447. A dog with a bloated abdomen shivers a lot

E-MAIL REPLY FROM DR SING DATED MAY 20, 2011
2:39 AM

Thank you for your email to Judy. I am Dr Sing in charge of your case.


PATIENT'S HISTORY
Maltese, Female, Not Spayed, 5 years old.
Last estrus was reported by you to me from our tele-conversation from Hong Kong as to be around December. Your dog was boarded in a friend's place for the last 2 weeks. "Shivering" and not active were the complaints from your mum.

At around 10 am on May 19, 2011, your mum and brother brought XXX to consult me. Your mum complained that the dog was still shivering and not her usual self as she would normally "bite and tug at her pants" on seeing her.

The presenting sign was an acute abdomen. Your mum and I could see that your dog had a rounded "bloated" abdomen. The day before, a vet had treated the dog. I had phoned him and he had kindly told me about his clinical findings of abdominal pain and treatment. He had advised blood test and X-ray. According to your mum, he had advised surgery but she could not say what type of surgery was advised. She said that if surgery was needed, she would want it to be done by me.

EXAMINATION
The dog did not have a fever as she had been treated by Vet 1 the previous day. The pulse was normal but the dog was panting. The presenting sign was an acute abdomen. The abdomen was swollen. I could feel a large firm swelling of around 5 cm x 3 cm indicative of a swollen bladder. A swollen womb due to infection and pus (closed pyometra) could be present. The dog had a swollen inflamed vagina. She felt uncomfortable on abdominal palpation and started panting. Intestinal sounds were present on auscultation.

BLOOD TESTS
A complete blood test done today showed nothing abnormal. No increase in white cell count which might indicate pyometra. However Vet 1 had given antibiotic injection and so I would not eliminate the beginning of a pyometra.

X-RAY
Lateral view. A large distended bladder pushing all intestines to the front of the abdomen. The small and large intestines had several opaque lumps of around 1 cm and this would not be a problem if it was some foreign bodies as they would be passed out once the dog could urinate.

An ENEMA
was given by Dr Vanessa at around 6 pm. At around 10 am, I had injected the dog with antibiotic and an anti-spasmodic to relax the bladder muscles. However, the dog did not urinate till after 6 pm (see below).

URINE TEST
1. A dipstick showed a moderate amount of white blood cells present indicating a bacterial infection of the bladder. This would lead to painful urination and so the dog did not pee normally. More urine got retained and the bladder became distended causing pain and abdominal swelling.

2. As your mum came in the evening, I asked her whether the dog would run away if let free on the grass patch outside the surgery. She said no. So, I got the dog out under her supervision and gave her a urine collection bottle.

The dog peed at around 6 pm onto the grass outside the Surgery. Your mum kindly collected a full bottle of turbid urine which would be sent to a laboratory for urinalysis including a check for blood, bacteria and urinary crystals. Results will be known later today (Friday). The dog passed out some dark brown stools with oil from the enema.

ABDOMINAL PALPATION AFTER URINATION ON MAY 19, 2011.
The abdomen was normal. No more abdominal swelling. The dog started to paw your mum who was most happy. I spoke to you over the phone that the dog could go home. However, your mum was worried and so the dog would go home today on May 20, 2011.

DIAGNOSIS
A urinary tract infection based on dipstick results of white cells found in the urine and X-ray of urinary retention and clinical examination. The laboratory would confirm if urinary crystals were present as well and I would follow up with your brother soon as to what to do. The dog would go home on antibiotics and a follow up 7 days later is recommended.

ADVICE
I advise spaying of the dog around 4 weeks later as it is possible that a pyometra had started to develop.

UPDATE ON SATURDAY MAY 21, 2011
Dog normal. No abdominal distension. Will go home on Sunday.