Owner did not seek veterinary treatment for many weeks. Looks like a descemetocoele from close up images.
Thursday, September 14, 2017
3136. A long-standing corneal ulceration and pigmentation in a dog
Owner did not seek veterinary treatment for many weeks. Looks like a descemetocoele from close up images.
Wednesday, September 13, 2017
3135. INTERN, EOSINOPHILIC GRANULOMA COMPLEX. A very old cat has eosinophilic granuloma complex ? Evidence needed.
Sep 12, 2017. At Toa Payoh Vets, big bleeding granuloma now seen.
Thin. Gums are cyanotic and possibly anaemic. No mouth or gum ulcerations.
Only a large granuloma, 1.5 cm x 2 cm x 1.0 cm below the chin.
No heart disease. No blood test, so not possible to assess liver and kidney functions.
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Owner had handphone pictures. Asked to be sent to me.
Need dental scaling. Cat has periodontal disease.
No blood test to screen health. Heart and lung and abdomen OK. .
biopsy of granuloma - advised
Fine Needle Aspiration. Impression smear of granuloma - advised. See lots of eosinophils in the smear or biopsy
Check for FIV/Feline Leukaemia needed.
Megestrol acetate given instead of corticosteroid in this case. 5 mg/day for 7 days and then alternate days. Cat's granuloma no longer bleeds so much, according to the owner when phoned 8 days after treatment. See images.
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WHAT IS EGC? 3 presentations
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OTHER SUSPECTED CASES OF EGC BELOW:
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Diagnosis
DIAGNOSIS is best confirmed by a biopsy or fine needle aspirate of the eosinophilic plaque but the owner wanted to save money and permitted FIV and blood tests only as she has other stray cats to pay for expenses. In this case, the blood test show a higher % of eosinophils at 6% and the clinical signs of oral ulcers, plaques and an old leg wound now healed) indicated a likelihood of the EGC.
Blood Test Results - significant findings
1. Glucose elevated 11.0 (normal 3.9 - 6.0) - "stressed induced hyperglycaemia" in the cat.
2. Liver enzymes ALT & AST elevated --- clindamycin >15-20 days and other antibiotics and powders could affect the liver.
3. Urea below normal.
4. Platelets low 146 (300-800). Large platelets present --- toxic products from medications affecting the platelets?
RBC and WBC are normal.
Differential count - % and absolute numbers are:
N 64% 8.69
L 24% 3.19
M 6% 0.77
E 6% 0.81
B 0.3% 0.04
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3. RODENT ULCERS IN CATS (feline eosinophilic granulomatosis). Salivation and ulcers are signs.
Eosinophilic Granuloma Complex (EGC)
Three distinct but related clinical syndromes comprise the granuloma complex:
3.1 Eosinophilic (or rodent) Ulcer. This may occur on the skin or in the mouth but usually affects the upper lips. The lesions are well-demarcated ulcers.
3.2 Eosinophilic Plaque. These are raised, moist, red eroded or ulcerated areas with a well demarcated border. Pruritus is usually severe. Lesions usually occur on the underside of the cat (abdomen, brisket or inside the thighs).
3.3 Linear Granulomata. These can occur at most sites, especially behind the hind legs and within the mouth. They are well-demarcated lesions which are raised and yellow to
yellowish-pink in colour. They are often thin, hence the name *linear* granuloma.
Treatment:
1. Allergy to fleas, mites, parasites, environmental,
Steroid, ivomectin inj.
2. Allergy to dry cat food.
If food allergy, hypo-allergenic canned food 6 weeks
Thin. Gums are cyanotic and possibly anaemic. No mouth or gum ulcerations.
Only a large granuloma, 1.5 cm x 2 cm x 1.0 cm below the chin.
No heart disease. No blood test, so not possible to assess liver and kidney functions.
--------------------------------------------------------------
-----------------------------------------------------
Owner had handphone pictures. Asked to be sent to me.
Need dental scaling. Cat has periodontal disease.
No blood test to screen health. Heart and lung and abdomen OK. .
biopsy of granuloma - advised
Fine Needle Aspiration. Impression smear of granuloma - advised. See lots of eosinophils in the smear or biopsy
Check for FIV/Feline Leukaemia needed.
Megestrol acetate given instead of corticosteroid in this case. 5 mg/day for 7 days and then alternate days. Cat's granuloma no longer bleeds so much, according to the owner when phoned 8 days after treatment. See images.
------------------------
WHAT IS EGC? 3 presentations
--------------------------------------------------------
OTHER SUSPECTED CASES OF EGC BELOW:
---------------------------------
Diagnosis
DIAGNOSIS is best confirmed by a biopsy or fine needle aspirate of the eosinophilic plaque but the owner wanted to save money and permitted FIV and blood tests only as she has other stray cats to pay for expenses. In this case, the blood test show a higher % of eosinophils at 6% and the clinical signs of oral ulcers, plaques and an old leg wound now healed) indicated a likelihood of the EGC.
Blood Test Results - significant findings
1. Glucose elevated 11.0 (normal 3.9 - 6.0) - "stressed induced hyperglycaemia" in the cat.
2. Liver enzymes ALT & AST elevated --- clindamycin >15-20 days and other antibiotics and powders could affect the liver.
