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Today's VeTerinary PracTice | november/december 2015 | tvpjournal.com aPProach To resPiraTory disTress Peer reviewed 60 ABDOMINAL DISTENSION Etiology Signifcant abdominal enlargement (Table 5) can result in respiratory distress because it impedes thoracic expansion during inspiration. Dyspnea is rarely a presenting sign, but tachypnea is common in these patients. Clinical Signs & Diagnostic Approach Respiratory distress due to abdominal distension is usually visually obvious. Abdominal palpation and imaging (ie, abdominal radiographs and/or ultrasound) can help determine the underlying cause. Stabilization & Management Supplemental oxygen may provide some relief, but treatment should be aimed at reducing the degree of abdominal enlargement. Reducing the abdominal distension may be straightforward, such as with abdominocentesis in the case of ascites, or more complicated. For example, in the case of severe hepatosplenomegaly in dogs with immune-mediated hemolytic anemia, nothing can be immediately done other than treating the underlying cause and giving the patient time to recover. LOOK-ALIKE SYNDROMES Apparent breathing diffculty caused by non- respiratory conditions can occur in association with severe pain, acidosis (eg, Kussmaul respiration associated with diabetic ketoacidosis), anemia, drug administration (eg, opioids), shock, and hypotension. These diseases or conditions can generally be identifed based on a complete history, physical examination, and screening laboratory tests. Thoracic radiographs can help defnitively rule out underlying respiratory disease. Since the increased respiratory effort associated with these conditions is not usually oxygen responsive, management is aimed at treating the underlying disease. IN SUMMARY The mainstays of management of a patient in respiratory distress are: 1. Initial stabilization, including oxygen supplementation and potentially sedation 2. Characterization of the breathing pattern to localize the disease 3. Systematic approach to diagnostics and therapy based on identifying the anatomic location of the cause of respiratory distress. CT = computed tomography; FiO 2 = fraction of inspired oxygen; NSAID = nonsteroidal anti-infammatory drug; PTE = pulmonary thromboembolism References 1. Sharp CR, Rozanski EA. Physical examination of the respiratory system. Top Companion Anim Med 2013; 28:79- 85. 2. Sigrist NE, Adamik KN, Doherr MG, et al. Evaluation of respiratory parameters at presentation as clinical indicators of the respiratory localization in dogs and cats with respiratory distress. J Vet Emerg Crit Care 2011; 21:13-23. 3. Sharp CR. Feline lower airway disease: Presentation and diagnosis. Today Vet Pract 2013; 3:28-31,35. 4. Sharp CR. Treatment of feline lower airway disease. Today Vet Practice 2014; 4:28-32. 5. Goutal CM, Keir I, Kenney S, et al. Evaluation of acute congestive heart failure in dogs and cats: 145 cases (2007- 2008). J Vet Emerg Crit Care 2010; 20:330-337. 6. Kogan DA, Johnson LR, Jandrey KE, et al. Clinical, clinicopathologic, and radiographic fndings in dogs with aspiration pneumonia: 88 cases (2004-2006). JAVMA 2008; 233:1742-1747. 7. Schulze HM, Rahilly LJ. Aspiration pneumonia in dogs: Treatment, monitoring, and prognosis. Compend Contin Educ Pract Vet 2012; 34:E1. 8. Goggs R, Benigni L, Fuentes VL, et al. Pulmonary thromboembolism. J Vet Emerg Crit Care 2009; 19:30-52. 9. Goggs R, Chan DL, Benigni L, et al. Comparison of computed tomography pulmonary angiography and point-of- care tests for pulmonary thromboembolism diagnosis in dogs. J Small Anim Pract 2014; 55:190-197. 10. Lisciandro GR. Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals. J Vet Emerg Crit Care 2011; 21:104-122. 11. Olsen D, Renberg W, Perrett J, et al. Clinical management of fail chest in dogs and cats: A retrospective study of 24 cases (1989-1999). JAAHA 2002; 38:315-320 TABLE 5. Intra-abdominal Pathology That Results in Signifcant Abdominal Distension Abdominal masses Ascites Gastric dilatation +/- volvulus Hepatomegaly Late-term pregnancy Splenomegaly CLAIRE R. SHARP Claire R. Sharp, BSc, BVMS (Hons), MS, CMAVA, Diplomate ACVECC, is senior lecturer at Murdoch University in Perth, Western Australia, and adjunct assistant professor at Tufts Cummings School of Veterinary Medicine. Dr. Sharp received her BVMS from Murdoch University. She completed a rotating small animal internship at Oklahoma State University, and an internship and residency in small animal emergency and critical care at University of Missouri.