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

Revision as of 16:37, 11 October 2011

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|book = Small Animal Emergency and Critical Care Medicine Q&A}}
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[[File:ECC 09a.jpg|centre|500px]]
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'''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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'''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.'''
      
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<FlashCard questions="4">
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<FlashCard questions="3">
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|q1=What is your tentative diagnosis?
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|q1=What are the pros and cons of the following surgical procedures for preventing gastric volvulus from recurring:
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*circumcostal gastropexy;
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*antral incisional gastropexy;
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*tube gastropexy;
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*midline abdominal closure gastropexy?
 
|a1=
 
|a1=
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Eclampsia.
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Circumcostal gastropexy.
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|l1=
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:*Pros: most reliable adhesions obtained.
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|q2=What potential problems in the dam should be ruled out with your initial data base and physical examination?
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:*Cons: time-consuming preparation; potential for rib fractures; potential for entering pleural space and causing pneumothorax.<br>
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Antral incisional gastropexy.
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:*Pros: rapid technique with less technical difficulty.
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:*Cons: none. <br>
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Tube gastropexy.
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:*Pros: ability for postoperative decompression and feeding control.
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:*Cons: requires time for fistula formation before tube can be removed; requires exposure of the gastric lumen. <br>
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Midline abdominal closure gastropexy.
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:*Pros: rapid technique.
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:*Cons: makes a reapproach to the cranial abdomen very difficult.
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|l1=Gastric Dilatation and Volvulus#Treatment
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|q2=What vessels are most commonly torn during a gastric dilatation/volvulus episode, and where are these located?
 
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|a2=
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Hypocalcemia is often accompanied by hyperthermia, dehydration, hypoglycemia and cardiac arrhythmias.
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Short gastric arteries and left epiploic artery along the greater curvature of the fundus.
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|l2=
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|l2=Monogastric Stomach - Anatomy & Physiology#Vasculature
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|q3=What is your management plan for this case?
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|q3=What surgical findings would indicate that a splenectomy is required?
 
|a3=
 
|a3=
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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.
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*Dark/black areas suggesting an infarction/ischemia;
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*lack of palpable pulses in the splenic hilus suggesting arterial thrombosis;
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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.
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*disseminated masses that may be neoplastic;
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*bleeding mass;
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Fever, dehydration and hypoglycemia can be managed with i/v fluid therapy.
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*uncontrollable hemorrhage of the spleen.
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|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>
 
</FlashCard>
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[[Category:Small Animal Emergency and Critical Care Medicine Q&A]]
 
[[Category:Small Animal Emergency and Critical Care Medicine Q&A]]
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