LA clinical cases (Reuss)

Question 1

Case: Cisco

8 year old miniature donkey gelding

2 month history of low grade colic, intermittent hematuria

Answer 1

• Likely DDX
  
  • stones
• HX
  
  • worse after exercise, entire urine stream
• Urine throughout entire stream and hematuria after exercise = STONES

Question 2

Cisco treatment

3cm cystolith

Answer 2

• perineal urethrostomy
  
  • manual crushing of stone
  • bladder lavage
• TMS - 14 days
• Prevention
  
  • stay away from peanut/alfalfa (CaCarbonate stone)
  • drinking tricks
  • weight loss: extra weight pushing on urethra

Question 3

Case: Friendly Mickey

4 day old TB colt

stopped suckling

received one dose flunixin

distended abdomen

Answer 3

• Initial work up
  
  • blood gas
  • CBC
  • Chemistry panel
  • IgG analysis
  • Blood culture
  • abdominal / umbilical ultrasound

Question 4

Friendly Mickey

Arterial blood gas

pO₂: 47 mmHg (low)

Na: 111 mmol/L (low)

K: 5.7 mmol/L (high)

Ca: 1.0 mmol/L (low)

Lactate: 3.7 mmol/L (high)

CBC boring: cept fibrinogin high

Azotemic

Answer 4

• Azotemic
  
  • can’t say pre, renal, post (would need a USG to rule out pre-renal)
• Not ventilating well from distended abdomen
• DDX
  
  • uroperitoneum
  • constipation (retained meconium)
  • colitis (pre-diarrhea)
    
    • blood work would include a low white count (sequestration)
• Ultrasound next
• Then abdominocentesis
  
  • Cr more than double peripheral Cr for uroabdomen

Question 5

Lactate is a product of

Answer 5

• anaerobic metabolism
  
  • lack of tissue perfusion will cause increase lactate
    
    • hypovolemia, hypotension
    • Dehydration
    • excessive exercise

Question 6

Friendly Mickey

TX

Answer 6

• Started fluids while draining abdomen
  
  • 2L 0.9% NaCl bolus (fluid with no P)
    
    • plus 5% dextrose: neonate and drives K intracellular by generating endogenous insulin surge
• Calcium gluconate
  
  • cardioprotective (restores resting membrane threshold to avoid cardiac arrythmias)
• Drain abdomen for better ventilation
• antimicrobials periop
• surgical correction

Question 7

Case: Aristotle

Yearling Icelandic ram

Diet: grass forage + alfalfa and peanut + grain

5 day hist lethargy, anorexia

Owner treated with: SMZ, flunixin, vit C, ammonium chloride

Answer 7

• Ultrasound: fluid around Right kidney
• SX: tube cystotomy for breeding animal
• Post renal azotemia
• TX
  
  • 1L 0.9% NaCl plus 50mL 23% Ca gluconate
  • Ceftiofur 2.2mg/kg IV q12h
  • Tube cystotomy with urethral process amputation

Question 8

Aristotle post-op plan

Answer 8

• Fluid diuresis for 48 hours
  
  • creatinine decreased to 0.6 mg/dl
• Ceftiofur for 2 weeks
• Tube management
  
  • clamp and monitor for urethral patency in about 2 weeks
• Management changes
  
  • grass hay only
  • fresh water
• Recheck
  
  • able to void normally at 4 weeks post op
  • creatinine 1.0 mg/dl
  • ultrasound: fluid around kidney was gone
  • removed tube