Maltese terrier cross with enlarged abdomen

Signalment:

12-year-old female neutered Maltese Terrier cross

Presenting complaint:

abdominal enlargement, lethargy, inappetance for 3 months. Your physical exam shows an obviously distended abdomen with a very large (>10 cm diameter) firm palpable abdominal mass, mucous membranes pink but paler than normal, periodontal disease. Otherwise clinical exam within normal limits, and she seems surprisingly alert and responsive. The clients say the abdominal enlargement has only happened in the past month.

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What do you do next? Abdominal ultrasound Packed cell volume, total protein and in-house urinalysis Abdominal radiographs Options a and b Options b and c Please select an option Incorrect. Good choice, but better to include packed cell volume, total protein and urinalysis. Choose again. Incorrect. Good choice, but better to include abdominal ultrasound. Choose again. Incorrect. Because the mass is so large radiographs will probably not give as much useful information as ultrasound. Choose again. Correct. Incorrect. There is a better option.

Abdominal ultrasound report

PCV and TP report

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Review the abdominal ultrasound report, the packed cell volume and total protein report and the urinalysis report. What do you do next? Advise the clients that the ultrasound could not determine where the mass originated, so you would recommend surgery as the next step. Advise the clients that she has an abdominal tumour which is large and too difficult to remove, and probably not resectable. Advise the clients that she would benefit from a whole blood transfusion before further tests or treatment. Advise the clients that you would like to do more tests before carrying out surgery to remove the mass. Please select an option Incorrect. You have not staged the tumour before surgery. Before surgery it would be ideal to offer thoracic radiographs or thoracic and abdominal computed tomography (CT) scan, as well as results of serum biochemistry and haematology. You need to discuss the possibility of blood transfusion before, during or after surgery. It is also wise to give the option of referral in case surgery proves difficult, or blood transfusion is not available. Choose again. Incorrect. The fact that it is large does not mean it is not resectable. It proved to be a splenic mass, which was completely excised and found to be a primary splenic liposarcoma with 4 mitotic figures per high-power field. The patient has a fair to good prognosis with complete surgical resection as metastasis is generally uncommon. You could have done more to help this dog. You could also have offered the option of referral.] Incorrect. Her packed cell volume is 20%; she is stable and surprisingly alert and responsive. Her clinical signs and history fit with chronic anaemia rather than acute blood loss anaemia. A blood transfusion before surgery would be optimal but may not be necessary as long as there is minimal blood loss and short surgery time. Blood should be available for transfusion, her packed cell volume and total protein should be monitored during and after surgery, and transfusion should be carried out if packed cell volume falls below 15%. Complete blood count taken before transfusion will confirm whether the anaemia is regenerative. It is preferable to take blood for haematology and biochemistry before transfusion. Choose again. Correct.

Haematology report

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