Friday, July 1, 2016

2968. Script & Final Video: An 8-year-old female spayed poodle urinates a lot



An 8-year-old female spayed poodle urinates a lot in the past 2 months. Polyuria is the medical word for this condition. It is abnormal.

What's wrong with this dog?  The owner brought the dog to Toa Payoh Vets. 





This video is a case study of an 8-year-old female spayed poodle that urinates a lot

Dr Sing from Toa Payoh Vets enquired more and found that
in addtion to polyuria, the dog has
Polydipsia (drinks a lot of water)
Polyphagia (eats a lot, always hungry)
Abdominal Distension


EXAMINATION
The main finding is a large painless anterior abdominal swelling 50% the size of a tennis ball. Dr Sing needed further lab tests to provide evidence of what's wrong with the dog. These tests are as follows:.


X RAYS





BLOOD TESTS
High serum ALT indicate liver cell damage, enlargement and necrosis

ALT = 1054  u/L   (normal: less than  59)
AST = 421    u/L   (normal: less than 81)
 
An ABDOMINAL ULTRASOUND was recommended to the owner and he agreed.  The summary of the ultrasound report is as follows:

1. Liver is moderately to severely enlarged with no tumours
2. Left and right adrenal glands have a nodule each in the cranial pole
3. Other organs are normal
4. No fluid inside the abdomen


More details are as follows:
THE ULTRASOUND  OF LIVER AND ADRENAL GLANDS

 LIVER - moderately to severely enlarged; borders are rounded but margins are smooth; echogenicity is diffusely increased; parenchyma is homogenous and no discrete masses or nodules are seen; vessel size is subjectively normal

Liver

Liver


ADRENAL GLANDS - one hyperechoic nodule present in cranial pole of both adrenal glands; margins are smooth and no signs of invasion of the blood vessels are seen.

 Right Adrenal Gland - nodule size of 1cm x 1.4cm


 Left Adrenal Gland - nodule size of 7.8mm x 9.7mm


 
Left Adrenal Gland - another view


THE OTHER ORGANS ARE NORMAL AS SHOWN BELOW.

 Gall Bladder - has gall bladder sludge (cholestasis); gall bladder wall is thin and moderately distended with bile; small amount of echogenic material is seen on the dependent wall; material dot have distal acoustic shadowing or a stellate appearance; no masses or stones are seen; no dilation of the cystic or common bile duct


 Right Kidney - normal; symmetrical in size; no cysts, masses, stones or dilations
4.1cm

 Right Kidney - another view

 Stomach- normal; wall layering normal without thickenings or masses
4.3mm

 Duodenum - normal; wall layering normal without thickenings or masses
3.6mm
Jejunum: 2.6mm
Ileum: 2mm


 Pancreas - both lobes appear normal with no edema, enlargement (1.4cm) or masses seen; no increase in echogenicity of the surrounding mesentery.

 Spleen - size is subjectively normal; shape is normal with a smooth capsule; parechyma is fine, homogenous and bright; no masses

 Left kidney - normal; symmetrical in size; no masses or stones present
4.5 cm

  Left kidney - another view

 Bladder - normal; no masses or stones present; thin-walled and moderately distended with anechoic urine

Bladder - another view


 Urethra - normal; urethral wall normal; no dilation

 Colon - normal; thin wall with no masses seen
1.8mm

Small Intestine - normal; wall layering normal with no thickenings or masses seen  


COMMENTS ABOUT ULTRASOUND
1. Fluid: No free fluid.
2. Lymph Nodes: No enlarged lymph nodes

DIFFERENTIAL DIAGNOSIS
1. PDH - Pituitary-dependent hyperadrenocorticism. The pituritary gland inside the brain is abnormal
2. Adrenal gland nodular hyperplasia or neoplasia or both. e.g. adenocarcinoma, phaechromocytoma
3. PDH or adrenal tumours or both? Measurement of endogenous plasma ACTH concentration is the reliable way to differentiate between PDH and adrenal tumour. ACTH is low or undetectable in adrenal tumour while it is normal to high in PDH.
4. Steroid hepatopathy - Liver disorder and disease due to endogenous or exogenous steroids.
5. Liver infection - chronic active hepatitis
6. Liver abnormality e.g. diffuse infiltrative liver disease or tumours
7. Diabetes mellitus
8. Diabetes insipidus
9. Unknown cause of increase/decrease of serum cortisone

ADVICES TO OWNER
1. Adrenal testing. Hyperadrenocorticism e.g. ACTH, low dose dexamethosone suppression (LLDS) test or high dose dexamethosone suppression (HDDS) test.
2. Treatment of PDH is with mitotane or tilostane.
3. Surgical removal of adrenal nodules/tumours if present. Abdominal ultrasonography is a more sensitive way to identify adrenal tumours or nodules, including liver metastasis or invasion into the vena cava blood vessel. 

4. Radiation   

PROGNOSIS
The owner has not decided what to do with the poodle. It has been reported that the maximum number of years a dog with hyperadrenocorticism can live is 2 years

CREDITS
Roxanna Neo Yuan Xin - Narrator; video editor

Dr Sing Kong Yuen - Veterinary surgeon
BVMS (Glasgow), MRCVS
Toa Payoh Vets
Consultant Vet @ Royal Asia Veterinary Surgery

Dr Daniel Sing - Veterinary surgeon
Toa Payoh Vets
BSc, BVMS (Murdoch)

FOR MORE VIDEOS, VISIT www.toapayohvets.com/videos.htm
FOR MORE INFORMATION, VISIT www.toapayohvets.com
Tel. No.: +65 62543326, 96686468
E-mail: judy@toapayohvets.com
Date: 1/7/2016

A video is created with the help of Raffles Institution Intern Roxanna Neo:







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