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Monday, October 4, 2010
Case 22
A 12 year old, intact female Pompek canine presented to AcaseAweek clinic for abdominal distention.  The owner reported abdominal distention worsening for last one and half week.  As the patient was eating, drinking, eliminating and otherwise showing no remarkable behavioral changes at home, the owner was unsure of the exact duration of her condition.  The dog is upto date on vaccines and deworming but not on any ectoparasite or heartworm control. Animal is fed Hill’s Science diet for senior dogs. 
Physical Exam:
Weight= 5.5 kg
T=100.9 °F
HR/PR=160 bpm  
RR=panting/open mouth breathing
EENT:  Normal, except right prolapsed third eyelid
Oral:  MM pink/moist, CRT<2s, Halitosis, Excessive tartar, gum recession, missing teeth: 101/102, 201/202, 301-303, 401/402
LLN:  Normal
Thorax:  Heart/Lung auscultate normally, with normal peripheral pulse, no jugular vein            distention
Abdomen: Distended, Firm, Unable to palpate internal organs, No pain on manipulation, +ve reaction on Ballotment
U/G: Normal, intact
Skin: Normal
MSk: BCS 2/5
Neuro: Normal
PCV= 31.7% (37-55%)
Albumin= 1.2g/dl (2.6-4.0 g/dl)
Total Protein=3.8g/dl  (5.5-7.5 g/dl)
Cholesterol= 347 mg/dl (116-254 mg/dl)
All other values WNL
Protein= Dipstick protein ++++
Hyaline casts and few RBCs observed in urine sediment.
What is your tentative and differential diagnosis?
What further diagnostic tests you will perform?
What will be your treatment plan?
posted by Dr Banga's Websites @ 12:00 AM  
  • At October 4, 2010 at 2:32 AM, Blogger Ramesh hebballi said…

    asitis may b of cardic origin since dog is excersice intolarance.
    And also tachycardia and arthymia. Bt CBC report is showing low protien and i feel its suffering from hepatitis nd mild nephritis......ultrasono anD ECG may advisd for further diagnosis

  • At October 4, 2010 at 2:52 AM, Blogger dr. Prasad488 said…

    tentative diagnosis is chronic nephropathy. as the blood albumin value is less than 1.2 prognosiss may be poor means treatment may not be usefull. but stil need blood parameters like serum creatinine. bun. uric acid and blood electrolyte ie k+,Na+, bicorbonate.
    rx is hermin iv/albumin iv 25-50% dextrose. based on other values erythropotin .othr supportive therapy with decadurabolin.

  • At October 4, 2010 at 5:05 AM, Blogger Dr Swarupmay Majumdar said…

    I think Its a case of PLN protein losing nephropathy and related ascites. It required aggresive fluid and amino acids in addition to diuretics.
    Plz go for more tests

  • At October 4, 2010 at 7:15 AM, Anonymous dr.zain said…

    radiographs and ultrasound along with blood parameters needed...as cbc showing hypoproteinemia my minds clicking towards something wrong to liver but further blood parameters will tell about renal disturbance or not...

  • At October 4, 2010 at 9:01 AM, Blogger Dr Banga's Websites said…

    Dr Ramesh, there was no arrhythmia in this case. Dr Majumdar you are on right track... think of more tests to be done...

  • At October 4, 2010 at 11:13 AM, Anonymous eshak said…

    history: which is shown the dog is female intact , showing abdominal distention , no other abnormalities is shown, up to date for vaccine, but not heart warm prevention or in apply for ecto parasite .
    physical exam:
    clinical signs :which is shown in the case
    problematic list
    temp :almost normal .heart rate shown tachycardia prolapsed 3rd eyelid ,halitosis,excessive tartart
    abdominal distention , ASCITIES :+ve reaction to ballotment,low pcv, hypoalbumenemia ,hyperchlostermia ,low tb, proteinueria,presence of RBCS in urine
    7-hyperadrencorticsm 8-pancreatitis
    9-kidney stone 10- urinary tract infection
    according to the clincal sings which no abnormality in eating or drinking we can rule out pancreatitis and amyloidosis and pyometra as primary cause but if there is porblem in the eating behaviour then we need to consider this diseases
    in my opinion the tentative diagnosis is heart worm disease most heart worm signs are asymptomatic , but it shown as the sign start as panting and and aascities ,which sign of right CHF
    presence of the protein in the urine and hypolbumenemia is secondary to immune complex glumerulnephritis , or right-sided CHf ,presence of rbcs in urine could be due to kidney stone or uti
    so we need to make further test such as heart warm antigen test, and -x-ray
    but i guess the heart warm test will be +ve ,
    treatment; for heart warm is adulticide therapy 1-thiacetramide or melarsamine
    the microflarial therapy should be done after the adultcide therapy by 4-6week
    milbemycin or ivermctine
    should be not give this medication for collie
    and we should also be aware of the complication of adulticide therapy can also make thromboembolic


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