Diagnostic Tree / EMERGENCY MEDICINE / CRITICAL CARE Peer Reviewed

Acute Abdominal Pain

ACUTE ABDOMINAL PAIN

Record history Examine systems

Signalment Hydration: Skin turgor, tacky mucous membranes, sunken eyes?
Presenting complaint Oral: String under tongue, ulcerations, erosions, halitosis, foreign
Previous history, surgery, trauma body, ptyalism?
Diet (normal diet, recent ingestion, fatty Cardiorespiratory: Lung sounds, heart rate, pulse quality, capillary
meals, table food) refill time?
Vaccine/medication status Abdominal: Organomegaly, ascites, pregnancy, pain localization,
fluid-filled loops, borborygmi, foreign body, masses?
Toxin exposure
Integumentary: Petechiae, ecchymoses?
Travel history
Musculoskeletal/neurologic: Mentation, cranial nerves, ataxia,
Progression
dysautonomia, decreased rectal tone, ambulatory?
Systemic/metabolic signs (anorexia,
Rectal: Prostatomegaly, fecal evaluation, melena?
coughing, sneezing, vomiting, diarrhea,
regurgitation, polyuria, polydipsia, poly- Urogenital: Bladder evaluation, neuter status, vaginal discharge,
phagia, weakness) pain on kidney palpation?
Foreign body
Indoor/outdoor status (feline patients)

Evaluate if signalment, history, presenting

complaint, and examination findings help rule
in/out differential diagnoses

Includes
Digestive: Gastric/duodenal ulcer, gastritis, gastroenteritis, GD, GDV, GI obstruction, intussus-
ception, ileus, pancreatitis, intestinal parasitism, protein-losing enteropathy, inflammatory
disease, neoplasia, hepatic disease
Metabolic: Acute renal failure, hepatopathy, hyperadrenocorticism, hypoadrenocorticism,
diabetes
Peritoneal cavity: Trauma, septic peritonitis, GI tract perforation, foreign body, splenic torsion,
ruptured abdominal abscess, uroabdomen, penetrating trauma, bile peritonitis, hemoabdomen,
liver lobe torsion
Urinary: Ureteral/urethral/cystic calculi, acute nephritis, pyelonephritis, urethral obstruction,
acute renal failure, uroabdomen
Reproductive: Pyometra, labor/dystocia, uterine/testicular torsion, prostatic disease
Musculoskeletal: Intervertebral disk disease, abdominal muscular trauma, referred orthopedic
pain
Infectious disease: Infectious canine hepatitis, leptospirosis, parvovirus, panleukopenia, FIP,
Giardia spp infection, Salmonella spp infection, Clostridium spp infection, vector-borne diseases
Other: Toxicity, bezoar, caustic/corrosive ingestion, nausea secondary to ileus (opioid therapy,
postoperative)

12 .......................................................................................................................................................................NAVC Clinicians Brief / October 2012 / Diagnostic Tree

 Justine A. Lee, DVM, DACVECC
Pet Poison Helpline
Minneapolis, Minnesota

Complete initial diagnostics

PCV/TS/BG, electrolytes, BUN, VBG
CBC + blood smear evaluation
Serum biochemistry profile
Abdominal radiography
FAST ultrasonography

Complete additional diagnostics Complete advanced diagnostics

Fecal smear to evaluate bacterial overgrowth Abdominocentesis
(Clostridium spp, Campylobacter spp) Cytology evaluation (eg, intracellular bacteria)
UA culture Fluid analysis (eg, culture; comparison of serum:abdominal
Thoracic radiography fluid ratios for creatinine, bilirubin, glucose, lactate)
FeLV/FIV Barium series
Pancreatic evaluation (TLI, PLI) Fluoroscopy
Abdominal ultrasonography Pneumocolonography
Coagulation panel
Advanced GI testing (bile acids, cobalamin, folate)
Reevaluate & repeat examination

Continuing pain?

Nonsurgical cause Surgical cause

Fluid therapy (crystalloids, colloids, blood transfusions)* Fluid resuscitation/stabilization before anesthesia/surgery
Antiemetic therapy Correction of underlying cause for abdominal pain*
GI protectants* Feeding tube placement*
Analgesic therapy Biopsies*
Nutritional support Postoperative care
Antidiarrheal therapy Heat support
Treatment for underlying metabolic disease Antiemetic therapy
Deworming Fluid therapy
Reevaluation of clinicopathologic analysis Analgesia
Antibiotic therapy* Antibiotic therapy*
Symptomatic supportive care Symptomatic supportive care
Monitoring Nutritional support

Differential
Treatment
See Aids & Resources, back page, for references & suggested reading.
Diagnosis

Investigation Results *If appropriate

BG = blood glucose, FAST = focused assessment with sonogram for trauma, FIC = feline idiopathic cystitis, FIP = feline
infectious peritonitis, GD = gastric dilatation, GDV = gastric dilatation-volvulus, PLI = pancreatic lipase immunoreactivity,
TLI = trypsin-like immunoreactivity, TS = total solids, VBG = venous blood gas

Diagnostic Tree / NAVC Clinicians Brief / October 2012 .......................................................................................................................................................................13