ruptured bladder?

Re: ruptured bladder?

Kate Richardson — Mon, 30 Apr 2012 11:21:45 GMT

[quote user="Lorna McHardy"]

[quote user="Kate Richardson"]

Amylase may also be elevated due to reduced renal clearance eg in renal disease or hypovolaemia/dehydration

[/quote]

Yes, but if that were the cause, I don't think it would be off the scale along with the ALT, and accompanied by a mildly raised glucose and a lipase of 5876 U/L. And her renal disease appears to be mild.

[/quote]

Agreed, wasn't saying she didn't have pancreatitis, seems very likely if lipase elevated too and didn't take in that amylase and alt were off the scale, just suggesting other reasons for elevated amylase. Glad doggy doing well

Re: ruptured bladder?

Gerry Henry — Mon, 30 Apr 2012 10:53:27 GMT

Gerry m'dear, I tried that...

Ma Cher Kissy,

Practice makes perfect; keep trying.

Tout a toi.

Re: ruptured bladder?

Lorna McHardy — Mon, 30 Apr 2012 10:42:21 GMT

Gerry m'dear, I tried that...

But thanks anyway

P.S. she's doing ok this morning. With a bit of luck, her pancreatitis will continue to stabilize, and the resident orthopaedic wizard will be able to fix the pelvis. I do love a good analgesia CRI. It's nice to be back home!

Thanks to everyone for helpful suggestions.

Re: ruptured bladder?

Gerry Henry — Mon, 30 Apr 2012 10:24:19 GMT

Dear Kismet,

Practice placing a catheter without using a speculum; choose a size smaller than you would normally, pinch the ventral part of the vulva and draw it ventrally and caudally (i.e. we're stretching and straightening the anterior vagina); slide the catheter along the ventral floor of the vagina (avoiding the clitoral fossa obviously) and it should slot in nicely; introduce a bit of air and Bob's your mother's brother.

Always a pleasure.

Re: ruptured bladder?

Lorna McHardy — Sun, 29 Apr 2012 19:19:31 GMT

[quote user="Kate Richardson"]

Amylase may also be elevated due to reduced renal clearance eg in renal disease or hypovolaemia/dehydration

[/quote]

Re: ruptured bladder?

Lorna McHardy — Sun, 29 Apr 2012 19:15:21 GMT

[quote user="james herriot lied"]

Sorry to hear that your weekend's a bit of a 'mare, Lorna. All things will come to pass, though, and that first post-work dram will taste pretty good when you finish.

My collie went through very similar biochemical changes 6 or 7 years ago - a transient diabetes (transient being about a week) with increase in alt and pancreatic enzymes following RTA where the car went right over the top of her. It all fixed itself with a bit of support. I'd suspect that fluids and pain relief will see you through.

Sorry also that you seem to be on the red-starring pondlife's hit list. We all have to take a turn these days - I don't tend to mind myself, but it's easy to feel a bit wounded when things are stressy. Mainly, I find this and a couple of regular trolls to be depressing sign that we have some damaged individuals in the profession.

[/quote]

Thanks

But honestly, there are so many red stars about that appear to be distributed randomly that I really don't give a monkeys. I asked for opinions on an xray, and got a constructive and helpful discussion that developed with my case and supplied some very welcome moral support. What more would I want? To oblivion with the red-starrers, who cares. As long as it doesn't stop people from asking clinical questions, of course... I'd hate to think it might be putting people off.

On the plus side, since following the blood results, I've increased her fluid levels, introduced ranitidine, and changed her pain meds to a methadone/ketamine CRI, she has sat up and started wagging again. And she's not vomited any more, either. I think she might be ok, eventually!

P.S. I don't drink alcohol.... but the post-on-call-relax tomorrow morning will be none the less pleasant

Re: ruptured bladder?

Lorna McHardy — Sun, 29 Apr 2012 19:06:33 GMT

[quote user="Andrew Kent"]

It seems an odd response to trauma, if anything muscle crush injuries should cause hyperkalaemia so the changes that you report sound more like an osmotic diuresis, this may be worse due to the concurrent renal disease. Equally if the dog has been in shock then renal excretion of lactate will cause an increased loss of K+.

[/quote]

My favourite laboratory results interpretations book lists such injuries as a differential for hypokalaemia. I'm too tired to remember the mechanism!

Re: ruptured bladder?

Gillian Mostyn — Sun, 29 Apr 2012 18:49:56 GMT

[quote user="james herriot lied"]Sorry also that you seem to be on the red-starring pondlife's hit list. We all have to take a turn these days - I don't tend to mind myself, but it's easy to feel a bit wounded when things are stressy. Mainly, I find this and a couple of regular trolls to be depressing sign that we have some damaged individuals in the profession.[/quote]

Just give her a better start rating yourself.....it is an average so as long as a few people give a better rating it'll get rid of unfair red stars very quickly.

Re: ruptured bladder?

james herriot lied — Sun, 29 Apr 2012 18:33:23 GMT

Sorry to hear that your weekend's a bit of a 'mare, Lorna. All things will come to pass, though, and that first post-work dram will taste pretty good when you finish.

Re: ruptured bladder?

Kate Richardson — Sun, 29 Apr 2012 17:41:09 GMT

Amylase may also be elevated due to reduced renal clearance eg in renal disease or hypovolaemia/dehydration

Re: ruptured bladder?

Andrew Kent — Sun, 29 Apr 2012 16:05:08 GMT

Re: ruptured bladder?

