An 18 month old F/I Yorkshire Terrier presented to the emergency room for acute onset of vomiting. Once arriving at the ER, her signs progressed with marked weakness, tachycardia, hypothermia, and hypotension. An initial “FAST” exam did not show any free fluid in her abdomen. She was admitted for fluid therapy and supportive care.
As a veterinary internist who has been performing diagnostic abdominal ultrasounds and echocardiograms for the last 18 years, I was reluctant to understand the value of FAST exams in every day practice. However, for the past 7-8 years, I have been incorporating FAST techniques into my practice and I strongly believe that is has improved my patient care in ways that I did not expect. FAST stands for Focused Assessment of Sonography for Trauma but the techniques are not limited to trauma patients. Global FAST has been developed as an assessment tool to allow you to evaluate both the thoracic and abdominal cavities as well as lung. Obvious applications include the Triple T of Trauma, Triage (non-trauma), and Tracking (monitoring) of critically ill dogs and cats. However, I recommend using Global FAST every day as part of the physical exam in sick small animal patients, in pre-anesthetic screening, and as part of daily rounds in all hospitalized dogs and cats for monitoring both medical and surgical conditions.
Indications for Pericardiocentesis. Pericardial effusion with life-threatening cardiac tamponade, generalized weakness due to obstructive shock, or respiratory distress.
Pericardial effusion is a fairly common disease in dogs. In general, dogs with pericardial effusion present with weakness, collapse, or respiratory difficulty. However, dogs may have more general signs including inappetance, lethargy, exercise intolerance, or abdominal distention. The signs are especially difficult to detect in patients with chronic pericardial effusion. In addition, patients with chronic pericardial effusion may have physical exam findings that are non-specific and not be helpful in detecting the disease. In acute cases or patients with cardiac tamponade, signs may include distention of the jugular veins, muffled heart sounds, tachycardia, dyspnea, and poor pulse quality. Abdominal distention and ascites develop in patients with chronic disease.
Ultrasound is useful for assessment of small intestinal diseases. In Part I (June 2018 blog at blog.oncurapartners.com), we discussed normal appearance of small intestine with tips for taking measurements. In this blog, we are going to a look at a few of the most common findings you may see with diffuse small intestinal disease.
It makes sense that information should be consistent across all of the devices and records within your practice. Primary functions such as scheduling or billing are all headache-free because of the availability of database-enabled software that helps keep related information unique with minimal effort, and it stands to reason that this should apply to patient information as well. Because a variety of advanced technology has become commonplace within hospitals, well maintained and consistent patient records allow you to quickly pull up a patient’s information no matter what device or system you are using and is crucial to ensure that imaging from multiple modalities (ultrasound, X-Ray, CT, etc.) relates to each other, building a picture of a patient’s health record.
“Misty” is a 4 year old F/S English Setter who presented to her veterinarian for inappetance and weight loss. She had lost 6 lbs in the course of 3 weeks. She had an occasional dry cough but no other specific clinical signs were reported. The working diagnosis based on a brief ultrasound exam by the referring veterinarian was stump pyometra.
“Willy” is a 5 year old M/N Golden Retriever with Grade 3 Mast Cell Tumor that was removed from the right thorax. An abdominal ultrasound with focus on the liver and spleen was requested in order to further stage his mast cell disease. CBC showed mild normocytic normochromic anemia with a hematocrit of 34%. Chemistry profile was normal. Ultrasound examination of the spleen showed the following:
A 8 year old F/S Cocker Spaniel presented for a 5 day history of vomiting, diarrhea and inappetance. She had been seen 2 days earlier and treated empirically for non-specific gastroenteritis with Cerenia and bland diet. On presentation, she had a fever of 104.2 and was tense but not overtly painful on abdominal palpation. CBC showed mild anemia (HCT 32%) and thrombocytopenia (52,000). Chemistry profile revealed elevation of ALT (235 U/L), ALP (982 U/L), GGT (24 U/L) and total bilirubin (1.2 mg/dl). cPL was normal. Abdominal radiographs showed splenomegaly and loss of serosal detail in the cranial abdomen. She was admitted to the hospital for supportive care. During hospitalization, she became hypoglycemic (blood glucose 52 mg/dl) but she responded to administration of intravenous dextrose. A complete abdominal ultrasound was requested.