The Case of the Missing - PowerPoint Presentation

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The Case of the Missing HedgehogGastric Foreign Body in a Dog

VETE: 4325 Anesthesia and Surgical NursingSarra Borne, LVT

Gustav

2 years old

Intact male

Airedale terrier mix

2 day history of vomiting and lack of appetiteLethargicOther dog is unaffectedMissing squeaky toy?

Vital Signs:

Quiet, alert and responsive

Weight: 53

lbs

(24 kg)Rectal Temperature: 102.4 FThoracic Auscultation: 140 beats per minute, no murmur or arrhythmia detectedRespiratory Rate: 36 breaths per minuteMucous membranes: pink, slightly tackyCapillary Refill Time: <2 secondsAbdominal Palpation: Tense, painful in the cranial abdomen. Firm structure palpable in the stomach region.

Veterinary Detective Work

Blood work (CBC,

Chem

27)

Abdominal X-Ray+/- Abdominal Ultrasound

Laboratory DatabaseCBCWBC – 19 x 10

3/ulNeutrophils – 12000/ulBand

Neutrophils – 450/

ul

RBC – 7 x 106PCV – 65%Consistent with dehydration, and a mild left shift. Serum Chemistry

BUN – 20 g/dLCreatinine – 0.7 g/dLAlbumin – 4.5 g/LTotal Protein – 5.8 g/

dL

ALT (

Alanine Aminotransferase

) - 18 u/L

ALP (

Alkaline Phosphatase

) – 72 u/L

Total Bilirubin - 0.1 mg/

dL

Serum chemistry is normal.

The Inside Picture (ACVS: American College of Veterinary Surgeons, 2014)

Right, lateral survey radiograph

There’s the firm structure palpated in the stomach. Could it be the missing toy?

Choices: Endoscopy or surgery?

Pre-Anesthetic Drugs and SetupIV catheterFluid therapy for the dehydrationPlasmalyte

at Body weight (kg) x % dehydration = volume (L) / 24 hours plus his maintenance requirements at 132 x body weight (kg) 0.75 / 24 hours (Davis et al.,

2013)

24 x 0.05 = 1.2 L or 1200 mL plus 132 x 24 = 2376 ml /24 hours = 149 ml/

hrPremedicationsGustav is painful so a combination including opioids is a good choice.Midazolam (5 mg/mL) 0.2 mg/kg IV = 0.96 mL IVHydromorphone (2 mg/mL) 0.1 mg/kg IV = 1.2 mL

Induction and IntubationGustav will be induced with Propofol

(10 mg/kg) IV at 4-6 mg/kg 96 – 144 mg IV given to effect.He will be intubated and maintained on

Isoflurane

in a semi-closed system.Oxygen will be provided at 0.5-1 L/ 10 kg bodyweight per minute

Endoscopic Foreign Body VideosBasket Snare (Theodore Veterinary Hospital, 2013)

Net

(

AB Vet veterinarni klinika, 2012)

Success!

The toy was extracted endoscopically.

Gustav would not have to undergo surgery.

Healing time will be shorter and less painful.

His owners are very pleased.

Aftercare in the hospital24 hour hospital stay

Additional doses of hydromorphone for painSucralfate 1g every 6 hours for the irritated esophagus and stomach

Kept off food for an additional 12 hours

Feed a bland diet once food is allowed

Aftercare at home

Back to his old self.

Tramadol 50 – 100 mg orally every 8 hours as needed for pain or discomfort for 3 days

Sucralfate

1 gm tablet as a slurry orally every 6 hours for 7 daysRecheck in 1 weekNo toys that are small enough to ingest.

References

AB Vet veterinarni

klinika

. (2012, November 29). 

Gastroscopy dog - Endoscopic removal of foreign body [Video file]. Retrieved from https://www.youtube.com/watch?v=qSs7mMVEd7k

ACVS: American College of Veterinary Surgeons. (2014). Gastrointestinal Foreign Body X-Ray [image].

Retrieved

from

https

://

www.acvs.org/sites/default/files/images/Figure%202%20Gastric%20foreign%20body%20latera l%20radiograph.jpg

Davis, H., Jensen, T., Johnson, A., Knowles, P., Meyer, R.,

Rucinksy

, R., &

Shafford

, H. (2013). 2013

AAHA/AAFP

fluid therapy guidelines for dogs and cats. 

Journal of the American Animal Hospital

Association

, 

49

(3), 149-159. Retrieved from DOI 10.5326/JAAHA-MS-5868

Theodore Veterinary Hospital. (2013, February 5). 

Canine Minimally Invasive Foreign Body Removal - Bouncy

Balls

 [Video file]. Retrieved from https://

www.youtube.com/watch?v=IlH_qUHstU8

Thomas, J.,

Kerche

, P., &

McKelvey

, D. (2011).

Anesthesia and analgesia for veterinary technicians.

St. Louis, MO: Mosby/

Elsiver

.