Answers and Discussion--Abdominal Trauma

Case #1-- Abdominal Trauma

• Describe the most important organ system to assess in "Oreo".  The most important organ system requiring emergency treatment is the respiratory system.  By eliminating the pneumo- or hemothorax, venous return will be improved and this will help resolve some of the shock experienced by "Oreo".

• Explain whether you would request thoracic radiographs prior to any treatment.  Radiographs are not required early in this emergency.  You would be better off spending your time with thoracocentesis.  "Oreo" had his chest tapped and a total of 90 ml of air was removed from the left hemithorax and 50 ml from the right hemithorax.

• Explain why you would perform abdominal radiographs before abdominocentesis.   If you plan abdominocentesis ("Oreo" has pain in the caudal abdomen), and you also plan abdominal radiography, the abdominal radiograph should precede the abdominocentesis.  Should exogenous air be introduced via centesis, the radiographic interpretation of free gas in the abdomen would make this patient a candidate for immediate exploratory surgery.  Free gas in the abdomen is most commonly associated with a rupture in the gastrointestinal tract. 
  • Abdominocentesis was performed on "Oreo" and a bloody, cloudy, fluid was removed.  The packed cell volume of the fluid was 5% (peripheral blood PCV = 45%).   This shows there is some fluid likely diluting the blood.  The most likely dilutional fluid in abdominal trauma would be urine.
• Explain whether you would request a urea nitrogen or creatinine on the abdominal fluid obtained via abdominocentesis.  Creatinine is the "gold standard" for diagnosis of a uroabdomen.   However, many veterinarians cannot get results of a creatinine in an emergency.   Recent literature has affirmed the urea nitrogen to be as accurate as creatinine in acute urological injury.

  • An Azostik was used to confirm the presence of urine in "Oreo's" abdomen.  The dark green color indicates an elevated urea nitrogen concentration.

  

   

  • Laboratory confirmation was as follows:

  	Peripheral Blood	Abdominocentesis Fluid
  Urea Nitrogen	125	Azostick > 80 mg/dl
  Creatinine	5.7	20.1
  Phosphorus	12.2
  Potassium	5.5
  Osmolality	371

• Describe how you would  manage "Oreo's" uroabdomen before taking him to surgery.  Abdominal drains and a urethral catheter were used to drain the urine from the abdomen into a closed collection system.

• "Oreo" was administered Propofol and an 8F Foley catheter introduced into his abdomen.  The urinary catheter was also placed and urine flowed freely to the collection systems.

Click on the picture to see an enlargement.

Follow-Up:

    "Oreo" was taken to surgery and a ruptured urinary bladder was repaired the following day.  There was subcapsular renal hemorrhage and evidence of a laceration of the spleen.  No surgery was required for the kidney nor spleen.   "Oreo's" recovery was uneventful.

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Copyright Wayne E. Wingfield, Colorado State University, 2000.  All rights reserved.
This page was last updated:  08/24/00