Nice veterinary medicine Case studies

1. Sissy
• 12 year old SF choc lab
• Tx for hypothyroidism
• Owner called a couple of weeks ago, and said she
was having some trouble posturing to defecate –
never came in
• Called on emergency Sat night. Sissy was lethargic
and not taking food
• Recommended that she come in
• He wants to wait until Monday
• Sun morning – taking food
• Sunday aft – breathing hard, passing black stools,
vomiting coffee grounds, very weak

2. Sissy
Exam – T 102.8oF, P 185 bpm
• Tachypnea, dyspnea
• Very pale mucous membranes
• Unable to walk – carried in on stretcher
• Weak femoral pulses, undetectable dorsal pedal
pulses
• Systolic BP 80 mmHg
Hx – no exposure to rodenticide
CBC
• PCV 17%, WBC 17K (segs, monos)
• Platelets 44K

3. Sissy
Profile
• Glucose 352 g/dl
• Albumin 2.0 g/dl
• globulin 2.5 g/dl
• BUN 85, creat normal, phos normal
Working Dx – acute GI Blood Loss
DDx:
• Coagulopathy – primary, secondary or both
• *Bleeding GI lesion – neoplasia, ulcer*
• Hookworm anemia unlikely (Sentinel®)
• GI foreign body

4. Sissy
Tx Plan:
• Transfuse
• Vit K 5 mg/kg SC
Dx Plan:
• Get BTT prior to transfusion
• PT – 34 sec (n. 7-12 sec)
• PTT – 117 sec (n. 12-22 sec)
• ACT – 270 sec (n. <120 sec)
• GlobalFAST®

5. Sissy
Coagulopathy:
• Problems with both
primary and secondary hemostasis
DDx:
• Liver failure – (acute), chronic
• Paraneoplastic coagulopathy
• DIC
• (Rodenticide toxicity)
• Old dog, GI bleed, DIC – cancer
• Not a simple GI bleed

6. Sissy
GlobalFAST®:
1. VetBLUE®
2. TFAST®
3. AFAST®

7. Sissy
GlobalFAST®:
1. VetBLUE®
2. TFAST®
3. AFAST®

8. Sissy
GlobalFAST®:
1. VetBLUE®
• Glide sign rules out pneumothorax & pleural effusion
• Many nodules in the lungs 3-5mm
• No lung rockets – no bleeding into the lungs
• Rodenticide toxicity unlikely
2. TFAST®
• no pericardial effusion
• Volume contraction
3. AFAST®

9. Sissy
GlobalFAST®:
1. AFAST®
• No GB halo, AFS = 0, no pleural or pericardial effusion,
flat cava
• Rules out anaphylaxis (too insidious)
• No abdominal masses seen
• Liver appears normal
• Chronic liver failure unlikely
DDx: lung nodules, DIC
• Metastatic neoplasia + bleeding GI mass
• SIRS due to lung granulomas (fungal)

10. Sissy
Sissy arrests and dies
during transfusion
Necropsy:
• Mineralized 3-5mm nodules throughout all lung lobes
• Generalized hemorrhage in the GI tract – very small GI
mural mass with no evidence of local bleeding
• Tissues submitted from lungs, liver, spleen, kidneys, gut, GI
mass
• Dx – Metastatic carcinoma with DIC, splenic thrombosis