. palpate the deeper structures. GASTRIC VOLVULUS abdominal venous return is severely restricted and signs of hypovolemic shock may occur DIAGNOSTIC PLAN A . Any change in the anatomical conformation of the normally projecting bones. Look for soft-tissue edema May appear distended. Example: Ileus may be secondary to peritonitis or an obstructed bowel. Next. II. Five Arbitrary regions of the abdomen (LATERAL): 1] DORSOCRANIAL REGION: right lateral and caudate liver lobes spleen left part of stomach kidneys . EXTERNAL PALPATION Its object is to ascertain size and shape of the various organs. of normal size or reduced in capacity. History » Helpful in narrowing the possible causes of abdominal distention B. the character of the intestinal contents and the detection of any pain focus. II. and note any localized or general rigidity or tenderness. NON FLUID CAUSESOF ABDOMINAL DISTENSION Pathophysiologic mechanisms also vary depending on the cause. Begin with a very light systemic palpation of the entire abdomen.  NOTE FOR THE FOLLOWING: o o o o o Whether the abdominal walls move normally during respiration Whether the abdominal musculature seems tense. OBSERVATION (Inspection) Provides an opportunity to assess the relative size of the abdomen and to determine the presence of any localized lesions which may be obvious. Physical examination » Should be complete. EXAMINATION OF THE ABDOMEN I.

gastric . duodenal and gastric lymph nodes 3] CENTRAL ABDOMEN spleen pancreas mesenteric lymph nodes intestinal tract ovaries left kidney and uterus 4] DORSOCAUDAL REGION sublumbar lymph nodes terminal rectum or colon terminal ureters 5] VENTROCAUDAL REGION urinary bladder prostate uterus vagina Four regions of the abdomen (ventrodorsal) 1] RIGHT CRANIAL REGION pyloric portion of stomach right liver lobes gallbladder and bile duct pancreas right kidney and adrenal duodenal.adrenals right ovary dorsal limb pancreas hepatic and splenic lymph nodes 2] VENTROCRANIAL REGION right and left liver lobes body and pyloric portions of stomach pancreas gallbladder and bile duct right hepatic . and right hepatic lymph nodes 2] LEFT CRANIAL REGION left liver lobe stomach spleen left adrenal 3] CENTRAL REGION spleen pancreas mesenteric lymph nodes intestinal tract ovaries left kidney uterus 4] CAUDAL REGION urinary bladder prostate .

IV. Other Diagnostic Procedures  Abdominal fluid wave is easily detected through: a] Paracentesis b] Fluid analysis » 20 to 22 gauge. AUSCULTATION Carry out the auscultation in a quiet room and determine whether the peristaltic sounds are normal. Large amount of abdominal fluid often HISTORY.5G/DL) G/DL) ( (>2.uterus and vagina large bowel iliac lymph nodes mesorectum and related lymph nodes III.5G/DL G/DL) ) (< TRANSUDATE TRANSUDATE OBESITY OBESITY RULE OUT PREGNANCY PREGNANCY GASTIC/ GASTIC/ BOWEL BOWEL DISTENTION DISTENTION ORGANOORGANOMEGALY MEGALY MASS MASS HYPER HYPER ADRENOCORADRENOCORTICISM TICISM .5 2. PHYSICAL PHYSICAL EXAMINATION EXAMINATION INITIAL PLAN FOR DIAGNOSING ABDOMINAL DISTENTION FLUIDWAVES WAVES FLUID OBVIOUS OBVIOUS DIAGNOSTIC DIAGNOSTIC PARACENTESIS PARACENTESIS ANDFLUID FLUID AND ANALYSIS ANALYSIS FLUID FLUID PRESENT PRESENT HIGHPROTEIN PROTEIN HIGH CONTENT CONTENT >2. *It is better to tap the right cranial quadrant to avoid the spleen Fluid Analysis o protein content. increased. obscure detail  HISTORY. it is safer to use a butterfly needle unit * Risk is minimal. PERCUSSION The normal abdomen yields a tympanitic-like tone throughout except over a solid viscus such as liver. 1 inch needle and 6 ml syringe * If the animal is FRACTIOUS. or a full bladder Increased accumulations of air in the stomach or abdomen will give a larger area of tympanitic sound. o cell count and differential o sediment examination and o culture or sensitivity if indicated o Amount of fluid required: < 1 ml Abdominal and thoracic radiographs Often needed to evaluate an animal with abdominal distention Although small quantities are often needed to detected radiographically. spleen. decreased or absent B.5 EXUDATE EXUDATE RULE OUT MODIFIED MODIFIED TRANSUDATE TRANSUDATE FLUIDWAVES WAVES FLUID NOT NOT OBVIOUS OBVIOUS ABDOMINAL ABDOMINAL RADIOGRAPH RADIOGRAPH FLUID FLUID NOT NOT PRESENT PRESENT FLUID FLUID PRESENT PRESENT LOWPROTEIN PROTEIN LOW CONTENT CONTENT (<2.

 Dietary sodium restriction markedly slows the rate at which ascitic fluid is reformed and lessen the severity of hypoalbuminemia and hyponatremia  Symptomatic treatment of intra-abdominal diseases caused by exudates depends upon the cause. but hypoalbuminemia and hyponatremia often worsen due to subsequent fluid retention and reformation of ascites.  → The exception is the animal with dyspnea in which ascites is restricting lung expansion and causing difficult breathing.  Restoration of circulating blood volume with IV fluid and whole blood may be necessary. .  → It should be done without delay in such cases.  Symptomatic Treatment of ascites best done by:  » Using diuretics such as Furosemide DIURETICS are more efficient in mobilizing edema than ascites but are helpful  Side effects: o dehydration o reduced glomerular filtration resulting in increased blood urea nitrogen o potassium depletion  Intermittent (every 2 or 3 days) use of diuretics and potassium supplementation (potassium gluconate) in the diet (1 to 3 mEq potassium per kilogram per day) » Restricting dietary sodium » Paracentesis is usually reserved for patients that do not respond to diuretics and sodium restriction within 48 hours.  Ascitic fluid may be rapidly withdrawn without causing signs of cardiovascular collapse.SYMPTOMATIC THERAPY  Treatment of abdominal transudate and exudates  → depends upon the causes  Therapy of ascites  → Unsatisfactorily (often) unless the primary cause is successfully managed without a reasonably short time.