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Monday, November 10, 2008
Case 2
A 13 year old, female spayed, mixed breed dog was presented to AcaseAweek Clinic with history of collapse, depression, lethargy and vomiting 3 times the night before presentation. The patient had been anorexic for the past 2 days and appeared healthy previously. The patient lives mostly inside and her owner reported no possibility of accidental ingestion of foreign body or chemicals. Her vaccination status is current and she is on heartworm preventative. She was treated for Ehrlichiosis with doxycycline two months back.

Physical Exam:
Remarkable weight loss and muscle atrophy.
T: 98
P: 88
R: 44
MM: pale pink
CRT> 2 sec

Cardiovascular: murmur, cardiac arrhythmia, pulse deficit.
Respiratory: lungs sound clear
Abdomen: distended, positive succession, moderately painful

CBC/Cytology:
PCV: 23% [37-55]
WBC: 28.9 x103/μL [6-16.9]
Mature Neutrophils: 26.3 x103/μL [3.3-12]
Band Neutrophils: 0.6 x103/μL
Lymphocytes: 0.3 x103/μL
NRBC: 0.9 x103/μL
Smear: Platelets: 1-4/hpf
RBC morph: marked polychromasia, moderate anisocytosis

Biochemistry:
ALKP: 267 U/L [23-212]
ALT: 164 U/L [10-100]
AMYL: 2490 U/L [500-1500]
BUN: 130 mg/dL [7-27]
CREA: 6.1 mg/dL [0.5-1.8]
PHOS: >16.1 mg/dL [2.5-6.8]
TBIL: 1.4 mg/dL [0-0.9]

Urinalysis:
Bilirubin: ++
SG: 1.013
Blood: +++
pH: 5.0
Protein: +

Abdominocentesis:10 mL fluid was withdrawn.
Abdominal Fluid Analysis/Cytology:
Color: red
Turbidity: 3+
Protein: 7.2 g/dL
PCV: 23%
Smear: many RBCs, neutrophils and macrophages, moderate lymphocytes, almost no platelets seen, few reactive mesothelial cells.
What will be your tentative and differential diagnosis?
What further diagnostic test(s) you will perform to confirm your diagnosis?
What will be your treatment plan(s)?



Solution to this case

posted by Dr Banga's Websites @ 12:00 AM  
4 Comments:
  • At November 10, 2008 at 2:13 AM, Anonymous Kirandeep said…

    Tentative diagnosis:-
    Anemia R/O blood loss, haemorrhagic,hemolytic , chronic disease ,
    Murmur , cardiac arrythmia , pulse deficit R/O anemia , cardiac disease
    distended abdomen R/O hemorrhage , ruptured spleenic mass, intestinal rupture , tumor.
    Chemsitry and CBC R/O anemia , inflamation , renal compromise ,effect on liver ,

    Abdominocentesis - fluid shows blood having high PCV and Protein .

    Further Diagnostic plans

    1. radiography

    2. ultrasound

     
  • At November 11, 2008 at 6:41 AM, Blogger Irene Arboleda said…

    Tentative Diagnosis:
    Unresolved Chronic Ehrlichiosis

    Differential Diagnosis:
    (1)Rocky Mountain Spotted Fever - do serologic testing
    (2) SLE - perform ANA test
    (3) Chronic Lymphocytic Leukemia - do cytology of bone marrow

    Additional Diagnostic Tests to Confirm Chronic Ehrlichiosis:

    PCR, IFA and Tests for Other Accompanying Pathogens: Babesiosis, Hemobartonellosis, Hepatozoon

    TREATMENT:

    (1)Initial medication for anemia and hemorrhagic tendencies, balanced electrolyte solution, platelet-rich plasma or blood transfusion
    (2)Doxycycline 10mg/kg PO q 24 hours for 14 days, Give IV for 5 days because dog is vomitting
    (3) Imidocarb - as an alternative to Doxycycline, 5mg/kg for 2 doses for 14 days apart
    (3) Oxymetholone or Nandrolone Decanoate to stimulate bone marrow production
    (4) Treat also against ticks

    Patient Case Management
    (1) Platelet Monitoring - every 3 days
    (2)Serologic Testing - repeat after 9 months

     
  • At November 13, 2008 at 10:31 PM, Anonymous Anonymous said…

    Diagnosis:
    Hemangiosarcoma

    Tests: Thoracic and abdominal radiographs to look at the extent of spread and organs involved
    RX: Surgical or Doxirubicin

    Prognosis: grave

     
  • At November 14, 2008 at 10:16 AM, Blogger BangaVet.com said…

    Radiography or ultrasound were not diagnostic in this case because of lots of fluid in abdomen.

     
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