31,596
edits
Changes
Rabbit Medicine and Surgery Q&A 15 (view source)
Revision as of 19:01, 10 August 2011
, 19:01, 10 August 2011Created page with "{{Template:Manson Keeble Meredith}} centre|500px <br /> '''A seven-year-old intact male English rabbit, housed indoors, presents with acute on..."
{{Template:Manson Keeble Meredith}}
[[Image:Rabbit Medicine 15.jpg|centre|500px]]
<br />
'''A seven-year-old intact male English rabbit, housed indoors, presents with acute onset tachypnoea and laboured breathing. There is a three-month history of weight loss, hindlimb weakness and rapid fatigue. The rabbit is alert, thin and weak. The mucous membranes are pale, with prolonged capillary refill time. A good response is noted to oxygen administration. The rabbit is sedated with intravenous midazolam and lateral and ventrodorsal radiographs of the thorax are taken.'''
<br />
<FlashCard questions="3">
|q1=What are the differential diagnoses in this case?
|a1=
Congestive heart failure (myocardial, valvular and congenital disease) is seen in middle-aged to older rabbits. The weakness, weight loss and rapid fatigue observed, although non-specific signs, should arouse suspicion of cardiac or lower respiratory disease. <br><br>
Other differentials include:
*pyothorax – pleuropneumonia typically due to pasteurellosis but other bacterial agents are often involved;
*modified transudates seen secondary to neoplasia, lung lobe torsion or diaphragmatic hernia;
*haemothorax – seen in viral haemorrhagic disease, coagulopathies or trauma.
|l1=
|q2= Based on the radiographic findings, what immediate treatment would you consider?
|a2=
The radiographs show a pleural effusion. Immediate thoracocentesis will help stabilize the rabbit as well as determine the type of effusion.
*Drain the thorax bilaterally using a 23 gauge butterfly catheter placed ventrally in the chest wall.
*Remove as much fluid as possible by aspirating multiple sites.
*Oxygen should be provided via a face mask during this procedure and stress should be kept to a minimum.
*Sedation is often not required in debilitated animals, although diazepam (0.5–1 mg/kg i/v or i/m) or midazolam (1–2 mg/kg i/v or i/m) may be used if necessary. <br><br>
In this case 20 ml of a serosanguinous fluid was obtained from both left and right sides of the chest. It was found to be a modified transudate with a protein of 22.4 g/l (2.4 g/dl) (ref: 25–30 g/l [2.5–3 g/dl]) and a nucleated cell count of 2 × 109/l (2000/μl) (ref: 1–7 × 109/l [1000–7000/μl]). No organisms were cultured.
|l2=
|q3=What further diagnostic tests might be helpful?
|a3=
#Once the rabbit is stable the thoracic radiography is repeated to evaluate fully the thoracic contents.
#Echocardiography should be carried out to characterize any cardiac disease further.
#Electrocardiography, blood pressure measurement and routine blood tests are useful in reaching a definitive diagnosis and treatment plan.
|l3=
</FlashCard>
{{#tag:imagemap|Image:Next Question.png{{!}}center{{!}}200px
rect 0 0 860 850 [[Rabbit Medicine and Surgery Q&A 16|Rabbit Medicine and Surgery Q&A 16]]
desc none}}
[[Category:Rabbit Medicine and Surgery Q&A]]
[[Image:Rabbit Medicine 15.jpg|centre|500px]]
<br />
'''A seven-year-old intact male English rabbit, housed indoors, presents with acute onset tachypnoea and laboured breathing. There is a three-month history of weight loss, hindlimb weakness and rapid fatigue. The rabbit is alert, thin and weak. The mucous membranes are pale, with prolonged capillary refill time. A good response is noted to oxygen administration. The rabbit is sedated with intravenous midazolam and lateral and ventrodorsal radiographs of the thorax are taken.'''
<br />
<FlashCard questions="3">
|q1=What are the differential diagnoses in this case?
|a1=
Congestive heart failure (myocardial, valvular and congenital disease) is seen in middle-aged to older rabbits. The weakness, weight loss and rapid fatigue observed, although non-specific signs, should arouse suspicion of cardiac or lower respiratory disease. <br><br>
Other differentials include:
*pyothorax – pleuropneumonia typically due to pasteurellosis but other bacterial agents are often involved;
*modified transudates seen secondary to neoplasia, lung lobe torsion or diaphragmatic hernia;
*haemothorax – seen in viral haemorrhagic disease, coagulopathies or trauma.
|l1=
|q2= Based on the radiographic findings, what immediate treatment would you consider?
|a2=
The radiographs show a pleural effusion. Immediate thoracocentesis will help stabilize the rabbit as well as determine the type of effusion.
*Drain the thorax bilaterally using a 23 gauge butterfly catheter placed ventrally in the chest wall.
*Remove as much fluid as possible by aspirating multiple sites.
*Oxygen should be provided via a face mask during this procedure and stress should be kept to a minimum.
*Sedation is often not required in debilitated animals, although diazepam (0.5–1 mg/kg i/v or i/m) or midazolam (1–2 mg/kg i/v or i/m) may be used if necessary. <br><br>
In this case 20 ml of a serosanguinous fluid was obtained from both left and right sides of the chest. It was found to be a modified transudate with a protein of 22.4 g/l (2.4 g/dl) (ref: 25–30 g/l [2.5–3 g/dl]) and a nucleated cell count of 2 × 109/l (2000/μl) (ref: 1–7 × 109/l [1000–7000/μl]). No organisms were cultured.
|l2=
|q3=What further diagnostic tests might be helpful?
|a3=
#Once the rabbit is stable the thoracic radiography is repeated to evaluate fully the thoracic contents.
#Echocardiography should be carried out to characterize any cardiac disease further.
#Electrocardiography, blood pressure measurement and routine blood tests are useful in reaching a definitive diagnosis and treatment plan.
|l3=
</FlashCard>
{{#tag:imagemap|Image:Next Question.png{{!}}center{{!}}200px
rect 0 0 860 850 [[Rabbit Medicine and Surgery Q&A 16|Rabbit Medicine and Surgery Q&A 16]]
desc none}}
[[Category:Rabbit Medicine and Surgery Q&A]]