Presentation: A 7 month old, intact female mixed breed canine was presented to AcaseAweek Clinic as an emergency with epistaxis of one night duration and abdominal pain of about 5 days duration. The owner has recently placed rat bait (Klerat = Bradisacoum) under the house. The owner does not believe the patient ingested any but is not certain. The dog is fed people food and chicken bones. The owner does not and is unable to monitor urination and defecation as the dog lives outside. The owner does not believe there was any trauma to the patient. Physical Exam:
Weight = 8.8kg
T = 104
mm = pale
P = 210
R = 40
EENT: Pale conjunctiva, epistaxis x1 day
C/V: Tachycardia, no other abnormalities heard
U/G: Brown/mucoid vaginal d/c.
GI: Very painful on abdominal palpation, mostly caudal abdomen.
LNN: Mildly enlarged pre-scapular and popliteal LN’s
The patient had a “hunched” appearance. The dog was shivering and had bloody nasal discharge (epistaxis). The epistaxis was more pronounced from the Right nare. The dog was also groaning.
PCV = 9.0%
WBC = 3.1
Plt = 41
CBC revealed a severe hemorrhagic regenerative anemia with severe thrombocytopenia, leucopenia and granulocytopenia. MCHC was borderline normal/elevated.
Blood Chemistry revealed hypoalbuminemia along with borderline normal/high BUN and borderline normal/low Creatinine and ALT. All other values were within normal limits. Radiographs of abdomen were taken as shown in following pictures:Give interpretations of the radiographs. What is your tentative diagnosis? Give your differentials. What further tests you will do to confirm your diagnosis? How will you treat and manage this case? Solution to this case