Difference between revisions of "Small Animal Emergency and Critical Care Medicine Q&A 09"

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'''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.'''
'''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.'''
 
  
 
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<FlashCard questions="3">
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<FlashCard questions="4">
|q1=What are the pros and cons of the following surgical procedures for preventing gastric volvulus from recurring:
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|q1=What is your tentative diagnosis?
*circumcostal gastropexy;
 
*antral incisional gastropexy;
 
*tube gastropexy;
 
*midline abdominal closure gastropexy?
 
 
|a1=
 
|a1=
Circumcostal gastropexy.
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Eclampsia.
:*Pros: most reliable adhesions obtained.
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|l1=
:*Cons: time-consuming preparation; potential for rib fractures; potential for entering pleural space and causing pneumothorax.<br>
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|q2=What potential problems in the dam should be ruled out with your initial data base and physical examination?
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=Gastric Dilatation and Volvulus#Treatment
 
|q2=What vessels are most commonly torn during a gastric dilatation/volvulus episode, and where are these located?
 
 
|a2=
 
|a2=
Short gastric arteries and left epiploic artery along the greater curvature of the fundus.
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Hypocalcemia is often accompanied by hyperthermia, dehydration, hypoglycemia and cardiac arrhythmias.
|l2=Monogastric Stomach - Anatomy & Physiology#Vasculature
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|l2=
|q3=What surgical findings would indicate that a splenectomy is required?
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|q3=What is your management plan for this case?
 
|a3=
 
|a3=
*Dark/black areas suggesting an infarction/ischemia;
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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.
*lack of palpable pulses in the splenic hilus suggesting arterial thrombosis;
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*disseminated masses that may be neoplastic;
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A second dose of calcium gluconate (1–2 ml/kg) can be given s/c if it is diluted 50:50 with saline.
*bleeding mass;
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*uncontrollable hemorrhage of the spleen.
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Fever, dehydration and hypoglycemia can be managed with i/v fluid therapy.
|l3=Gastric Dilatation and Volvulus#Treatment
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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.
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|l3=
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|q4=What problems have been associated with oral and parenteral calcium administration?
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|a4=
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Calcium supplementation prior to whelping inhibits parathormone secretion and makes the dam more prone to hypocalcemia during lactation.
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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.
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Calcium chloride must never be administered i/m or s/c, as tissue necrosis and skin sloughs can occur.
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|l4=
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</FlashCard>
 
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Revision as of 11:37, 17 August 2011


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.


Question Answer Article
What is your tentative diagnosis? [[|Link to Article]]
What potential problems in the dam should be ruled out with your initial data base and physical examination? [[|Link to Article]]
What is your management plan for this case? [[|Link to Article]]
What problems have been associated with oral and parenteral calcium administration? [[ |Link to Article]]


Small Animal Emergency and Critical Care Medicine Q&A 10Next Question.png