Enlarged Abdomen and Discomfort

RE: Enlarged Abdomen and Discomfort

Anthony Todd — Mon, 27 Mar 2017 23:37:59 GMT

[quote user="Beats"]only dry as the wet forms are too high in fat.[/quote]

Yes, fat goes off in oxygen, I assume, which is why the energy in cat and dog dry food is replaced with carbohydrate [and why Zn deficiency in dry food, carried in fat, was an early problem]

[quote user="Beats"]Millie Wolfhart Tracker dry[/quote]...

Er, "This specially formulated recipe boasts low fat and easy digestible protein sources."

RE: Enlarged Abdomen and Discomfort

Beats — Mon, 27 Mar 2017 21:03:58 GMT

[quote user="Sarah Keir"]

Chappie is not low fat enough. Most wet food is not low fat.

My recommendations are:

- Hills I/d low fat (wet and dry)

- Arden Grange light (dry)

- Millie Wolfheart tracker(tripe based) or low fat - only dry as the wet forms are too high in fat.

[/quote]

Sarah, I don't quite follow how these are lower fat than chappie (dry).

My rough back of an envelope calc is that these foods rank as follow in terms of %calories as fat (assuming roughly approximate digestibilities of the various constituents) from least to greatest is:

Royal Canin GI low fat tin

Royal Canin GI low fat dry

Chappie Dry / Hill's I/D low fat dry (tied in third place)

Arden Grange Light Dry / Hill's i/d low fat tinned (tied, incidentally, many other foods such as ASDA smartprice complete dog food would also tie here)

Millie Wolfhart Tracker dry

Chappie Tins

I may be getting something wrong though?

RE: Enlarged Abdomen and Discomfort

Sarah Keir — Mon, 27 Mar 2017 08:22:27 GMT

yes, don't feed the wet.

RE: Enlarged Abdomen and Discomfort

Rob Loxley — Sun, 26 Mar 2017 21:06:28 GMT

A quick google suggest on a dry matter basis Hills i/d low fat dry food is 7.4% fat; Chappie Adult dry food is 7.1% (the tins are higher fat %).

RE: Enlarged Abdomen and Discomfort

Sarah Keir — Sun, 26 Mar 2017 14:33:33 GMT

Chappie is not low fat enough. Most wet food is not low fat.

My recommendations are:

- Hills I/d low fat (wet and dry)

- Arden Grange light (dry)

- Millie Wolfheart tracker(tripe based) or low fat - only dry as the wet forms are too high in fat.

RE: Enlarged Abdomen and Discomfort

Anthony Todd — Sun, 26 Mar 2017 12:41:54 GMT

[quote user="Michael Woodhouse"]If not improving then I'll see if she wants to go off to a specialist.[/quote]

What will a specialist do that Michael hasn't done apart from, as usual, repeating all the tests ......?

We've had expert opinions on here already!

Is it possible to explore the "pancreatitis" possibility definitively via further bloods?

[er, note my silence regarding an ex-lap except that the pancreas would probably have shown obvious signs....]

RE: Enlarged Abdomen and Discomfort

Rob Loxley — Sun, 26 Mar 2017 12:29:15 GMT

[quote user="Michael Woodhouse"]Is there a particular low fat diet that people recommend?[/quote]

RCW Low Fat; Chappie

RE: Enlarged Abdomen and Discomfort

Michael Woodhouse — Sun, 26 Mar 2017 00:01:55 GMT

[quote user="Glen McIntosh"]

How's the dog?

Getting better?

Getting worse?

Appetite?

How is the pain?

[/quote]

Dog seems ok in itself. I will enquire whether painkillers have made any difference.

My temptation is to try Sarah Keir's suggestion with Destolit (unless there is now a dog one I don't know about?!) and low fat diet and monitor fats and T4 in a month.

If not improving then I'll see if she wants to go off to a specialist.

Is there a particular low fat diet that people recommend?

