This dog is not a pyo....

Re: This dog is not a pyo....

Bob Russell — Tue, 28 Sep 2010 15:52:35 GMT

[quote user="bob lehner"]

[quote user="Bob Russell"] At the moment everything here is pancreatitis unless proved otherwise as this seems to be where the diagnostic roads all seem to end.[/quote]

Yes, it's interesting how pancreatitis is such a 'flavour of the month diagnosis' in dogs and cats these days. Is this due to better diagnostic tests/more awareness/ CPD, or is there truly an epidemic of the condition for reasons unknown ?

I find it interesting how diseases seem to come and go over the years. - In the '70s epi was a regular diagnosis, in young GSDs especially, (albeit based on a bit of a dodgy lab test, which involved putting strips of x-ray film in serially diluted poo samples). Nowadays epi seems to be rather uncommon.

[/quote]

I suspect a lot of pancreatitis cases fell into give antibiotic and steroid category, investigate if they don't get better. Perhaps not surprisingly a lot of them did get better!!!

Re: This dog is not a pyo....

Mark Holmes — Tue, 28 Sep 2010 15:21:16 GMT

[quote user="Martin Atkinson"]I think pancreatitis is far more common than previously suspected [/quote]

Really? I think it is over-diagnosed, or rather primary pancreatitis is over diagnosed, secondary pancreatitis is frequently diagnosed (as primary pancreatitis) leaving a primary condition untreated, such as a foreign body. Unless a dog is middle aged fat and female I would be very careful diagnosing pancreatitis without a concerted effort to find a primary problem and I even had a mid aged fat female cocker spaniel that having diagnosed primary pancreatitis eventually turned out to have a linear foreign body. Damn it (it died)

I would agree that cats all seem to have overt or subclinical pancreatitis though whether they know it or not.

Mark

Re: This dog is not a pyo....

Steve Leonard — Tue, 28 Sep 2010 14:27:05 GMT

Have you considered pyelonephritis? You can get very low urine SGs with endotoxins blocking ADH, similar to a pyo. It may account for symptoms. If it improves on abs then may be worthwhile running a urine culture shortly after finishing the course.

Re: This dog is not a pyo....

Martin Atkinson — Mon, 27 Sep 2010 18:44:25 GMT

I think pancreatitis is far more common than previously suspected and I find it in a disturbingly high proportion of PM exams. on cats that apparently died of another reason, yet 10 years ago it didn't register on the differential list in cats because we didn't think they got it as there was no signalment in routine blood tests. I believe there is a statistic somewhere that says that around 50% of humans are found to have some degree of chronic-acute pancreatitis on PM exam. - scary. We're better at diagnosing it because we are more aware and have a semi-reliable test with PLi but this can fall to normal fairly rapidly after an acute attack especially in cats. There is a danger it could become the opposite and be a catch-all diagnosis leading to surgical cases being left too long.

Re: This dog is not a pyo....

Simon Neuhoff — Mon, 27 Sep 2010 17:41:12 GMT

[quote user="bob lehner"]

[quote user="Bob Russell"] At the moment everything here is pancreatitis unless proved otherwise as this seems to be where the diagnostic roads all seem to end.[/quote]

[/quote]

Shrug - in my first job the older partner used to diagnose "tonsillitis" in every off colour dog he saw. I don't seem to see very many cases of tonsillitis these days. I guess when it comes to pancreatitis there are several aspects to it - people are more aware of it but also it is a convenient handle to justify ivft, pain relieff and abx and possib;ly even corticosteroids. If it aint fixed by that lot, well.........

Re: This dog is not a pyo....

bob lehner — Mon, 27 Sep 2010 17:05:55 GMT

[quote user="Bob Russell"] At the moment everything here is pancreatitis unless proved otherwise as this seems to be where the diagnostic roads all seem to end.[/quote]

Re: This dog is not a pyo....

Bob Russell — Fri, 24 Sep 2010 11:22:12 GMT

This is a procedure labelled abdominal ventilation in this practice. Can be very useful on occasions - may well be letting the evil spirits out. At the moment everything here is pancreatitis unless proved otherwise as this seems to be where the diagnostic roads all seem to end.

Pain and misery can be extreme and sometimes lab work can be surprisingly 'normal'. Not sure if abdominal ventilation helps with pancreatitis!

Re: This dog is not a pyo....

Martin Atkinson — Fri, 24 Sep 2010 09:08:26 GMT

[quote user="Michael Woodhouse"]

It's funny what a gut airing can cure!

[/quote]

We view it as letting out the evil spirits. More likely in most cases that by the time the decision is made to do an ex lap it was about to get better anyway depite the treatment.

Re: This dog is not a pyo....

Martin Jones — Thu, 23 Sep 2010 23:15:52 GMT

Peritoneal Aeration, if you don't mind. I don't know how may cows I've 'cured' with that. Unfortunately, this girl didn't seem to be any better afterwards. We'll see what the morning brings.

Re: This dog is not a pyo....

Michael Woodhouse — Thu, 23 Sep 2010 23:10:20 GMT

It's funny what a gut airing can cure!

Re: This dog is not a pyo....

Martin Jones — Thu, 23 Sep 2010 23:05:27 GMT

Yep, all good stuff. Ongoing tests will of course include imaging (although this practice doesn't have ultrasound, there are a few guys around who do) and standard cardiac work-up - but only if the patient survives the acute phase.

There's heart disease, and that's under initial, stabilising treatment. Tamponade is unlikely, although a milder effusion can't be ruled out. I agree that DI is a bucket diagnosis, but I don't think it's as rare as is stated.

The problem is that we have pain, pupd and heart issues. They may be three separate issues, but they all started around the same time. As I say, we do have a fair bit of (suspected) lungworm around, so are good for that. But otherwise, a stumper.

I'd rather view the palpation of a viscus as something other than imagination - charitably, perhaps an over-interpretation, or a transient symptom.

Oh, and Martin, the surgeon was a laydee. Shame on you.

Re: This dog is not a pyo....

Mark Holmes — Thu, 23 Sep 2010 19:52:58 GMT

Have you considered Pericardial Tamponade? Bit of a zebra diagnosis but I have seen a few and they do look a little pyoish easy ultrasound diagnosis if available.

Re: This dog is not a pyo....

Martin Atkinson — Thu, 23 Sep 2010 19:37:20 GMT

So what was the smooth viscus in the abdomen or was it just a figment of imagination, pity he didn't do some biopsies while in there or did he? I would want to work up the heart a bit more if there's a known heart problem, any arrythmias?: ECG, X-ray, echo, NT-proBNP. Also CPLi for pancreatitis. And don't dismiss HAC, DI is over-diagnosed and very, very rare.