Path 2 - Midterm - Auburn Rounds 1

drraythe's version from 2015-04-18 22:34

Week 2 (which is the first one we did)

Question Answer
CASE 1: There is a flock of Bobwhite quail (avian) that are about 9 weeks old.They are off feed and water, and are skinny.They have a low-grade diarrhea, and are dying at a rate of 300/day out of a flock of 25,000. The farmer said he has been giving LS50 and Tylan in the water. WHAT ARE THE THREE DDX for a skinny qual??(1) ulcerative enteritis (*clostridium colinum), (2)crop worms (esophageal worm...capallaria. Look for worms in crop), (3)blackhead (histamonas) (r/o: histamonas affects cecum)
CASE 1: There is a flock of Bobwhite quail (avian) that are about 9 weeks old.They are off feed and water, and are skinny.They have a low-grade diarrhea, and are dying at a rate of 300/day out of a flock of 25,000. The farmer said he has been giving LS50 and Tylan in the water. With silverstain, there were white spots found on intestines. Of Ulcerative enteritis, cropworms, and blackhead, how can you determine which it is?Look for worms in crop...not there. And blackhead is caused by histamonas, which affects the cecum, which wasn't an issue. Must be ulcerative enteritis. *why didn't tx work? Always ask about HOW the farmer is administering any medications- he was underdosing the tylan so it wasn't helping
CASE 1: There were other birds on a diff quail farm which had soapy and yellowish air sacs--> yellowish= purulent discharge (this comes from heterophils)...This is AIRSACCULITIS. What are possible causes, and how would you determine what it was?DDx for airsaculitis is Infectious quail bronchitis virus (adenovirus), which causes intranuclear inclusion bodies, so another ddx is herpes (also intranuclear inclusion bodies), and mycoplasma and e. coli ALSO can both cause airsaculitis. In this case, it was The Infectious quail bronchitis virus (there were intranuc. IBs)
CASE 2: There is a 1yo dog (staffordshire terrier), F, intact, who presented with a puncture wound in her mouth, swollen neck, painful abdomen and lymphadenopathy. CBC/chem revealed leukocytosis, hypernatreamia, hypokalemia, and hypoglycemia. Due to the painful abdomen and leukocytosis, they did an exploratory celiotomy and found pieces of plastic in her colon. She ended up with DIC and She had to be euthanized. Infarcts were found on her LNs. What do you think happened?SEPTIC SHOCK. The inital puncture wound in mouth--> abscessation and lymphadenitis which went to bacteremia/septicimia--> septic shock. the septic shock can trigger DIC (multisystemic thromboemolism and shock).
CASE 2: what respiratory problem might be associated with a septic shock leading to DIC?ARDS--> acute respiratory distress syndrome (Condition in which fluid collects in the lungs' air sacs, depriving organs of oxygen)
CASE 3: there is a angus (bovine) calf found dead in pasture with a distended abdomen (abomasum distended and red), and pallor in the liver and lungs. In the abomasum there was clotted milk and red gelatenous blood clots in the rumen/abomasum.There were also wounds/abscesses in the esophagus. What do you want to look at?look at the contents of the abomasum/rumen! There were long stems with thorns stuck in the digesta, which probably tore this calf up (hence, pale from hemorrhage)
CASE 3: if you think the calf died from eating thorns, what should you tell the farmer?find a better pasture for his cattle, they'd have to be pretty hungry to eat something like that
CASE 4: Beef cattle, 7mo. Recumbent and off feed for 24 hours, feces were the color and consistancy of strawberry jam. She was pale and had a PCV of 16. You decide to do an ultrasound of the abdomen, and see a "sauage shape appearance" to part of the jejunum, and it is firm. What are you seeing, and what probably caused this and the other clincal signs? what should you tell the farmer to do?Sausage-shaped small intestines--> INTUSSUSEPTION! what usually causes this? PARASITES! look in intestines post-mortem and yep, there's a big ball of cestode just before the intussecption. The blood-feces was probably from irritation and sloughing of the intuss. Tell the farmer to get his deworming protocols in order.
CASE 4: if there is a ball of cestodes causing an intussecption in the small intestine, what kinda tapeworm do you think it is?Moniezia expansa
CASE 5: female AQH (equine), 3yo. ADR, chronic weight loss but good appetite. She has profuse liquid diarrhea. A gastroscopy shows bleeding gastric ulcers. Duodenal biopsy shows LYMPHOPLASMACYTIC ENTERITIS, and the GI mucosa is thickened and has pinpoint red spots. There were roundworms in the duodenum. there is marked hypoalbuminemia, mild anemia, and hypocalcemia. before euthanasai, horse would go on steroids, get better, as soon as she was off she'd get sick again though. What are some things this could be?roundworms were parascaris equorum, but since the GI had lymphoplasmacytic enteritis, prolly not just some roundworms. There was no evidence for lymphoma. However, having all those macrophages in the wall of the GI means she couldn't absorb food (-->weight loss/cant absorb calcium) and there was a lot of inflammation which would cause a "leaky" wall (bleeding, protein loss,etc). (steroids make inflammation dec,which is prolly why they'd temp. help) So, what causes a bunch of white cells to live in the wall of the intestine? probably a MYCOBACTERIuM (think about jonnes in cattle), since this is a horse they can sometimes get myco. avium

