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    Date:   12 July, 2010  
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Acute Abdomen In A Young Male Shih Tzu 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Upd
ated:  12 July, 2010
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Be Kind To Pets
Veterinary Education
Project 2010-0129
Patient: Shih Tzu, Male, 2 years

History: On Jul 6, 2010, 9pm. Lethargy, not eating for 2 days. Fever and white gums and tongue. The domestic worker said that the dog was given (chicken +/or fish) bones by a family member recently.

Presenting signs
Acute abdomen (anterior). The dog turned and nearly bit me when  I palpated the anterior abdomen.

Blood test on Jul 7, 2010 - toxaemia and anaemia. The following significant results were:
Low red cell count ( 4.1) and haemoglobin (10.4)
Low packed cell volume (0.3)
Low platelets (47). No platelet clumps seen but few giant platelets present. Surprisingly, the White Cell Count on admission was below normal at 5.4 with neutrophils 94% and lymphocytes 4% instead of a big increase.
The liver profile was normal. Kidney profile - urea was normal. Creatinine was below normal.

Blood Heartworm test: negative

Urine test on Jul 8, 2010. Full bladder was catheterised to collect brownish red urine.  X-rays showed one urinary stone. Results were as follows:
Urine was brown and turbid. SG 1.020 pH 7.0. Abnormal findings are as follows: Protein 3+, urobilinogen 1+, bilirubin 3+, blood 4+, White Cell Count 58, RBC 243, Crystals of amorphous phosphate 2+, triple phosphate occasional, bacteria 3+

X-rays on Jul 8, 2010.
Stomach was filled with radio-opaque granules. Some larger radio-opaque lumps are present in the intestines. These were likely bones and other foreign bodies. The spleen was moderately enlarged.
 
shih tzu, male, stomach, intestines, filled bone fragments, anaemia, fever, toapayohvets, singapore shih tzu, male, stomach, intestines, filled bone fragments, anaemia, fever, toapayohvets, singapore
What's the solution? What to do?

Diagnosis
Toxaemia. Impacted stomach and intestines and urinary tract infections.

Treatment on Jul 7 & 8, 2010
IV drip x 2 bottles (glucose saline + saline) x 500 ml each for 24 hours
Vit K1 2ml in drip. Baytril 1.0 ml, Tolfedine 4% 1.0 ml x 2 days in IV.
No fever on Jul 8, 2010. Dog more alert but does not want to walk or poop.

Stomach mucosa bleeding? The dog went home for the next 2 days for observation of pooping. A laxative liquid was given.  The owner had been informed about poor prognosis if the dog does not poop or has more stomach bleeding

In this case, the blood results, especially the low platelet count were important and indicated that the dog was a very high anaesthetic risk.

I stabilised the dog using IV saline (5% glucose saline 500ml, then saline 500 ml), Vit K1 (2 ml, slow IV), baytril and tolfedine IV. 24 hours later, the owner's son and domestic worker came to visit. The dog's tongue was pinkish and he looked much more alert.

Goes Home On Day 3
The dog was eating a bit of the canned food (A/D diet). I observed that he had rapid respiratory movement when crated. He went home on Day 3. What was the cause of his toxaemia and fever? Poisons inside the stomach? Tick fever? Urinary tract infection? It was hard to know as the owner disputed the domestic worker that the dog ate bones.

I sent the dog home with a laxative and antibiotics and instructions to call me in 2 days if the dog was not all right. 5 days after consulting me, the dog was all right as the owner e-mailed me as follows:
 

OUTCOME
E-MAIL TO DR SING Sun, Jul 11, 2010

Dr Sing,
Thanks. My dog  is much better now - it eats well and passes urine and motion daily.
Do we continue giving it all the prescribed medicines? When do I bring it back for you to check?

As to what was the exact cause of the toxaemia, this is hard to say. There are many causes and supporting IV drips and drugs returned this dog to normal so far. For more interesting canine cases, go to:
Dogs

To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

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Be Kind To Pets
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