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 ( < 2.5g/dl ) ascites

A. TRANSUDATE
o CHON(g/dl) < 2.5
o Cells/mm
< 1,000

Hypoalbuminemia (<0.8 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).
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.
2] The primary disturbance
The Excessive renal retention of electrolytes and water, leading to ECF
expansion and transudation of fluid from plasma into tissue spaces.

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.
II. NON FLUID CAUSESOF ABDOMINAL DISTENSION
Pathophysiologic mechanisms also vary depending on the cause.
Example: Ileus may be secondary to peritonitis or an obstructed bowel.
GASTRIC VOLVULUS abdominal venous return is severely
restricted and signs of hypovolemic shock may occur
DIAGNOSTIC PLAN
A . History and physical examination
A. History
Helpful in narrowing the possible causes of abdominal distention
B. Physical examination
Should be complete.
EXAMINATION OF THE ABDOMEN
I. 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.

NOTE FOR THE FOLLOWING:

o
o
o
o
o

Whether the abdominal walls move normally during respiration

Whether the abdominal musculature seems tense, the abdomen tucked up.
Look for soft-tissue edema
May appear distended, of normal size or reduced in capacity.
Any change in the anatomical conformation of the normally projecting bones.

II. EXTERNAL PALPATION

Its object is to ascertain size and shape of the various organs, the character of
the intestinal contents and the detection of any pain focus.
Begin with a very light systemic palpation of the entire abdomen, and note any
localized or general rigidity or tenderness. Next, palpate the deeper structures.
Five Arbitrary regions of the abdomen (LATERAL):
1] DORSOCRANIAL REGION:
right lateral and caudate liver lobes
spleen
left part of stomach
kidneys

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 , 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, gastric , 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

uterus and vagina

large bowel
iliac lymph nodes
mesorectum and related lymph nodes
III. PERCUSSION
The normal abdomen yields a tympanitic-like tone throughout except over a
solid viscus such as liver, spleen, or a full bladder
Increased accumulations of air in the stomach or abdomen will give a larger area
of tympanitic sound.
IV. AUSCULTATION
Carry out the auscultation in a quiet room and determine whether the peristaltic
sounds are normal, increased, decreased or absent
B. Other Diagnostic Procedures

Abdominal fluid wave is easily detected through:

a] Paracentesis
b] Fluid analysis
20 to 22 gauge, 1 inch needle and 6 ml syringe
* If the animal is FRACTIOUS, it is safer to use a butterfly needle unit
* Risk is minimal.
*It is better to tap the right cranial quadrant to avoid the spleen
Fluid Analysis
o protein content,
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,
Large amount of abdominal fluid often HISTORY;
obscure detail

HISTORY;
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
>2.5G/DL)
G/DL)
( (>2.5

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
(<2.5
2.5G/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

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.
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.
The exception is the animal with dyspnea in which
ascites is restricting lung expansion and causing difficult
breathing.
It should be done without delay in such cases.

Ascitic fluid may be rapidly withdrawn without causing signs of cardiovascular

collapse, but hypoalbuminemia and hyponatremia often worsen due to
subsequent fluid retention and reformation of ascites.
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.
Restoration of circulating blood volume with IV fluid and whole blood may be
necessary.