Saturday, October 20, 2012

1145. KPI Vomiting female Schnauzer - Cystotomy + Exploratory Laparotomy

Yesterday, Sat Oct 20, 2012, I performed the surgery on this vomiting 4-year-old female Schnauzer. Vomiting past 5 days. Not eating. Had 2 bottles of drips before surgery today.

Anterior abdominal pain - dull whimpering sound. Why?  X-ray - a left kidney stone or stomach stones?  Liver enzymes higher than normal.
Bladder pain - struvite stones known and seen on X-ray. Still vomiting prior to surgery white mucus or water and during mask anaesthesia.


ANAESTHESIA
A: Inject sedation drug   10.20am
B: Isofl first given           10.27 am. Mask, then intubate. Dog vomited again.
C:  Isofl stopped             11.37 am
D: First skin incision       10.39 am
E: Completion of skin stitching   11.37 am

E-A = 57 min
E-D = 58 min  (time taken to check out stomach, kidneys visually and remove >10 bladder stones)
C-B = 64 min

SURGERY
1. Exploratory laparotomy. Big incision. Stomach empty. Intestines with some gas. Colon with black streaks inside. Spleen dark red. Liver dark red. Blood spots near to enlarged left kidney (3x normal right kidney - pic taken).  No foreign bodies inside stomach or intestines.  Kidney stones inside the right kidney?  To review X-ray again.

2. Bladder surgery. Bladder chronic cystitis.Wall >5mm thick, dark red, 9 big yellow bladder stones and four smaller ones. Previous bladder surgery scars. Bladder empty, size of quail's egg.
Incision 1 cm long. Stones massaged out. PDS 3/0 x.  1 apposing stitch closes mucosa. 2 layers of inverting sutures. Syringe of saline to flush out any sand.
 
UPDATE 24 HOURS POST OP (Sunday Oct 21, 2012)
Dog Ok. Drinks, not eat. Had passed water (brownish colour). On medication.
No vomiting as at 11.35 am

PROBLEM
Right kidney much swollen and congested capsule (pic taken). Kidney stones and infection?
Total WCC was high, platelets low indicating a septicaemia.
The liver and kidneys

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