We were the 4th clinic on the long list of animal hospitals that have treated this client’s dog with a limited amount of success; not for lack of trying of course!
We were the 4th clinic on the long list of animal hospitals that have treated this client’s dog with a limited amount of success; not for lack of trying of course!
- 10-year-old F/S Maltese with hx of bladder and renal calculi was presented 8 days from initial consultation at another clinic for persistent ADR, intermittent vomiting, and anorexia for 2 days.
- She was shaking, had the appearance of bile in her stool (stained bright yellow on fur near rectum), and had an odd upper airway sound although lungs were clear.
- Abdominal palpation was difficult due to tense, but non-painful abdomen. Temperature was 103.4, CRT was extended, gums were tacky and rather injected in appearance.
- Blood work from initial clinic 8 days prior was for the most part WNL with the exception of some mild liver enzyme elevations. We ran a repeat in-house CBC/Chem stat and found her Alk phos at 1918 U/L and her WBC was at 50,000! Yowzers.
- cPL snap test was negative, but we did administer Buprenex in case of pancreatitis and any discomfort in general.We also hooked her up with a Norm-R IVC with B-vits and gave Cerenia and Convenia injections.
- Radiographs were unremarkable except the obvious calculi hanging about. U/S still of kidney stone.
- After the Buprenex took effect a more thorough abdominal palpation was achieved and the doctor felt a possible mass in the caudal abdomen just before the bladder. We are thinking “bad juju” at this point.
- 8 days later the patient is finally being scheduled for an abdominal ultrasound. The kicker here is that these clients have money concerns and have now spent many dollars on good diagnostics no doubt, but still are without an answer. Now their dog has been feeling not well for over 1 week, the owners are frustrated with lack of answers, and they are not happy to now have to pay for an ultrasound.
Do you think this sounds like a cancer dx? Poss pylonephritis or ??? Thanks! 🙂
Comments
Looks like a frustrating case
Looks like a frustrating case !! Pyelonephritis possible but not that obvious on the ultrasound, neoplasia alway possible but with that WBC count infection (hepatic, gall bladder, pancreas) is a distinct possibility, especially with the tense abdomen and bile-stained faces. Caudal abdominal mass should not push the ALP that high unless it is involving the biliary tree/gall bladder. Another reason for the sudden spike in ALP is that the other clinics gave her prednisone.
What is the breakdown of the WBC count and do you have a urinalysis?
Looks like a frustrating case
Looks like a frustrating case !! Pyelonephritis possible but not that obvious on the ultrasound, neoplasia alway possible but with that WBC count infection (hepatic, gall bladder, pancreas) is a distinct possibility, especially with the tense abdomen and bile-stained faces. Caudal abdominal mass should not push the ALP that high unless it is involving the biliary tree/gall bladder. Another reason for the sudden spike in ALP is that the other clinics gave her prednisone.
What is the breakdown of the WBC count and do you have a urinalysis?
Don’t you love being at the
Don’t you love being at the end of the list of clinics, when the owners are just about out of money and frustrated with it all? My my, such diagnostic inefficiency! Anyway, this is your chance to shine and hopefully get the owners some answers. Please follow up with the ultrasound results!
Don’t you love being at the
Don’t you love being at the end of the list of clinics, when the owners are just about out of money and frustrated with it all? My my, such diagnostic inefficiency! Anyway, this is your chance to shine and hopefully get the owners some answers. Please follow up with the ultrasound results!
Dr. Lobetti a urinalysis was
Dr. Lobetti a urinalysis was wnl and here are the CBC results. Sorry I did not get the whole strip.
Dr. Lobetti a urinalysis was
Dr. Lobetti a urinalysis was wnl and here are the CBC results. Sorry I did not get the whole strip.
Just checked with my clinic,
Just checked with my clinic, she was diagnosed via ultrasound with an intestinal mass. I don’t have all the details yet, but will follow up once we get the report. Owners opted for humane euthanasia. 🙁
Just checked with my clinic,
Just checked with my clinic, she was diagnosed via ultrasound with an intestinal mass. I don’t have all the details yet, but will follow up once we get the report. Owners opted for humane euthanasia. 🙁
Follow up on the CBC and
Follow up on the CBC and urinalysis – pyelonephritis unlikely but the neutrophilia and monocytosis fits with an intestinal mass that has most likely ulcerated.
Follow up on the CBC and
Follow up on the CBC and urinalysis – pyelonephritis unlikely but the neutrophilia and monocytosis fits with an intestinal mass that has most likely ulcerated.
Just thoughts – a week of
Just thoughts – a week of bouncing around clinics makes me wonder more about the clients than the clinics…they may have declined ultrasound a week ago. Gentle on our colleagues, friends.
Just thoughts – a week of
Just thoughts – a week of bouncing around clinics makes me wonder more about the clients than the clinics…they may have declined ultrasound a week ago. Gentle on our colleagues, friends.
No doubt on the part of the
No doubt on the part of the owners, I think the only other reason they did agree, is because they had realized this was the way to get the answers they were looking for. I always feel for the patient though. 🙁
No doubt on the part of the
No doubt on the part of the owners, I think the only other reason they did agree, is because they had realized this was the way to get the answers they were looking for. I always feel for the patient though. 🙁
Here is a selection from the
Here is a selection from the ultrasound report: The intestines had normal contractility, wall layering, and thickness. There was an intestinal mass that is suspected to be at the ileocecal junction. The mass itself measured about 4cm in length and some of it appeared to be thickened bowel with poor to almost complete loss of wall layering. Immediately contiguous with this is a mineralized mass that cast a curved strong acoustic shadow and is painful and surrounded by severely reactive mesentery.
DIAGNOSTIC IMPRESSIONS:
Intestinal mass. This appears to be mineralized and is suspected to be the ileocecal junction. A foreign body with chronic severe with prior perforation is considered less likely.
Cholecystitis gallbladder.
Nephroliths kidneys.
Suspected vacuolar hepatopathy.
Thoracic radiographs were recommended. An abdominal exploratory would be recommended for mass removal. Given the severity of the severity of the inflammation surrounding the mass and the high white count, adhesions are a possibility and this could be a technically challenging surgery.
Here is a selection from the
Here is a selection from the ultrasound report: The intestines had normal contractility, wall layering, and thickness. There was an intestinal mass that is suspected to be at the ileocecal junction. The mass itself measured about 4cm in length and some of it appeared to be thickened bowel with poor to almost complete loss of wall layering. Immediately contiguous with this is a mineralized mass that cast a curved strong acoustic shadow and is painful and surrounded by severely reactive mesentery.
DIAGNOSTIC IMPRESSIONS:
Intestinal mass. This appears to be mineralized and is suspected to be the ileocecal junction. A foreign body with chronic severe with prior perforation is considered less likely.
Cholecystitis gallbladder.
Nephroliths kidneys.
Suspected vacuolar hepatopathy.
Thoracic radiographs were recommended. An abdominal exploratory would be recommended for mass removal. Given the severity of the severity of the inflammation surrounding the mass and the high white count, adhesions are a possibility and this could be a technically challenging surgery.