Roxy is a 8 yr Pomeranian mix, FS, 15.2#
Being evaluated for chronic diarrhea, pan hypoproteinemia, ascites. Albumin was less than 1.5. Abdominal fluid had been collected but not evalutated yet, suspect a modified transudate. Appears that a large portion of the abdominal fluid had leaked subcutaneous and had a great deal of subcutaneous edema and a mild to moderate amount of ascites at the time of the ultrasound.
Roxy is a 8 yr Pomeranian mix, FS, 15.2#
Being evaluated for chronic diarrhea, pan hypoproteinemia, ascites. Albumin was less than 1.5. Abdominal fluid had been collected but not evalutated yet, suspect a modified transudate. Appears that a large portion of the abdominal fluid had leaked subcutaneous and had a great deal of subcutaneous edema and a mild to moderate amount of ascites at the time of the ultrasound.
It seems there are subtle changes in the intestinal mucosa but I was afraid I was imaging it as I was hoping to find something that looked like lymphangectasia.
Recommended endoscopic biopsies. Renal loss had been ruled out and liver looked normal on ultrasound.
Thanks!
Comments
These two images didn’t show
These two images didn’t show up on the first post though I did upload them. Not sure why.
These two images didn’t show
These two images didn’t show up on the first post though I did upload them. Not sure why.
You just needed to press
You just needed to press “insert” for the images. I had IT dept check on it.
On low albumin cases the loss is either renal, GI or liver (lack of production) or if mild subnormal look for addisons.
No significant proteinuria (i.e. normal or usual geriatric 1+protein and usg 1035) and liver looks decent then its usually GI. In this case I see a mucosal striation in the still image. Some dogs show them better than otehrs. You can enhance it by having them eat corn oil wiht a fatty meal like AD or somethign and scan a couple of hours afterwards.
This is PLE til rpven othersie see my arrow on your image.
Here is my generic quick therapy for PLE for your convenience and adapt to your patient:
PLE Therapy
OBJECTIVE: keep albumin levels > 2 g/dl, Avoid thromboembolism and cavitary effusions, monitor concurrent PLN (Wheaton Terrier PLE/PLN) and liver disease:
Plasma 10 mL / kilogram IV over 4 hours
Or Human albumin 2 ml/kg/h over 10 hours. Total daily volume 20.l/kg/day
And Colloids/Hetastarch
10 to 20 mL per kilogram per hour and dogs
10 to 15 mL per kilogram per hour cats
(Can bolus first 1/3 of dose over 15 minutes)
& maintain on LRS maintenance otherwise.
Metronidazole (10-20 mg/kg po bid)
Famoditine 1 mg/kg Iv Im po dc Sid /bid
Sucralfate 0.5-1 g po tid dogs, 0.5 g bid cats in slurry Or Misoprostol 1-5 ug/kg po tid
Diet: Highly digestible high quality protein, low fiber, low fat diet (< 15% of dry matter). Hydrolyzed protein or novel protein. Purina HA or Royal Canine HP or similar.
Prednisone or prednisolone 2 mg/kg bid x 3-5 days then 2 mg/kg sid. Chlorambucil in refractive severe IBD/alimentary lymphoma cases (monitor cbc for rare bone marrow suppression) 4 mg/m2 Q 24-48 hours.
Cobalamine (B12) 250-1500 ug/dog weekly x 6 weeks.
Calcium supplementation if necessary.
Aspirin 0.5-1 mg/kg/day or Clopidrel (Plavix) 1-5 mg/kg/day.
You just needed to press
You just needed to press “insert” for the images. I had IT dept check on it.
On low albumin cases the loss is either renal, GI or liver (lack of production) or if mild subnormal look for addisons.
No significant proteinuria (i.e. normal or usual geriatric 1+protein and usg 1035) and liver looks decent then its usually GI. In this case I see a mucosal striation in the still image. Some dogs show them better than otehrs. You can enhance it by having them eat corn oil wiht a fatty meal like AD or somethign and scan a couple of hours afterwards.
This is PLE til rpven othersie see my arrow on your image.
Here is my generic quick therapy for PLE for your convenience and adapt to your patient:
PLE Therapy
OBJECTIVE: keep albumin levels > 2 g/dl, Avoid thromboembolism and cavitary effusions, monitor concurrent PLN (Wheaton Terrier PLE/PLN) and liver disease:
Plasma 10 mL / kilogram IV over 4 hours
Or Human albumin 2 ml/kg/h over 10 hours. Total daily volume 20.l/kg/day
And Colloids/Hetastarch
10 to 20 mL per kilogram per hour and dogs
10 to 15 mL per kilogram per hour cats
(Can bolus first 1/3 of dose over 15 minutes)
& maintain on LRS maintenance otherwise.
Metronidazole (10-20 mg/kg po bid)
Famoditine 1 mg/kg Iv Im po dc Sid /bid
Sucralfate 0.5-1 g po tid dogs, 0.5 g bid cats in slurry Or Misoprostol 1-5 ug/kg po tid
Diet: Highly digestible high quality protein, low fiber, low fat diet (< 15% of dry matter). Hydrolyzed protein or novel protein. Purina HA or Royal Canine HP or similar.
Prednisone or prednisolone 2 mg/kg bid x 3-5 days then 2 mg/kg sid. Chlorambucil in refractive severe IBD/alimentary lymphoma cases (monitor cbc for rare bone marrow suppression) 4 mg/m2 Q 24-48 hours.
Cobalamine (B12) 250-1500 ug/dog weekly x 6 weeks.
Calcium supplementation if necessary.
Aspirin 0.5-1 mg/kg/day or Clopidrel (Plavix) 1-5 mg/kg/day.
With the albumin that low I
With the albumin that low I don’t think I would be doing
endoscopic biopsies.
With the albumin that low I
With the albumin that low I don’t think I would be doing
endoscopic biopsies.
Hyperechoic mucosal striation
Hyperechoic mucosal striations in dogs are associated with lacteal dilation and are frequently associated with mucosal inflammation and protein losing enteropathy – lymphangectasia
Recent report on the use of corn oil concluded: Corn oil administered orally improves conspicuity of characteristic ultrasonographic lesions in dogs with lymphangiectasia, however some of these lesions may also be present in healthy dogs that recently received a fatty meal.
Hyperechoic mucosal striation
Hyperechoic mucosal striations in dogs are associated with lacteal dilation and are frequently associated with mucosal inflammation and protein losing enteropathy – lymphangectasia
Recent report on the use of corn oil concluded: Corn oil administered orally improves conspicuity of characteristic ultrasonographic lesions in dogs with lymphangiectasia, however some of these lesions may also be present in healthy dogs that recently received a fatty meal.
Riobetti- I liked your CE on
Riobetti- I liked your CE on PLE. Very educational
Riobetti- I liked your CE on
Riobetti- I liked your CE on PLE. Very educational