Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 141

As soon as the major body systems are assessed and stabilization is in progress, a complete physical examination with focused abdominal examination should be performed. Initial examination may reveal abdominal distension, obvious signs of penetrating trauma or other wounds, and bruising. Periumbilical bruising (Cullen's sign) is suggestive of intra‐abdominal hemorrhage. Bruising in the inguinal region is suggestive of retroperitoneal or pelvic hemorrhage. Abdominal palpation should then proceed carefully and methodically to reveal whether pain is focal, regional, or diffuse, and to aid in localizing the source of pain. Focal abdominal pain is more likely in cases of foreign body obstruction, intestinal intussusception, prostatic disease, or mild pancreatitis. Regional abdominal pain may be present in cases of more severe pancreatitis and pyometra. Diffuse abdominal pain is found in diseases that affect the entire peritoneum, including septic peritonitis and diffuse gastroenteritis. Gentle ballottement of the abdomen should then be performed to aid in the detection of gas or fluid distension as found in cases of gastric dilatation and volvulus and hemoabdomen, respectively. Rectal examination may also prove helpful to pinpoint the underlying cause of acute abdomen. Rectal palpation of the pelvis, pelvic urethra, prostate, intrapelvic lymph nodes, and feces can provide key information including the presence of pelvic fractures, distal urethral obstruction, prostatomegaly, neoplasia, and changes in feces such as melena, hematochezia, acholic feces, and ingested foreign material. Imaging studies, including abdominal radiography and ultrasound, are recommended to confirm and/or help further differentiate between these causes of acute abdomen. In recent years, following the trend of human medicine, computed tomography (CT) has gained significant attention for its ability to rapidly and accurately diagnose various acute abdominal pathologies in dogs and cats. In the authors' practice, CT is used equally as often or more commonly than ultrasound for the diagnosis of acute abdominal pathology.