Veterinary Clinical Medicine-I (General and Systemic)

TREATMENT 

• Treatment of the patient with the acute abdomen should always be predicated on correction or amelioration of the underlying disease. There are nevertheless, certain fundamental principles that must be applied to all patients. These are the treatment of shock, antimicrobial therapy, ensuring adequate tissue oxygenation and protection of the gastric mucosal barrier.
• Fluid loss or sequestration is common in many patients with acute abdominal disease and fluid therapy and correction of electrolyte disturbances are critical. Diseases that compromise gastrointestinal integrity can increase the likelihood of bacterial translocation from the gut, decrease venous return, or cause portal hypertension or septicemia that predispose the patient to endotoxemia and shock. Intravenous fluid therapy with a balanced electrolyte solution containing supplemental potassium is critical in many if not all patients. The administration of blood products or colloids may also benefit critically ill patients.
• While culture and antimicrobial sensitivity testing are always indicated in instances of infection, it is prudent to begin empirical antibiotic therapy in a systemically ill patient while awaiting test results. Appropriate choices of antibiotics include cefazolin sodium or amoxicillin trihydrate clavulanate potassium. Combination therapy with ampicillin sodium and enrofloxacin or ampicillin sodium and amikacin sulfate may be used for more coverage of gram-negative infections. Metronidazole or clindamycin can be used for expanded anaerobic coverage.
• The gastric mucosal barrier can be disrupted in many patients with acute abdominal disease. This can occur as a result of hypovolemia or of sepsis which both cause decreased gastric mucosal blood flow. Portal hypertension can cause a congestive gastropathy with similar results. The end result is diffuse gastric erosion or ulceration with loss of blood and tissue fluid. This can be minimized with aggressive prophylactic therapy early in the disease process. Intravenous ranitidine is a good initial choice with an oral proton pump inhibitor in severe disease. Oral sucralfate is also beneficial since it forms a protective shield over the eroded mucosa.