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:'''Genital''' – [[prostatitis]], prostatic abscess, [[pyometra]], uterine/ovarian torsion, testicular torsion, ovarian cyst/neoplasia, uterine rupture, uterine/prostatic neoplasia
:'''Genital''' – [[prostatitis]], prostatic abscess, [[pyometra]], uterine/ovarian torsion, testicular torsion, ovarian cyst/neoplasia, uterine rupture, uterine/prostatic neoplasia
:'''Abdominal Wall''' - strangulating hernias, abdominal wall rupture
:'''Abdominal Wall''' - strangulating hernias, abdominal wall rupture
:'''Lymph nodes''' – lymphadenitis, reactive lymphadenopathy, neoplastic infiltrate
:'''Lymph nodes''' – [[Lymph Node Abnormalities|lymphadenitis, reactive lymphadenopathy, neoplastic infiltrate]]
:'''[[Peritonitis]]''' – septic or non-septic
:'''[[Peritonitis]]''' – septic or non-septic
:'''Other''' - e.g. haemoabdomen, [[FIP|feline infectious peritonitis (FIP)]], migrating foreign bodies, pansteatitis
:'''Other''' - e.g. haemoabdomen, [[FIP|feline infectious peritonitis (FIP)]], migrating foreign bodies, pansteatitis
==Signalment==
==Signalment==
Cats present with fewer clinical signs of abdominal pain than dogs. Parvovirus and intussusception are more common in younger dogs, or in the case of parvovirus, those which are unvaccinated. Pancreatitis is more common in middle aged miniature schnauzers. Any entire female should be checked for pyometra, and entire males for prostatic disease. Recent use of NSAIDs may increase the likelihood of ulceration. Gastric dilatation and volvulus is more common in large breed deep-chested dogs. Male cats are more likely to present with urinary tract obstruction.
Cats present with fewer clinical signs of abdominal pain than dogs. [[Parvovirus Enteritis|Parvovirus]] and [[intussusception]] are more common in younger dogs, or in the case of [[Canine Parvovirus|parvovirus]], those which are unvaccinated. [[Pancreatitis]] is more common in middle aged miniature schnauzers. Any entire female should be checked for [[pyometra]], and entire males for prostatic disease. Recent use of [[NSAIDs]] may increase the likelihood of ulceration. [[GDV|Gastric dilatation and volvulus]] is more common in large breed deep-chested dogs. Male cats are more likely to present with urinary tract obstruction.
Clinical Signs
==Clinical Signs==
Often non-specific, though some can present severely depressed and collapsed. Signs include anorexia, [[vomiting]], [[diarrhoea]]. Some animals may present in the typical ‘praying position’ associated with abdominal pain (the cause is often in the cranial abdomen). If this is seen it is often considered to be a specific sign of abdominal pain<ref>House, A., Brockman, D. (2004), '''Emergency management of the acute abdomen in dogs and cats: 2. Surgical treatment''', ''In Practice''; 26:530-537</ref>. A thorough history should be taken to help identify the cause e.g. foreign body ingestion, dysuria/pollakiuria etc.
Animals often present with signs of shock (usually either distributive or hypovolemic); an elevated heart rate, poor pulse quality, reduced CRT and pale mucous membranes. If a severe inflammatory process is occurring (e.g. septic peritonitis or severe acute pancreatitis) signs of hyperdynamic systemic inflammatory response syndrome (SIRS) may be present (injected mucous membranes, rapid CRT, strong, short pulses, tachycardia, pyrexia) with or without those of hypovolemia.
Tachypnoea secondary to pain is likely to be present, though every animal that has a history of vomiting should be checked for signs of aspiration pneumonia or any concurrent pleural space disease.
The mouth should be examined for signs of ingestion of foreign bodies/material, as linear foreign bodies can often attach under the tongue. [[Lymph Nodes - Anatomy & Physiology|Lymph nodes]] should be palpated, as if [[Lymph Node Abnormalities|lymphadenopathy]] is present this may indicate the presence of [[lymphoma]] or generalised infection.
Animals often present with signs of [[shock]] (usually either distributive or hypovolemic); an elevated heart rate, poor pulse quality, reduced CRT and pale mucous membranes. If a severe inflammatory process is occurring (e.g. septic peritonitis or severe acute pancreatitis), signs of hyperdynamic systemic inflammatory response syndrome (SIRS) may be present (injected mucous membranes, rapid CRT, strong, short pulses, tachycardia, pyrexia) with or without those of hypovolemia.
Tachypnoea secondary to pain is likely to be present, though every animal that has a history of [[vomiting]] should be checked for signs of [[Aspiration Pneumonia|aspiration pneumonia]] or any concurrent pleural space disease.
