Friday, October 7, 2011

669. Ultrasound or x-ray of the stomach for foreign bodies?

Stomach ache suspected - ultrasound or X-ray? Record AMA.
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
10 October, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
A young beagle puppy became lethargic. What's wrong?

I put her on the consultation table and put my left hand to palpate the abdomen. pain. She yelped when I palpated the anterior abdomen in front of the two women, one of whom was the owner. "Your puppy had stomach ache," I said. "You can see the and hear her discomfort crying. I advise an X-ray as puppies do swallow pebbles and other foreign bodies when they go outdoors."

This was a case I collaborated with Dr Vanessa on the management of the case. Sometimes I do intervene as part of quality control and mentorship of my associate vets. Dr Vanessa later spoke to me as she wanted an ultra-sound.

"I don't think ultrasound will be good in this case," I said.
She had shown me an ultrasound of a pyometra case. The ultrasound scan showed an increase in thickness of the endometrium. So it was pyometra and the surgery proved it.

"Speak to Vet 1," I said. "He has experience in ultrasound and X-ray." As vets have their own preferences and judgment, it would be a matter of decision and so I did not object when Dr Vanessa to favour ultra-sound. There are more than one way to handle a case of anterior acute abdomen. I decided to phone Vet 1. However, it was difficult to contact Vet 1 as he was busy in his practice. I left a message with Vet 1's staff to call me back.

Vet 1 phoned me when the Beagle arrived at his Surgery. I asked him whether ultrasound would be useful or an X-ray in the Beagle suspected of having foreign bodies (bones, stones and others) in his stomach.

"If you are looking for foreign bodies in the stomach, an X-ray is better," he advised me. "Why scan for the other organs like kidneys and liver when you suspect foreign bodies in the stomach?"




"Go ahead with the X-ray, 2 views," I thanked him. I told Dr Vanessa the switch to X-rays while she was consulting.






Acute anterior Abdominal Pain in a Beagle. I put the dog on the consultation table. Then I palpated a swollen stomach with my good left hand. The dog arched her back high and gave a whimpering cry. The lady owner heard the cry.

RECORD ANY AMD (AGAINST MEDICAL ADVICE)
If the owner does not want to have X-rays taken, this ought to be recorded in the case sheet. "If the dog dies a few days later," the family members who are not present during consultation will bad-mouth the vet as not even competent as he has not taken any X-ray!
No two vets will have the same method of using ancillary aids to diagnosis, but it is best to consult another vet who has more experience in practice and in doing ultrasound and X-rays on certain conditions, as in this case.

To excel in veterinary science, a small animal vet in private practice needs to open his or her mouth to seek advices as veterinary medicine is extremely diverse as vets are anesthetists surgeons and general practitioners unlike human medicine where there is specialisation. Usually they are given as this case illustrates. Experience comes with time and cases handled.

One needs to be humble to ask for veterinary advices from others. There is no way a vet can know everything as interpretation and when to use veterinary radiology and ultrasound is again another big specialised field that will take years to master.





Case at:

http://www.sinpets.com/dogs/20111018ultrasound-x-ray-suspect-foreign-bodies-stomach-singapore_ToaPayohVets.htm

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