opd no. 540-700 17/10/2015 dvm. naridsara panyakrue (bearing pet hospital) dvm. naridsara panyakrue...

OPD No. 540-700 17/10/2015

DVM. Naridsara Panyakrue(Bearing pet hospital)

DOZO

Signalment

• Name: Dozo• Species: Canine• Breed: Poodle• Sex: Intact Male• Age: 10 yr.• Weight: 6 kg.

Owner Complain (17/10/2015)

• Depress• Cough • Decrease appetite

Duration : about 3 weeks

History taking• Mental status: Depress• Appetite: Decrease appetite• Type of Diet: Commercial• Urination: Normal• Defecation: Normal• Environment: Outdoor• Other animal contact: Yes (other dogs)• Program ectoparasite control : NO

History treatment• 23 September 2015(Bearing vet pet hospital)

subcutaneous fluid and ABO injected

• 14 October 2015(Bearing vet pet hospital)Give ABO drug, Mucolytic drug and vitamin

General Physical Examination• Rectal Temperature: 104.2°F• Body Condition Score: 3/5• Hydration Status: <5 %• Mucus Membrane: Pale pink • Cardiovascular

• Regular Heart Sound• Normal Heart Sound• Pulse quality: Strong• CRT 2 second

• Respiration:• Type of Respiration: Normal• Normal lung sound

• Ectoparasite: Tick• Orther: Havn’t Nasal discharge and Ocular discharge• Cough reflex: possitive

Problem List1. Fever

2. Depress

3. Decrease appetence

4. Tick infestation

Differential diagnosis1. Blood parasite

2. Hepatic disease

3. Kidney disease

Initial plan

• CBC + Blood parasite• Blood Chemical analysis• Snap4Dx

BloodHematology Result Reference

Hct (%) 30.3 39-56

Hb (g/dl) 9.8 11-19

RBC (106/µl) 4.8 5.5-8.5

MCV (fl) 72.6 62-72

MCH (pg) 22.2 20-25

MCHC (g/dl) 30.6 30-38

WBC count (*103 (µL)) 18 6-17

Granulocyte (%) 82.9 60-83

Lymphocyte (%) 14.8 12-30

Monocyte (%) 2.3 2-9

Eosinophil (%) 1.3

Basophil (%) - ≤ 0.25

Platelet count (*103 (cells/µl)) 41 117-460

MPV (fl) 11.9 -

PDW 17 -

PCT (%) 0.048 -

Blood parasite Ehrlichia spp. +ve -

17/10/58

Normocytic Hyperchromic anemia, Thrombocytopenia, Ehrlichiosis

Blood chemistry Result ReferenceBUN (mg/dl) 8 7-27

Creatinine (mg/dl) 0.4 0.5-1.8

BUN/Crea 18

AST((SGOT) (U/L)) 183 0-50

ALT ((SGPT) (U/L)) 201 10-125

ALP (U/L) 344 23-212

Result• Ehrlichiosis• Thrombocytopenia• Anemia• Hepatocellular injury

Systemic involve• Cardiovascular system• Hepatobiliary system

Differential Diagnosis

Anemia

Hemolytic anemia

Non-regenerative anemia

Regenerative anemia

• Bone marrow disease

• Drug/Chemical induced

• Infectious• Chronic disease• Decrease

Erythropoietin• Immune

• External blood loss

• Internal blood loss

Blood loss anemia

• Blood paraite• Immune-mediated anemia• Chemical or toxin• Herediary hemolytic anemia• Heartworm

Revise Problem ListProblem List1. Fever

2. Depress

3. Decrease appetence

4. Tick infestation

5. Cough

Lab• CBC : Normocytic Hyperchromic

anemia, Thrombocytopenia

• Ehrlichia spp +ve

• Blood Chemical analysis : High AsT, ALT and ALP

• Cough induce: possive

Final diagnosisEhrlichiosis

Hepatocellular injury

Tentative diagnosis• Anaplasmosis• Babiesiosis

Doxycycline(100) 1 t. po pc sid/14t

Metadoxil(500) ½ t. po pc sid/7t

Ursolin 1 cap po pc sid/7t

Tolfedine(60) ½ t po pc sid/1t

Folic 1 t. po pc sid/7t

FBC 1t po pc sid/7t

Bromhexine 1t po pc bid/14t

Treatment plan

Future plan• Blood Recheck: CBC, Serum chemistry

every 14 day• Following every two week• Recheck blood parasite in the next month• Snap4DX?: orther blood parasite• Ultrasound:? differantiate bile duct

obstruction and hepatic parenchyma• Liver biopsy?: final diagnosis Live disease

Prognosis• Poor to guard

Client education• Food management

Recommend: l/d• Prevention : control tick , flea ,

Environment : Bayticol 10 cc/15 liter for

wash cage animal : Bayticol 10 cc/15 liter bath every 2 week.

• Vaccination

Thank you for attention