LA clinical cases (Reuss) Flashcards

1
Q

Case: Cisco

8 year old miniature donkey gelding

2 month history of low grade colic, intermittent hematuria

A
  • Likely DDX
    • stones
  • HX
    • worse after exercise, entire urine stream
  • Urine throughout entire stream and hematuria after exercise = STONES
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2
Q

Cisco treatment

3cm cystolith

A
  • 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
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3
Q

Case: Friendly Mickey

4 day old TB colt

stopped suckling

received one dose flunixin

distended abdomen

A
  • Initial work up
    • blood gas
    • CBC
    • Chemistry panel
    • IgG analysis
    • Blood culture
    • abdominal / umbilical ultrasound
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4
Q

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

A
  • 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
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5
Q

Lactate is a product of

A
  • anaerobic metabolism
    • lack of tissue perfusion will cause increase lactate
      • hypovolemia, hypotension
      • Dehydration
      • excessive exercise
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6
Q

Friendly Mickey

TX

A
  • 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
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7
Q

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

A
  • 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
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8
Q

Aristotle post-op plan

A
  • 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
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