Gentle abdominal palpation should be performed last during the clinical examination to avoid the pain from abdominal palpation interfering with the rest of the findings. Abdominal distension may be present and can indicate gastric dilation, effusion, abdominal masses, hernias or cellulitis. Percussion is useful to identify free fluid or air accumulation. If gas is present in the stomach, this will be tympanic, whereas pneumoperitoneum is not. A fluid thrill will be present with effusions, though there can also be non-pathogenic causes of an abdominal thrill such as intrabdominal fat.
Gentle abdominal palpation should be performed last during the clinical examination to avoid the pain from abdominal palpation interfering with the rest of the findings. Abdominal distension may be present and can indicate gastric dilation, effusion, abdominal masses, hernias or cellulitis. Percussion is useful to identify free fluid or air accumulation. If gas is present in the stomach, this will be tympanic, whereas pneumoperitoneum is not. A fluid thrill will be present with effusions, though there can also be non-pathogenic causes of an abdominal thrill such as intrabdominal fat.
Diagnosis
Cranial abdominal pain is often associated with [[pancreatitis]] and caudal pain with prostatic disease. [[Intestinal Obstruction|Intestinal foreign bodies]], cholecystitis, tumours will cause focal areas of pain. Septic peritonitis usually causes diffuse abdominal pain and often severe depression - often the animal will only react to abdominal palpation. Some causes (e.g. uroabdomen, [[pyometra]]) may not cause abdominal pain.
Rectal examination should be performed especially in intact male dogs to assess for the presence of prostatic disease, and the vulva should be examined in intact female dogs for signs of discharge etc., which may indicate a [[pyometra]]. Rectal examination can also reveal the presence of melena indicating upper GI bleeding or may reveal acholic faeces indicating a [[Biliary Tract Obstruction|biliary obstruction]].
If bile peritonitis is present animals will often appear [[Icterus|jaundiced]] unless the biliary tract rupture is very recent. [[Pancreatitis]] can also cause biliary obstruction and hence jaundice.
Neurological examination should also be carried out as pain due to [[Intervertebral Disc Degeneration|intervertebral disk disease]] can often mimic the signs of abdominal pain.
==Diagnosis==
Blood and urine samples should be taken, both to assess the stability of the animal and to aid in diagnosis. This should (ideally) be done before fluid therapy has begun in order to avoid false results. Gastric obstructions will cause metabolic alkalosis, electrolyte abnormalities and dehydration. Acute renal failure will cause hyperkalaemia. Azotaemia will often be present due to either pre, post or renal causes which urine specific gravity measurement will help to differentiate. Urine samples can also be used to detect the presence of any infection.
Blood and urine samples should be taken, both to assess the stability of the animal and to aid in diagnosis. This should (ideally) be done before fluid therapy has begun in order to avoid false results. Gastric obstructions will cause metabolic alkalosis, electrolyte abnormalities and dehydration. Acute renal failure will cause hyperkalaemia. Azotaemia will often be present due to either pre, post or renal causes which urine specific gravity measurement will help to differentiate. Urine samples can also be used to detect the presence of any infection.
Low total solids (TS) and normal packed cell volume (PCV) on blood results can be indicative of either acute haemorrhage or severe vasculitis (e.g. due to septic peritonitis). Vasculitis will also cause hypoproteinemia due to loss of protein into the peritoneal cavity. Thrombocytopenia may be an early warning sign of disseminated intravascular coagulation, which can be caused by many of the conditions associated with acute abdomen. Hypoglycaemia will be present in sepsis or pancreatic/hepatic neoplasia. Clotting times are also useful to rule out the presence of a coagulopathy e.g. in cases of haemoabdomen.
Low total solids (TS) and normal packed cell volume (PCV) on blood results can be indicative of either acute haemorrhage or severe vasculitis (e.g. due to septic peritonitis). Vasculitis will also cause hypoproteinemia due to loss of protein into the peritoneal cavity. Thrombocytopenia may be an early warning sign of disseminated intravascular coagulation, which can be caused by many of the conditions associated with acute abdomen. Hypoglycaemia will be present in sepsis or pancreatic/hepatic neoplasia. Clotting times are also useful to rule out the presence of a coagulopathy e.g. in cases of haemoabdomen.
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1. .
2. House, A., Brockman, D. (2004), Emergency management of the acute abdomen in dogs and cats: 2. Surgical treatment, In Practice; 26:530-537
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3. Beal, MW (2005), Approach to the acute abdomen, Vet Clin North Am Small Anim Pract. 2005 Mar;35(2):375-96.
3. Beal, MW (2005), Approach to the acute abdomen, Vet Clin North Am Small Anim Pract. 2005 Mar;35(2):375-96.