Читать книгу Point-of-Care Ultrasound Techniques for the Small Animal Practitioner - Группа авторов - Страница 217

Nontraumatic hemoabdomen requires a more cerebral approach and knowledge base. Coagulopathy should always be ruled out, including minimally performing basic testing of prothrombin time (PT), activated partial thromboplastin time (aPTT), and a buccal mucosal or nail clip bleed time (platelet function test), readily available onsite tests at most practices. In coagulopathic cases, the coagulopathy generally needs to be corrected before invasive procedures. In noncoagulopathic cases, a bleeding mass is most common in dogs and cats and surgical intervention is required for definitive care. However, canine anaphylaxis must also be considered in all dogs with hemorrhagic effusions, some of which may have PT and aPTT times of <25% over the upper reference range, and thus not significantly coagulopathic (Lisciandro 2016b; Hnatusko et al. 2019). Because of this newly described complication in dogs, a focused spleen is now recommended following the AFAST examination in all canine hemoabdomens, and in general following any AFAST examinations in both dogs and cats (see Chapter 6 and Figure 6.35. See also canine anaphylaxis and gallbladder wall edema section within this chapter).

The focused spleen is a rule‐in test, meaning that when a mass is detected, it is probably real (see Figure 6.35). In contrast, if a splenic mass is not seen then it could have been missed, depending on the proficiency of the sonographer and location of the mass. Thus, the focused spleen examination should be considered as it has high specificity as a screening test, but with variable sensitivity. The focused spleen is helpful because when a cavitated midabdominal mass is detected, especially when associated with the spleen and deforming its capsule, such a finding raises the probability of being correct in concluding that the hemoabdomen is due to a bleeding mass (surgical management) rather than canine anaphylaxis (medical management) (Lisciandro 2014a, 2016b). Any mass that deforms the capsule of the spleen should be considered a serious finding.

Pearl: In contrast to dogs, cats with spontaneous nontraumatic hemoabdomen have a poor prognosis because the cause is likely advanced forms of neoplasia (Mandell and Drobatz 1995; Culp et al. 2010). However, the AFAST‐applied AFS is helpful in predicting degree of anticipated anemia, the need for blood transfusion and exploratory laparotomy, or other hemostatic interventions. The Global FAST approach may also be used to stage the feline.