- 10 year old dog initially presented to the first veterinarian for bilateral rear leg ataxia. The clinic submitted a 1 week old blood sample for an insulin to glucose ratio and was incorrectly diagnosed with an insulinoma.
- The dog was placed on prednisone and began vomiting and became profoundly depressed.
- Dog was presented to another clinic where she was diagnosed with diabetes mellitus, Glu>700mg/dL, and a urinary tract infection.
- 10 year old dog initially presented to the first veterinarian for bilateral rear leg ataxia. The clinic submitted a 1 week old blood sample for an insulin to glucose ratio and was incorrectly diagnosed with an insulinoma.
- The dog was placed on prednisone and began vomiting and became profoundly depressed.
- Dog was presented to another clinic where she was diagnosed with diabetes mellitus, Glu>700mg/dL, and a urinary tract infection.
- Abdominal ultrasound shows moderate to marked gastric distension with fluid, what looks like ingesta, and some unidentified echogenic densities that I cannot connect to the gastric lumen wall. The odd thing is that the owner and the clinic state that this dog has not been fed or received any oral meds for the last 48 hours. The pancreas appears normal. No other abdominal abnormalities are seen.
- My primary rule outs for the gastric distension and intraluminal content include ileus due to illness, polyps,gastric obstruction, foreign body, and neoplasia.
- What are your thoughts?
Comments
Would also add gastric
Would also add gastric hypomotility as a differential diagnosis. With that degree of hyperglycemia, would suspect that this dog would be severely polydipsic (and polyuric) so stomach may just be excessive water intake.
Interstingly enough, the one
Interstingly enough, the one pyloric antrum mass that I had as a referal case was hyperechoic and multi lobulated as well. We did go surgical on him and to the best of my knowledge was still doing fine 5 years later on.
You may ant to distend the stomach with fluid and repeat the US including color Doppler for visualizing any vascular perfusion. See the attacjed image.
1. Get the hyperglycmia under
1. Get the hyperglycmia under control. I agree with Remo that hypo-motility is likely here. You can distend the stomach with fluid- but it already looks like there is plenty of fluid on your images.
2. IMO a great case to refer for endoscopy/biopsy if the changes persist.
Use Position 13 SDEP right
Use Position 13 SDEP right intercostal and you can get into that pylorus/duodenal outflow no matter what is in the stomach to rulke out mass/mural lesions and fb. C-Loop in SDEP 14 will get you there as well just stay more dorsal toward the spine as you maneuver.
Thanks, all. When I last
Thanks, all. When I last checked in with the clinic, the dog’s GI signs had resolved, her DM had stabilized and she was sent home.
Thank you for the update,
Thank you for the update, time will tell! Good job imagining.
Thank you for the update,
Thank you for the update, time will tell! Good job imagining.