Genuinely appreciate everyone's help on this - thanks guys.

RE: Enlarged Abdomen and Discomfort

Sarah Keir — Sat, 25 Mar 2017 10:22:42 GMT

Looks like a primary hyperlipidaemia/hypercholesterolaemia of miniature schnauzers. This can be associated with pancreatitis and remember the specPLI is poor at picking up chronic pancreatitis. I would second getting a second opinion on the scan but is this is not possible starting UDCA and a low fat diet and monitoring.

RE: Enlarged Abdomen and Discomfort

Glen McIntosh — Sat, 25 Mar 2017 02:24:05 GMT

How's the dog?

Getting better?

Getting worse?

Appetite?

How is the pain?

I think primary presenting complaint of pain is significant. Hypothyroidism and Cushings don't usually have abdominal pain as part of their presentation, unless they have comorbities such as pancreatitis or hepatobilary disease (or both). Or some sort of intraabdominal thromboembolic disease secondary to cushings.

A mild pancreatitis may resolve spontaneously whatever you do. But probably the dog has underlying endocrine disease as well that also needs to be identified and treated.

More severe pancreatitis and some types of hepatobilary disease may not resolve spontaneously and have a tendency to get very very sick and, not infrequently, die.

Either way, about now I would definitely be considering referring this case to either a Internal Medicine specialist or at least a confident ultranographer with a good machine who can identify adrenals and pancreas. Especially if the dog is not getting better.

But, of course, you will be in a better position to judge.

RE: Enlarged Abdomen and Discomfort

Michael Woodhouse — Fri, 24 Mar 2017 22:36:33 GMT

Total Bilirubin 1.8 umol/L 0.1 - 4.2
Bile Acids (fasting) 11.6 High umol/L 0.1 - 5.0
Cholesterol >18.00 High mmol/L 3.20 - 6.20
Triglycerides 2.94 High mmol/L 0.30 - 1.20
*Thyroxine Low nmol/L (Microgenics) 8.0 13.0 - 51.0

Canine Serum TSH 0.15 ng/mL 0.00 - 0.50

Thoughts?

(No expert ultrasonographer but liver looked normal echogenicity and gall bladder uniform black and not 'sludgy').

RE: Enlarged Abdomen and Discomfort

Anthony Todd — Fri, 24 Mar 2017 17:45:26 GMT

[quote user="Anthony Todd"]

Crikey, MJV would have done an ex-lap [between consults], taken suspicious samples, if any, and [hopefully if nothing catastrophic] finished the consults and got the results next day and taken it from there......

[/quote]

PS Should have taken a urine sample first, thinking about it; easy etc. andwe could have been surprised.....

RE: Enlarged Abdomen and Discomfort

Thomas Johnson — Fri, 24 Mar 2017 09:27:09 GMT

[quote user="Claire Fisher"]

If Cushings is still a concern you could ask the lab to run 17 OHP on the pre and post ACTH samples in case it is an atypical case.

[/quote]

If the bloods you've sent off for bile acids, T4 etc come back okay I would also consider testing 17 OHP.

RE: Enlarged Abdomen and Discomfort

Anthony Dennison — Fri, 24 Mar 2017 09:19:51 GMT

You said the liver looked normal on scan, how did the gall bladder look?

I'm having problems with a very similar case! (see portal hypertension thread).

RE: Enlarged Abdomen and Discomfort

Michael Woodhouse — Thu, 23 Mar 2017 21:16:05 GMT

Bloods re-taken today and sent for T4/TSH bile acids, cholesterol and triglycerides.

It's a staff member's dog so I have confidence in the history and good access to do things if I want. Will get some urine if these bloods are WNL

RE: Enlarged Abdomen and Discomfort

Nicola Cole — Thu, 23 Mar 2017 21:11:20 GMT

If I'm not sure whether painful abdo and palpation tense (but not sure if just stressed in vets or whether painful) I will often temporarily admit, give opioids and palpate again an hour later, see if now comfy to confirm whether a) is actually painful and b) hopefully able to have a better feel for problems.

