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ABDOMINAL EXPLORATORY

Abdominal Exploratory
Sandi McWhorter
Tarleton State University
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ABDOMINAL EXPLORATORY

Abdominal Exploratory Case Study

A patient Elf was brought into the clinic. She is a 44 lb. spayed female Beagle who was

brought in by her owner because she had an acute onset of vomiting for that has lasted about 24

hours. The owner Mrs. Nyblade let us know that the patient had torn up a pillow and she could

not find the stuffing of the pillow. The patient then started vomiting the next day. (Rockett,

Christensen, 2010)

Her physical exam findings:

General appearance: Normal

Temperature: 102.1
Skin/coat: Normal
Ears/ Otoscope exam: Normal
Oral cavity Normal
Musculoskeletal: Normal
Cardiovascular: Normal rate/rhythm, no murmurs
Respiratory Rate: Panting
Mucous membranes: Pale pink.
Gastrointestinal: Painful to touch

Upon examination Elf’s temperature, weight, heart rate, and body score were normal. Elf

was painful when her upper quadrant of her abdomen was palpated possibly due to the pet eating

the stuffing of the pillow she shredded, but no mass was identified. (Rockett, Christensen, 2010)

Elf was also panting which is usually a sign of pain in dogs. Elf was 6 % dehydrated due to the

vomiting. When patients are 6 % dehydrated the sighs are when you tent the skin it is slow to

snap back or have loss of elasticity. The patient’s mucous membranes are pale pink, and this

could also be due to the percent dehydration from the vomiting. The mucous membranes will be

slightly tacky as well. The veterinarian decides from the history and physical findings
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that Elf needs to have abdominal x-rays with and without barium. The x-rays showed that there

was a delay in the gastric emptying on the bariums films, (Rockett, Christensen, 2010). Then the

veterinarian diagnosed that Elf has a foreign body and would need exploratory surgery. Once

we let the owner know about the surgery I had her sign a surgical release forms and explained to

her the risks involved with the surgery. I got her phone number and let her know we would call

if there were any complications or when Elf was awake from surgery.

The veterinarian decided that before the exploratory surgery he would like the technicians

to obtain and ECG. The veterinary assistant was getting the patient set up for thee ECG when I

walked in and noticed that the patient was not in the correct position and the leads were not

attached in the right places on the patient. I explained to the veterinary assistant that the patient

should be in right lateral recumbency as long as the patient is comfortable. The electrodes or

alligator clips should be placed according to the color of the lead. The spots where the

electrodes should be placed need to be wetted with a small amount of alcohol or saline so that the

leads will be able to conduct the electrical currant of the body. The white electrode should be

attached to the right forelimb the black electrode should be attached to the left forelimb with both

leads just proximal to the elbow. The green electrode should be attached to the right hindlimb

and the red electrode should be attached to the left hind limb both just proximal to the knees.

The ECG procedure was completed, and the results were given to the veterinarian. He looked at

the results and determined that the results were normal, so we could prep the patient for surgery.

Once all the tests were completed we need to get the patient and the surgery room set up

for the upcoming exploratory on Elf. We started with an esophageal stethoscope which we

would use to listen to the heart rate. We would place the esophageal stethoscope in the
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esophagus of the patient once the endotracheal tube has been placed after induction. Then we

would some equipment to measure the patient’s oxygen saturation. We could use a pulse

oximeter which would help to measure the oxygen saturation as well as the heart rate. We

should use a monitor that is multiparameter to measure respiration, CO2 levels, temperature and

blood pressure, so we can monitor the whole patient not just the oxygen saturation. Then, the

veterinary assistant was getting out the modified Jackson Reese non-rebreathing circuit. I let her

know that that was the wrong anesthesia machine because it was a non-rebreathing system that

was for a patient that is 7 kg or less. Elf is 9.09 kg and needs a rebreathing circuit machine

because of the size of the patient. I then get the surgery pack with the Olsen- Hager needle

drivers in the pack. The Olsen-Hegar needle drivers are the ones that have the scissors build into

the needle drivers. Other needle drivers like the Mayo-Hegar needle drivers do not have the

scissors built in the needle drivers. Once the surgery room is set up we move to prepping the

patient.

