Friday, July 22, 2011

Follow Up What's Your Diagnosis

So one of the major reasons that I posted previously is to help prove to myself that I haven't completely lost my mind. Above is a post-operative radiograph.

To reiterate and add details: 9y, NM, Labrador mix who presented for routine examination, vaccines, and heartworm testing. Radiographs were recommended because of a distended abdomen and urine leaking with mild discomfort associated with abdominal palpation.

As is too often typical where I currently practice, there was a significant financial limitation. The dog was bright, alert, and responsive and had not acted sick at all. Each time I attempted abdominal palpation, he began to urinate, even after going outside. I could not distinctly feel a mass but the bladder was huge at initial palpation although the sheer volume of urine made it clear there was not a complete obstruction. Based on the radiographs and cost problems, we opted to perform a scheduled exploratory one week later. (Boring bloodwork, by the way.)

One week later, exactly, I explored the dog. On pre-surgical examination, the abdomen was more comfortable and slightly less distended although he still had that "old dog" pendulous abdomen appearance and, while the urine was still somewhat uncontrolled, it was of a smaller volume than previously; otherwise there were no changes. Upon explore, there were no masses visible and all organs appeared within normal limits grossly other than the bladder. The bladder appeared thickened and very reddened, as one would expect of a bladder containing a stone. There was no free fluid present and no evidence of prostatic disease or previous bladder rupture. Upon performing a cystotomy, I found no stones at all; not even a single tiny one. Nothing. Nada. Zip. Zero.

Talk about confusing!!! The only logical explanation that I can reach is that maybe it was several small stones that the dog subsequently passed prior to surgery????? Told you is was surprising.

Friday, July 15, 2011

What's Your Diagnosis?

I'd like to see what you folks out there think of a case I dealt with recently. Gabe is a 9 year old, NM, labrador mix who presented for routine vaccinations, heartworm testing, and examination. On exam, it was noted that his abdomen appeared distended and mildly tense / painful on palpation of the caudal region. He was leaking urine uncontrollably and this increased with palpation. It was difficult to determine if there was a mass because of his tenseness but there was a moderately enlarged bladder for sure. Because of this, I recommended abdominal radiographs and submit the lateral view for your examination. What do you think?? I'll post a follow-up in a few days with the interesting results.