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