1. Emergency Quick Assessment
Immediate: PCV/TP, glucose, BUN
Get samples to run later
Blood (8-10cc)
EDTA tube (2-3cc)
Lithium heparin tube (2-3cc)
Potassium citrate tube (2-3cc)
Red top clot tube (2-3cc)
urine

2. Emergency Quick Assessment
Urinalysis
If you need a urinalysis later, you need a sample prior to fluid therapy, before specific gravity is diluted
If fever, you may want urine for possible culture prior to antibiotic therapy
Use a 5-8Fr x 36” infant feeding tube to catheterize male dog > 75 pounds
Use US guidance if needed for cystocentesis of small bladder

3. Emergency Quick Assessment
Indications for Diagnostic Abdominocentesis
Palpable fluid wave
Owner reports abdominal bloating
Suspect abdominal hemorrhage
Acute collapse, pale mucous membranes, weak pulses, low blood pressure, + anemia
Suspect peritonitis – shock and abdominal pain
Fluid seen on AFAST® ultrasound

4. Emergency Quick Assessment
Diagnostic abdominal tap technique
4 quadrants - R cranial, L cranial, R caudal, L caudal
Diagnostic Peritoneal Lavage

5. Emergency Quick Assessment
AFAST® Technique
HR site – half way between umbilicus and table (R lateral)
20-22g 1-1/2 needle or butterfly
no syringe – gravity drip into tubes
Put fluid in EDTA and red top tubes for analysis
EDTA - Spin down & direct for cytology
red top tube for culture if needed (closed - syringe)
Run EDTA through CBC machine for cell counts
Fluid Analysis Handout

6. Ascites Transudate or Modified Transudate
Remove enough fluid to alleviate dyspnea, and allow comfortable chest x-rays & abdominal ultrasound
Bloodwork and abdominal ultrasound to determine the cause, and treat accordingly
If cause is congestive heart failure, remove all fluid
Hemorrhage - usually a surgical problem, unless
Coagulopathy or anaphylaxis is identified and treated
Traumatic hemorrhage resolves spontaneously (serial AFAST®), + auto-transfusion
Non-septic exudate, chyle – tap if dyspneic
Rarely surgical

7. Ascites
Septic exudate, uroabdomen, bile peritonitis – usually surgical
Multiple species of bacteria suggest GI perforation
Plant material is very strong evidence
If no bacteria are seen, look for phagocytosed bacteria in WBC, and for toxic changes in the neutrophils
Feline Infectious Peritonitis (FIP) fluid
High protein – mucoid strings (TP > 5-10 g/dl)
Cell count usually <5,000/ul & almost always <10,000/ul
Mononuclear cells usually > segs
Albumin:glob usually <0.8: <0.45 is strong evidence

8. Ascites Compare abdominal fluid to plasma/serum
Abdominal amylase and lipase > plasma/serum
Pancreatitis
Abdominal fluid glucose <50 mg/dl and <plasma/serum
often indicative of bacterial peritonitis
Abdominal bilirubin > plasma/serum
Gallbladder/biliary tract rupture
Abdominal creat > plasma/serum (BUN the same)
Ruptured urinary tract
Abd. triglycerides > serum; Abd. Cholesterol < serum
chyle
Abdominal coronavirus PCR or AB titer >> serum
FIP