WikiVet English

Changes

Small Animal Emergency and Critical Care Medicine Q&A 09 (view source)

Revision as of 07:46, 11 October 2011

63 bytes removed ,  07:46, 11 October 2011
no edit summary
Line 4: Line 4:     
<br />
 
<br />
−
 
+
'''Your triage nurse alerts you that a three-year-old, male Coonhound (40 kg) with a few hours’ history of non-productive retching and pacing has entered the hospital. Primary survey reveals poor perfusion, rapid and irregular heart rate, and a tympanic, distended cranial abdomen. A lateral radiograph reveals gastric dilatation and volvulus.'''
−
'''A two-year-old mixed-breed bitch had four puppies 16 days ago. The puppies seem healthy but the owners report that the dam is salivating, walking stiffly, panting and has muscle tremors.'''
      
<br />
 
<br />
   −
<FlashCard questions="4">
+
<FlashCard questions="3">
−
|q1=What is your tentative diagnosis?
+
|q1=What are the pros and cons of the following surgical procedures for preventing gastric volvulus from recurring: circumcostal gastropexy; antral incisional gastropexy; tube gastropexy; midline abdominal closure gastropexy?
 
|a1=
 
|a1=
−
Eclampsia.
+
Circumcostal gastropexy.
−
|l1=Hypocalcaemia#Eclampsia
+
:*Pros: most reliable adhesions obtained.
−
|q2=What potential problems in the dam should be ruled out with your initial data base and physical examination?
+
:*Cons: time-consuming preparation; potential for rib fractures; potential for entering pleural space and causing pneumothorax.<br>
 +
Antral incisional gastropexy.
 +
:*Pros: rapid technique with less technical difficulty.
 +
:*Cons: none. <br>
 +
Tube gastropexy.
 +
:*Pros: ability for postoperative decompression and feeding control.
 +
:*Cons: requires time for fistula formation before tube can be removed; requires exposure of the gastric lumen. <br>
 +
Midline abdominal closure gastropexy.
 +
:*Pros: rapid technique.
 +
:*Cons: makes a reapproach to the cranial abdomen very difficult.
 +
|l1=
 +
|q2=What vessels are most commonly torn during a gastric dilatation/volvulus episode, and where are these located?
 
|a2=
 
|a2=
−
Hypocalcemia is often accompanied by hyperthermia, dehydration, hypoglycemia and cardiac arrhythmias.
+
Short gastric arteries and left epiploic artery along the greater curvature of the fundus.
−
|l2=Hypocalcaemia#Eclampsia
+
|l2=
−
|q3=What is your management plan for this case?
+
|q3=What surgical findings would indicate that a splenectomy is required?
 
|a3=
 
|a3=
−
Ten percent calcium gluconate (0.5–1.5 ml/kg) should be administered slowly i/v until clinical signs regress. The drug must be discontinued if bradycardia or other arrhythmias are noted on ECG. Vomition or ‘licking the lips’ are indications that i/v administration should be discontinued.
+
*Dark/black areas suggesting an infarction/ischemia;
−
 
+
*lack of palpable pulses in the splenic hilus suggesting arterial thrombosis;
−
A second dose of calcium gluconate (1–2 ml/kg) can be given s/c if it is diluted 50:50 with saline.
+
*disseminated masses that may be neoplastic;
−
 
+
*bleeding mass;
−
Fever, dehydration and hypoglycemia can be managed with i/v fluid therapy.
+
*uncontrollable hemorrhage of the spleen.
−
 
+
|l3=
−
Ideally, the pups should be removed and hand raised, but if they are allowed to remain with the dam, she should receive oral calcium supplementation (25–50 mg/kg/day divided every 8 hours) until lactation is completed.
  −
|l3=Hypocalcaemia#Eclampsia
  −
|q4=What problems have been associated with oral and parenteral calcium administration?
  −
|a4=
  −
Calcium supplementation prior to whelping inhibits parathormone secretion and makes the dam more prone to hypocalcemia during lactation.
  −
 
  −
If i/v calcium is administered too rapidly, cardiac arrhythmias may result. Oversupplementation with calcium may cause arrhythmias, neurologic impairment, GI dysfunction and renal failure.
  −
 
  −
Calcium chloride must never be administered i/m or s/c, as tissue necrosis and skin sloughs can occur.
  −
|l4=Hypocalcaemia#Eclampsia
   
</FlashCard>
 
</FlashCard>
   Line 42: Line 42:  
desc none}}
 
desc none}}
 
[[Category:Small Animal Emergency and Critical Care Medicine Q&A]]
 
[[Category:Small Animal Emergency and Critical Care Medicine Q&A]]
 +
[[Category:To do - Manson]]
Retrieved from "https://en.wikivet.net/Special:MobileDiff/129621"