Wednesday, June 26, 2013

1479. Update on Ascites dog - Abdominal exudate report from the lab

Jun 1, 2013

Jack Russell, M, 6 years
1. Abdominal distension 1-2 weeks. Active, no blood in urine, no dyspnoea, pulse weak. 38.5 C, cyanotic mucous membranes.  Losing weight in last 1-2 months.

Appearance: Red & turbid

White blood cells  0.16  10 power of 9/L(<0 .15="" br="">Red blood cells  present
Glucose 112   (glucose 10mg/dL lower then blood level
Protein 4.3     (g/dL (1-3)
Crystals Nil

Reference ranges applicable to synovial fluid only

Microbiological exam  - No bacterial growth
Cytology  - Atypical epithelias cells

Few small round clusters of atypical epithelial cells. Hyperchromatic ovoid nuclei and abundant cytoplasm. Background has abundant blood, scattered lymphoplasmcytic infiltrate and reactive mesothelial cells. 

Features are worrisome for an adenocarcinoma. To correlate with clinical features.

2. Blood test

Total protein 62 (62-85)
SGPT/ALT  90 (<59 p="">SGOT/AST  71 (<81 br="">)

Kidney Profile
Sodium 140 (141-152)
Potassium 5.5 (4.4 - 5.7)
Urea  4.7  (4.2-6.3)
Creatinine 41 (89-177)

Haematology normal except
Platelets  605 (200-500)

pH 6.5  SG 1.032  Protein +,  Blood 4+
White blood cells 25, Red blood cells 513, Epithelial cells 45,  Bacteria 2+. No crystals.

X ray and ultrasound not done at this time.

UPDATE on Jun 19, 2013
No abdominal distension.
Eating and drinking.  Bone protruding out, now skinny, can see ribs and backbones. But stomach not bloated. Running about. Superactive. Jumps onto owner when he is home.

Is this a case of abdominal neoplasia? For economic reasons, no further consultation or tests are done but the owner will give the following:
Azathioprine 50mgx 10 tab (1/4 sid) for 40 days and review
Pred 5 mg x 5 (1/4 sid)
h/d dry food.

Azathioprine impairs lymphocyte proliferation and rapidly dividing cells. As to the actual cause of ascites, it is hard to confirm without more tests.

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