Tuesday, November 19, 2013

1190. TP 43887. Painful anterior abdomen. Case 1. Silkie, MN, 9 yrs with shivering recovers on S/D diet. Case 2. Shih Tzu had grape poisoning.

Coincidence of 2 cases with painful anterior abdomen


Case 1. TP 43887

Silkie MN, 9 years

Jul 30, 2013  Shivering & dysuria. Anorexic.
5.1 kg, 39.1C

Painful anterior abdomen. No spinal pain. What's the problem?

Urine test 
Jul 30, 2013                     
pH 7.0
SG 1.041
Protein Trace
Blood Tracer
Mucus threads occasional
Crystals amorphous phosphate 2+

Advised X-rays for urinary stones

Jul 30, 2013
Blood test
Glucose low  3.7 (3.9-6.0)
Calcium very low  0.6  (1.5-3.6)
Urea low 2.6  (4.2-6.3)
creatinine very low 9  (89-177)
platelets  low 172  (200-500)


Advised canned S/D 30-90 days and urine check.
S/D given from Aug 1 2013 to date (Nov 2013)


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Phoned owner. Dog has no problem in urination

Urine test 
Oct 27, 2013                     
pH 7.0
SG 1.015
Protein negative
Blood   negative
Mucus threads  Nil
Crystals Nil






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FOLLOW UP IS IMPORTANT FOR PREVENTION OF RECURRENCE. The vet has to take time to do it and record the details of management as follows: 
Young lady returned call at 10.12 am  Nov 20, 2013.  Dog has no problem in urination.
Fed S/D past 3 months as follows: 1/3 S/D can with chicken + salmon + cabbage + warm water 2 x/day. Will not eat solely S/D, thereby wasting the can.
"Did you feed grapes in Jul 2013 when the dog came for s"hivering?" I asked.
"No," she said. "I  know grapes are poisonous."
"What special food did you feed?"
"Dog treats from the pet shop 2 pieces before I go to work."
"How long?" I asked.
"For some months but I stopped feeding since that day she was having difficulty in urination and after consultation."
This is a young lady with knowledge of grape toxicity.



Urine test 
Nov 17, 2013                     
pH 6.5
SG 1.038
Protein negative
Blood   negative
Mucus threads  Nil
Crystals Nil

Advised C/D maintenence for 3 months and check weight this coming Sunday as S/D diet is not to be given for a long period of time. No X-rays were done and so it is hard to say whether the kidneys had urinary stones hence resulting in anterior abdom pain on palpation.


Today is Wed.
This case shows S/D dissolves the crystals and acidify urine, preventing UTI although it is not the sole diet as chicken and others are fed too. Clinical research is important to understand the culture and management of the owners. No X-rays of bladder were done. The good outcome.is a dog peeing normally.

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Case 2. Shih Tzu, MN, 9 years

Vomited on Nov 18, 2013. Dysuria 7 days. Dark brown urine yesterday. Anorexic.
Similar signs of acute anterior abdominal pain
Suspected kidney or liver inflammation - surprisingly cried when I palpated ant abdominal area

 and blood in the urine, low urea and creatinine levels. X-rays x 2 show no radio-dense stones. Dog said to have eaten a lot of grapes the day before, leading to vomiting and blood in the urine. Yelped loudly on upper anterior abdominal palpation. Possible grape toxicosis. Dog has recovered after IV drip and treatment with antibiotics for leucocytosis. 

Urine dark reddish brown peed onto waiting room floor on arrival.   

http://2010vets.blogspot.sg/2013/11/1186-9-year-old-male-shih-tzu-peed-dark.html

 
Urine test 1. Dog peed dark brown urine onto consultation floor and bladder empty in the morning.
Nov 18, 2013                     
pH 7.0
SG 1.038
Nitrite Positive
Protein 3+
Blood   4+
Mucus threads  Nil
Epithelial cells 38
White blood cells >2250
Red blood cells >2250

Bacteria 2+
Crystals Nil
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Urine test 2. Dog peed reddish brown urine onto newspapers after I/V drip in the evening. Not possible to catherise. Dr Daniel said results would be the same anyway as first urine sample from the floor.


Nov 18, 2013                     
Brown turbid
pH 7.0
SG 1.036
Nitrite Positive
Protein 3+
Blood   4+
Mucus threads  Nil
Epithelial cells 0
White blood cells >2250
Red blood cells >2250

Bacteria 2+
Crystals Nil



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Blood test
Nov 18, 2013
Urea low 3.8  (4.2-6.3)
Creatinine 46 (89-177)

Total white cell count 27 (6-17)
Neutrophils 81.4% Absolute 22
Lymphocytes 8.7% Absolute 2.4
Monocytes 8.1%  Absolute 2.2
Platelets OK


  X-rays on Nov 18, 2013  x 2 show no radio-dense stones.

Dr Daniel phoned owner on Nov 19 and recorded that the mum had fed grapes resulting in renal toxicity and blood in the urine.


Two cases with anterior abdominal pain.   


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