124. Fever, Anaemia & anterior abdominal pain 2-year-old male Shih Tzu

History

Shih Tzu, M, 2 years
Admitted on Jul 6, 2010, 9pm. Lethargy, not eating for 2 days. Fever and white gums and tongue. The domestic worker said that the dog was given (chicken +/or fish) bones by a family member recently.

Presenting signs
Acute abdomen (anterior). Bites vet when the anterior abdomen was palpated.

Blood test on Jul 7, 2010 - anaemia, dehydration and toxaemia
Low red cell count ( 4.1) and haemoglobin (10.4)
Low packed cell volume (0.3)
Low platelets (47). No platelet clumps seen but few giant platelets present.
Surprisingly, the WCC on admission was below normal at 5.4 with neutrophils 94% and lymphocytes 4% instead of a big increase.
Liver profile normal. Kidney profile - urea is normal. Creatinine is below normal.

Urine test on Jul 8, 2010. Full bladder catheterised to collect urine. There appears to be one urinary stone in the bladder on X-ray.
Catherised urine results taken after X-ray showing one urinary stone are as follows:
brown, turbid, SG 1.020 pH 7.0. Abnormal findings are as follows:
Protein 3+, urobilinogen 1+, bilirubin 3+, blood 4+, WBC 58, RBC 243, Crystals of amorphous phosphate 2+, triple phosphate occasional, bacteria 3+

X-rays on Jul 8, 2010.
Stomach is filled with radio-opaque granules. Some larger radio-opaque lumps are present in the intestines. These are likely bones.
Spleen is enlarged.

Diagnosis
Toxaemia. Impacted stomach and intestines and urinary tract infections.

Treatment on Jul 7 & 8, 2010
IV drip x 2 bottles (glucose saline + saline) x 500 ml each for 24 hours
Vit K1 2ml in drip
Baytril 1.0 ml, Tolfedine 4% 1.0 ml x 2 days in IV.
No fever on Jul 8, 2010. Dog more alert but does not want to walk or poop.

Stomach mucosa bleeding. Surgical removal of foreign bodies in the stomach is needed but highly risky. The dog is unlikely to survive the anaesthesia.
Goes home for the next 2 days for observation of pooping. Owner has been informed about poor prognosis if the dog does not poop or has more stomach bleeding

X-ray images x 2 showed stomach and intestine are impacted with radio-opaque foreign bodies