Week 3

Question Answer
CASE 1: GSD, M, castrated, 7yo. 5 month history of weight loss and inappetance. He vomited a foul smelling fluid upon presentation and then died. Upon necropsy, there was a mediasteinal mass adhered to the pericardial sac, in the stomach there were thickened ruggae and ulcers, there were nodules on capsules and parynchyma of kidney, and the spleen had infarctions. In the GI there were 2 intussuceptions--> necrosis/hemorrhage---> adhesions of jejunum moving into the ileum. You did impressive smears of the nodules and found lots of plasma cells. What do you think this is?PLASMA CELLS--> Multiple myeloma, ddx thymoma... ended up being a B-cell lymphosarcoma which has disseminated/metastasized.
CASE 2: broiler chickens 43 days old (THIS IS CLOSE TO SLAUGHTER AGE). They had a hx of air sacculitis. This is a flock of 20,000 birds with some mortality. Necropsy reveals lesions in the cr and ca air sacs, pericarditis, a small bursa and thymus, vertebral spondylitis, osteomyeleitis in tibia, synovitis--> edematous hock joint. What is going on, you think?Many problems. First off, small bursa+thymus--> probably coinfection of bursal dz and chicken anemia, which means they are prolly very immunocompromised. The air sacculitis is often caused by INFECTIOUS BRONCHITIS VIRUS, but usually birds are vx and should have immunity (did farmer vx?). Broilers as a breed often get vertebral spondylitis because they have SUPER heavy breasts which causes back problems/breaking, and bacteria can get in their pneumatic bones bc of this--> synsacrum dz. The osteomyelitis in tibia synovitis--> edematous hock joint--> usually caused by a reavirus (the green exudate from heterophils)
CASE 3: male boxer dog, 7yo. There has been a 3 week 2-3 grade heart murmur, strong pulses. CBC normal. An echocardioram shows R ventricular hypertrophy, thickened mitral valve, with mild regurg., and turbulent flow on tricuspid valve. He dog is anorexic and lethargic, exercise intolerant, but BW is normal. upon necropsy there was clotted blood in the abdomen. On the kidney was a mass that hemorrhaged out. The thoracic cavity was covered in nodules (they were dark red and firm). There were also nodules on serosal surface of bladder and trachea. On the heart there was a nodule on the pericardial sac with a mass extending into myocardium and into tricuspid valve--> friable tissue. What do you think is going on?Well, dark red firm masses all over--> metastisized neoplasm. Which neoplasm? well a nodule HEMMORHAGED OUT, so probably a hemangiosarcoma. But NOT from the spleen! Most likely from the heart as primary site (lots of heart problems) and it metastisized from there
CASE 4: male bulldog, 2yo. presented with diarrhea and abdominal distension. Bloodwork showed a leukocytosis with large circulating blast cells. Rads revealed ascites (1.1 L yellow tinged fluid), kyphosis, cr abdominal mass. The dog was euthanized. Upon necropsy there was a hyerplastic trachea, enlarged LNs ALL over body, edematous lungs (emphysema), and an enlarged thymus. multifocal nodules on myocardium of heart, multifocal infliltrative WHITE nodules on liver, pancrease is hard, enlarged and hemorrhage, and the stomach has raised multifocal lesions. what would you want to do next as a dx, and what do you think this is?well, the hyperplastic trachea is from "brachycephalic airway syndrome". However, WHITE nodules everwhere, and in the better be thinking some sorta lymphosarcoma or leukemia. LN impression smears were done and there were sm->med stage 5 lymphoma or leukemia (if see lymphoblasts more likely leukemia). This dog might have (acute lymphoid leukemia) or a stage 5 lymphosarcoma? (The later test revealed it to be a multicentric lymphosarcoma)