Lorna McHardy — Sun, 29 Apr 2012 15:37:27 GMT

Hartman's; her electrolytes were normal last night and I dropped the rate to maintenance overnight since she'd been doing so well. I really don't think that's the problem. Rate's up again now, obviously.

Re: ruptured bladder?

Andrew Kent — Sun, 29 Apr 2012 15:24:19 GMT

What fluid type is she on? Even if crush injury is complicating things those changes would be exacerbated by saline. Andy

Re: ruptured bladder?

Lorna McHardy — Sun, 29 Apr 2012 15:06:09 GMT

I/m. I'll see how she goes once the antiemetics kick in; also, she might be needing to urinate again and improve once she has. I don't think it's the fluids that are destabilizing her electrolytes; I'm thinking crush injury effect. She's hanging in there; just need to keep her stable and control her pain until it settles back down again. Then refer for treatment of the fracture! It's one of those weekends where you consider changing your name by deed poll to Dr.Death, or Typhoid Mary, or somesuch. I really don't want to lose this one.

Re: ruptured bladder?

Andrew Kent — Sun, 29 Apr 2012 14:33:59 GMT

0.3mg/kg IM or IV? If IV then you are towards the top of the range and may need to consider alternative analgesia if still painful (eg MLK) but if IM then can increase up to 0.5 mg/Kg.

What fluid has she been on? Electrolytes could be a consequence of high volume of Saline if that is what you have been using. Traumatic pancreatitis certainly sounds a possibility.

Andy

Re: ruptured bladder?

Lorna McHardy — Sun, 29 Apr 2012 14:09:50 GMT

0.3mg/kg. She's now hypokalaemic and slightly hypernatraemic which I'm thinking is due to the trauma - nobody knows whether the wheels actually ran over her or not; her urea and creatinine are raised but not dramatically so which fits the renal disease history; and her amylase and alt are off the scale. There is also a slightly raised glucose. Traumatic pancreatitis? Might explain why she was doing really well after the first 12 hours and is now vomiting and more painful again.

Could the daft critter not have just left the rabbit alone????? She's absolutely lovely, as well :0((

Re: ruptured bladder?

Andrew Kent — Sun, 29 Apr 2012 13:01:18 GMT

What dose of methadone is she on? There is a big range and I frequently find that very painful animals will need to be towards the upper end of it.

Andy

Re: ruptured bladder?

Lorna McHardy — Sun, 29 Apr 2012 12:37:15 GMT

I scanned her yesterday and couldn't see any free fluid. Then she had a massive wee in the early hours so I'm much happier about her bladder now. Pain control, however, is a little difficult... she's still needing 4-hourly methadone which does not appear to be quite enough; still slightly moany now and then and generally looking unhappy. I'd not given her NSAID until this morning because she's on fortekor and the owner reports renal issues... however, I injected a dose a short while ago thinking she's really well hydrated now so it should be ok, and now she's just vomited. Am now running biochem, which maybe I should have done first. Sigh

Re: ruptured bladder?

jd2008 — Sun, 29 Apr 2012 11:47:06 GMT

[quote user="Michael Woodhouse"]

[quote user="Robin Grimmer"]You could do a paracentesis and check the potassium level in it to confirm it's urine - or even use an Azostick.[/quote]

My understanding (mainly a cow vet so claiming no great experience in this area) was to measure creatinine level in blood and peritoneal fluid and compare. My understanding was the urea and potassium diffuse across membranes too quickly to be reliable.

[/quote] You're spot on Michael.

Re: ruptured bladder?

jd2008 — Sun, 29 Apr 2012 11:45:20 GMT

In cases where urethral catheterisation is not possible you can use a foley catheter inserted into the vestibule. Inflate the cuff to occlude to vestibule (can also clamp the vaginal lips too as an extra safeguard against leakage) then instil contrast via the catheter. You'll get plenty contrast into the urethra and bladder this way.

Re: ruptured bladder?

Rob Loxley — Sun, 29 Apr 2012 11:20:49 GMT

[quote user="Mark Rowland"] I think the op said that bladder catheterisation was unsuccessful because of lack of a speculum and size of the bitch so plain radiographs only were available.[/quote]

I have used a sterile otoscope speculum for direct visualisation and catheterisation of the urethra in bitches and queens.

Re: ruptured bladder?

Mark Holmes — Sat, 28 Apr 2012 22:02:37 GMT

[quote user="Mark Rowland"][quote user="Mark Holmes"]Sorry iv contrast? Why not put it up a urinary catheter and fill the bladder. I would agree ultrasound better.

[/quote] Agree re ultrasound. I think the op said that bladder catheterisation was unsuccessful because of lack of a speculum and size of the bitch so plain radiographs only were available.

[/quote] Noddy's guide to exams - read the bleeding question! DOH!

Re: ruptured bladder?

Mark Rowland — Sat, 28 Apr 2012 21:22:56 GMT

Re: ruptured bladder?

Lorna McHardy — Sat, 28 Apr 2012 21:14:04 GMT

She is doing better.

Her tail's wagging, I'm almost sure now that the bladder is filling - abdomen much easier to palpate now that she's no longer quite so painful, and she's managing to stand up briefly to move herself about the kennel. And she's had a little lick at some food

Re: ruptured bladder?

Mark Rowland — Sat, 28 Apr 2012 20:42:54 GMT

[quote user="Mark Holmes"]Sorry iv contrast? Why not put it up a urinary catheter and fill the bladder. I would agree ultrasound better.

[/quote] Agree re ultrasound. I think the op said that bladder catheterisation was unsuccessful because of lack of a speculum and size of the bitch so plain radiographs only were available.