Signalment and History: "Daisy," a 9-year-old, 12 kg (26.4 lb) female spayed Miniature Poodle, is presented for evaluation of a constellation of clinical signs that have been progressing slowly over the past 18 months.
The owners provide a meticulous history. They first noticed an increase in Daisy's water consumption about a year and a half ago. This has now progressed to the point where she drinks constantly and has frequent urinary accidents in the house, despite having been perfectly house-trained her entire life. Her appetite, which was always good, is now described as "ravenous"; she begs for food relentlessly and scavenges for scraps.
Over the past year, her physical appearance has changed dramatically. She has developed a noticeably sagging, "pot-bellied" abdomen and pants heavily even while at rest in a cool room. Her once-thick coat of hair has thinned dramatically over her back and flanks, and the remaining hair is dry and brittle. Her skin seems thin, and she has developed what the owner calls "blackheads" on her belly. Despite her increased appetite, she seems weaker and more lethargic, hesitating to jump onto furniture.
Physical Exam:
T: 101.9°F
P: 120 bpm
R: Panting
BCS: 6/9
Blood Pressure (Doppler): 175 mmHg systolic [Ref: <160 mmHg]
Daisy is bright and alert but demonstrates generalized muscle weakness. The physical exam findings are striking and classic:
Abdomen: A tense, pendulous, pot-bellied abdomen is present, with hepatomegaly suspected on palpation.
Musculature: There is significant, symmetrical muscle wasting (atrophy) noted over the spine, ribs, and temporal bones of the head.
Dermatologic: A bilaterally symmetrical, non-pruritic alopecia (hair loss) covers the entire trunk. The underlying skin is thin, inelastic ("crepe paper skin"), and has poor wound healing noted from a recent scrape. The ventral abdomen shows prominent blood vessels, thin skin, and multiple large comedones.
Respiratory: The dog is panting constantly throughout the exam.
Initial Diagnostic Workup: A comprehensive baseline database was established.
Complete Blood Count (CBC): A classic stress leukogram is present, showing mature neutrophilia, lymphopenia, and eosinopenia.
Serum Biochemistry Profile:
Alkaline Phosphatase (ALP): Markedly elevated at 1,550 U/L [Ref: 23-212 U/L]
Alanine Aminotransferase (ALT): Mildly elevated at 190 U/L [Ref: 10-125 U/L]
Cholesterol: Elevated at 450 mg/dL [Ref: 110-320 mg/dL]
Glucose: Mildly elevated at 145 mg/dL [Ref: 75-125 mg/dL]
Urinalysis (Cystocentesis):
Urine Specific Gravity (USG): 1.014 (inappropriately dilute for a potentially dehydrated patient)
Dipstick: 2+ Proteinuria
Sediment: 3+ Bacteriuria with no white blood cells (pyuria) present, suggestive of a subclinical urinary tract infection.
Urine Protein:Creatinine (UPC) Ratio: 1.2 [Ref: <0.5], confirming significant renal protein loss.
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 Case 32 will be posed on Sept 19
No comments:
Post a Comment