Week 4

Question Answer
CASE 1: 10yo poodle presented to critical care with 4-6hr hx of extreme lethargy. 2 year history of CHRONIC ANEMIA (regen, PCV 15%). elevated titers for lyme dz and RMSP. Heat seeking b/h, alopecia, inappetance--> anorexia, weight loss, and HYPOTHYROIDISM. The ultrasound revealed hypoechoic nodules in pancreas(enlarged LNs with pigment), and the adrenal glands were small. There was liver failure (liver small and firm). The heart was thin and dilated--> passive congestion and pulmonary edema. what on earth do you think is going on?Well, tiny adrenal glands (And it's a POODLE) says hypoadreno. Also there is hypothyroidism. This usually means there is an autoimmune component if both are affected (if autoimmune its common both are affected). Many of these other problems are associated with the fact that all these systems depend on the adrenals and thyroid. *NOTE: it's very atypical that there were no electrolyte imbalances in this case. Final diagnosis: “Atypical hypoadrenocortisicsm” with liver and kidney lesions
CASE 2: brussels griffon dog, female, 5yo. BCS 8/9. Presented with a hx of a spinal cord lesion at C3. CSF tap attempted and neuro signs worsened. There was a ventral strabismus, and bilateral nystagmus. Thoracic ultrasound revealed a HEART BASE MASS, and MULTIPLE NODULES IN LUNG. The dog was euthanized. necropsy revealed a pale liver, and there were milliary nodues in the lungs. The heart was firm, white, and there was a lobulated mass between pulmonary aa and aorta (heart base masS). There was a subdural brain hemorrhage but grossly normal, no pericardial effusion. What do you think is going on?pale liver=steroid hepatopathy. HEART BASE TUMORS---> hemangiosarcoma is most common but this doesn't present like that. Chemodectomas are also heart base tumors (usually aortic or carotic body), and brachycepahlic breeds are prone. A heart base tumor could also be a thyroid tumor, They tested the tissues with immunostaining and discovered they were positive for thyroglobin! So, the heart base tumor was an ectopic thyroid carcinoma with metastasis to lungs
CASE 3: 10yo bulldog presented with a 4 day history of resp. distress and 1 day of wheezing. edema around the neck, choking upon swallowing food/water and foaming when drinking. It had been earlier diagnosed with prostate cancer. Radiology showed a large mass in the cranial thorax. Necropsy revealed a lot of pulmonary effusion with enlarged LNs everywhere. There was a mass at the base of the heart (aorta, pulmonary a, and R atrium involved). There was also serosanguinous fluid in pericardial sac (cardiac tamponade). There were also nodules in the liver. What might you think is going on?So, there was a mass in the heart, in the LNs, and in the liver. Most likely since prostate cancer was already dx, would be prostate cancer with metastisis or another type of cancer in the thorax and peripheral LNs. The offical Dx ended up being THREE DIFFERENT TUMORS--> (unusual) (1) chemodectoma (aortic body) in the heart caused all the cardiac tamponade and effusions. (2) perianal gland carcinoma--> chronic prostatits (3) papillary/biliary cyst adenoma --> lead to liver probs +cholangectasia (dilated biliary ducts)
CASE 4: 8yo labrador retriever with a 3mo hx of progressive weakness and ataxia. the dog has a depressed mentation, seizures and tremors, and tetraparesis. The glucose was 33, insulin was 51(RR: 25). glucose therapy was attempted but after fixing glucose dog remained tetraparegic. Necropsy revealed a mass in the pancreas, with red fluid in the stomach and esophagus. The stomach mucosa was hyperemic. What do you think is happeningISLET CELL (b cell) CARCINOMA--> insulinoma. Neuro signs related to fact too much insulin will out gluc into cells before neurons have a chance to get any.