3. Urea below normal.
4. Platelets low 146 (300-800). Large platelets present --- toxic products from medications affecting the platelets?
RBC and WBC are normal.
Differential count - % and absolute numbers are:
N 64% 8.69
L 24% 3.19
M 6% 0.77
E 6% 0.81
B 0.3% 0.04
------------------------------------------
3. RODENT ULCERS IN CATS (feline eosinophilic granulomatosis). Salivation and ulcers are signs.
Eosinophilic Granuloma Complex (EGC)
Three distinct but related clinical syndromes comprise the granuloma complex:
3.1 Eosinophilic (or rodent) Ulcer. This may occur on the skin or in the mouth but usually affects the upper lips. The lesions are well-demarcated ulcers.
3.2 Eosinophilic Plaque. These are raised, moist, red eroded or ulcerated areas with a well demarcated border. Pruritus is usually severe. Lesions usually occur on the underside of the cat (abdomen, brisket or inside the thighs).
3.3 Linear Granulomata. These can occur at most sites, especially behind the hind legs and within the mouth. They are well-demarcated lesions which are raised and yellow to
yellowish-pink in colour. They are often thin, hence the name *linear* granuloma.
Treatment:
1. Allergy to fleas, mites, parasites, environmental,
Steroid, ivomectin inj.
2. Allergy to dry cat food.
If food allergy, hypo-allergenic canned food 6 weeks
Tuesday, September 12, 2017
3134. INTERN_VIDEO. Rabbit eye disease - corneal dystrophy or kerattitis?
2 month-old female rabbit purchased. Left eye cloudy.
Article
http://www.medirabbit.com/EN/Eye_diseases/Disorder/Lipid/Lipid_en.htm
Article
http://www.medirabbit.com/EN/Eye_diseases/Disorder/Lipid/Lipid_en.htm
Corneal lipidosis - also called corneal dystrophy or lipid keratopathy - is a condition where excess lipids (usually cholesterol esters) or minerals (calcium) are deposited under the surface of the cornea. The infiltration usually starts at the edge of the cornea and can be observed in the anterior stroma, the epithelial basement membrane and the epithelium.
Corneal lipidosis is not associated to a disease; it is not breed or gender dependent.
Etiology
A lipid rich diet and/or trauma are the main causes for lipid deposits into the cornea. Congenital factors cannot be ruled out.
Clinical signs and diagnosis
It is based on a complete ophthalmic examination and a discussion with the owner about the food fed to the rabbit.
Both eyes are usually affected (bilateral) but not necessarily to the same degree. Unilateral lipidosis has rarely been reported. The fat deposits, which usually start near the third eyelid, can be opaque, raised, subtle and pale, bright white, silver or grey colored areas. Vascularization is observed in the affected part of the cornea. While the cornea is mainly affected, fat deposits have also been noted in the lens, iris and ciliary body of a Dutch rabbit. Often it is accompanied by macrophage invasion. An inflammatory process has been observed, but does not always seem to be present.
Unlike in dogs, corneal lipidosis is associated to gradual loss of vision in rabbits. If the deposit is severe, it can lead to ulceration of the cornea.
There is no pain associated to this condition.
http://circ.ahajournals.org/cgi/reprint/18/4/519Lipid plaque in hypercholesteremic rabbit cornea occurring at site of vascularity. Cornea had been cauterized several times by heated probe. | http://circ.ahajournals.org/cgi/reprint/18/4/519Sections of rabbit cornea in region of plaque stained with hematoxylin-Sudan. Noteworthy is abundance of intracellular globular lipid and relatively slight amount of granular sudanophilia. |
Treatment
There is no medical therapy available, other than bring modification to the diet. Fatty food and milk-based products (cheese, butter, and yogurt) should be discontinued.
It is not known if superficial keratotomy can help.
Further information
Fallon MT, Reinhard MK, DaRif CA, Schoeb TR. Diagnostic exercise: eye lesions in a rabbit. Lab Anim Sci. 1988; 38:612-3.
Garibaldi BA, Goad ME. Lipid keratopathy in the Watanabe (WHHL) rabbit. Vet Pathol. 1988; 25:173-4.
Gwin RM, Gelatt KN. Bilateral ocular lipidosis in a cottontail rabbit fed an all-milk diet. J Am Vet Med Assoc. 1977; 171:887-9.
Hillyer E.V., Quesenberry K.E., Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery, New York: WB Saunders Co., 1997, p. 339-345.
Sebesteny A, Sheraidah GA, Trevan DJ, Alexander RA, Ahmed AI. Lipid keratopathy and atheromatosis in an SPF laboratory rabbit colony attributable to diet. Lab Anim. 1985; 19:180-8.
Stock EL, Mendelsohn AD, Lo GG, Ghosh S, O'Grady RB. Lipid keratopathy in rabbits. An animal model system. Arch Ophthalmol. 1985 May;103(5):726-30.
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Procedure for corneal ulceration examination
1. Schirmer tear test
2. Assess corneal and palpebral reflex
3. Thorough examination of the eyelid and conjunctival anatomy and function including
the caudal surface of the 3rd eyelid.
4. Microbiological examination if corneal ulcer is believed to be infected.
5. Fluorescein staining
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video rabbit with corneal ulcer fluorescein stain test
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DOG CORNEAL DYSTROPHY
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Normal human eye cornea
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