The patient had been vomiting for almost 24 hours, so she was 6% dehydrated. A 20-

gage catheter was placed in the right cephalic vein, so fluids could be started to replace the fluids

that the patient had already lost from vomiting. The amount of fluid required to replace the fluid

loss would be “Body weight in lbs. x percent dehydration (as a decimal) x 500 = fluid deficit in

ml (Terry,2010).” Elf was 44 lbs. and she was 6 % dehydrated from vomiting. The total amount of

fluids required to replace the dehydration deficit is 1.32 L in addition to the maintance fluids which is

1 ml/lb. Therefore, the total fluid amount would be 1.32 L plus 44 ml which equals to 1.76 L. Once

the fluids have been started on Elf it is time to induce her for surgery and we are going to use

Propofol dose of 2 mg/lb IV. The dose to be administered would be 8.8 mls slowly to effect. The
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patient was then intubated and moved to the surgery room. The veterinarian started the exploratory

and while he was running through the intestines he found the pillow stuffing in the jejunum part of the

intestines. The small intestines start from the end of the stomach at the Pyloric sphincter. The small

intestines consist of the duodenum first, the Jejunium second or in the middle and the Illeum which is

the end that connects to the Large intestine. The stuffing was then removed from the jejunum which

is the middle section of the small intestines.

(Veterian Key).

The veterinarian finishes the surgery on Elf and she is moved to recovery. I extubate Elf

when I could see the sighs of her waking up which are when the patient can swallow, because a

patient can aspirate if the swallow reflex has not started to function after anesthesia. I waited until

the patient swallows 2 to 3 times before I extubate Elf. After about 5 minutes the Elf starts retching

like she is about to vomit. I then extent her head and made it as low as possible, so she will not

aspirate or vomit in her cage or on herself.

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While I am recovering my patient Elf, I ask the veterinary assistant to clean surgery. The

veterinary assistant would clean all surfaces of the surgery room with a disinfectant like Roccal or

Chlorhexidine to kill any bacteria or germs that may have gotten on the surfaces. She would remove

the instrument pack and then set it aside to clean the instruments. The instruments once cleaned

would need to be rewrapped and autoclaved. All equipment like the warming blanket that got dirty

from blood or urine during the surgical procedure should be cleaned and disinfected as well.

Elf will stay in the hospital for 3 to 5 days, so we can start to slowly get her to eat. We

will start her out with water and slowly introduce canned food to her the day after surgery.

When Elf is ready to go home I will let her owner know that we gave her an injection of

Convenia for her antibiotics that lasts 2 weeks in the patient and we are sending home with her

some tramadol for pain medications. The tramadol is safe for her GI tract and that is why we

chose this medication. We are also sending home some Hill’s I/d GI food for her to feed for the

next week or so because it is also easy on the digestive tract. I let owner know that she should

look for vomiting or not eating. If the patient is showing these signs, then she should call the

clinic and bring the pet back in for a recheck. If all is going well then Mrs. Nyblade should bring

Elf back in to see us for a recheck and suture removal in 10 to 14 days.

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References

Thomas, J., & Lerche, P. (2011). Anesthesia and analgesia for veterinary technicians. St.

Louis. Mosby Elsevier.

Tear, M. (2012). Small animal surgical nursing skills and concepts. St. Louis. Elsevier

Mosby.

Digestive system retrieved from https://veteriankey.com/digestive-system/

Terry. B, (2010). Fluid therapy: Calculating the rate and choosing the correct solution.

Retrieved from http://veterinaryteam.dvm360.com/fluid-therapy-calculating-rate-and-

choosing-correct-solution