RE: Enlarged Abdomen and Discomfort

Eilidh Corr — Thu, 23 Mar 2017 20:48:41 GMT

I think ALT that high would make me want to look more closely at liver.

RE: Enlarged Abdomen and Discomfort

Anthony Todd — Thu, 23 Mar 2017 20:18:15 GMT

[quote user="KathW"]Just adding to the general bigger picture.[/quote]

Sure, fair enough, cheap, sensible. easy, non-invasive, and you'd look pretty stupid if it was glucose+++ or bilirubin +++ etc.!

RE: Enlarged Abdomen and Discomfort

KathW — Thu, 23 Mar 2017 20:09:18 GMT

Suggestion of urine testing- dipstick and SG was just to get some more information fairly cheaply. May add nothing but sometimes haematuria noted or high protein in dilute sample.

In house urinalysis may or may not be helpful also - a little more cost.

SG from different times of day may also be useful ( early morning,after a long walk for example) - can the dog regulate USG or is the urine isothenuric/ dilute/ appropriately concentrated.

Just adding to the general bigger picture.

RE: Enlarged Abdomen and Discomfort

Anthony Todd — Thu, 23 Mar 2017 19:46:21 GMT

[quote user="Anthony Todd"]

[/quote]

So we've got one star, but we still don't know what's wrong with the dog or have any helpful suggestions....

A really helpful star that was!

RE: Enlarged Abdomen and Discomfort

Anthony Todd — Thu, 23 Mar 2017 19:18:16 GMT

RE: Enlarged Abdomen and Discomfort

Claire Fisher — Thu, 23 Mar 2017 19:14:36 GMT

If Cushings is still a concern you could ask the lab to run 17 OHP on the pre and post ACTH samples in case it is an atypical case.

RE: Enlarged Abdomen and Discomfort

janine redman — Thu, 23 Mar 2017 08:25:02 GMT

Gall bladder problems and cholestasis quite common in schnauzers we have seen. Sometimes gall bladder infections diagnosed when we refer for ultrasound guided needle aspirated with culture. Often E. coli and seem to cause distended abdomen and GI signs

RE: Enlarged Abdomen and Discomfort

Michael Woodhouse — Wed, 22 Mar 2017 23:32:21 GMT

Bilirubin was normal.

I'll see if I can get a cholesterol, triglyceride, bile acids and T4/TSH from the serum they have.

I spun the bloods from the ACTH stim and PCV would have been close to 50%.

Serum not icteric.

RE: Enlarged Abdomen and Discomfort

Beats — Wed, 22 Mar 2017 23:10:47 GMT

I'd second the thyroid function testing (and for all the cost of it fasting triglycerides+cholesterol+ manualPCV). Most hypoT4 dogs have low normal PCV and elevated fasting cholesterol, but I'd probably pop off a T4/TSH screen anyway.

Could there be biliary stasis?

I had a schauzer with scurfy coat and ridiculously high ALKP last year that I jumped through many of same hoops you have before concluding cholestatic liver disease secondary to hyperlipidemia.

Bloods almost normalised on ursodeoxycholic acid and white fish diet. Patient much improved. I restested the T4 that had been low but with normal TSH: T4 still low, normal TSH, fT4 low also. I toyed with idea of TSH Stim test before starting on trial thyroxine. After month or two was like a pup again (and no longer needing all those medicated shampoos...).

I'd assumed the cholestatic liver disease as most obvious blood change to be cause of lethargy, I'd assumed it to be secondary to idiopathic hyperlipidemia given breed. In hindsight the hypoT4 was the primary pathology.

I reckon only about 1 in 10 dogs I test for hypoT4 has it, but it's often not the one I was expecting, so that encourages me to cast a wide net.