Species: dog
Breed: Bernese Mountain Dog
Sex: f, neutered
Weight: 40 kg
Birth date: 2019-05-29 00:00:00
Primary diagnosis: Bilateral cavitary zygomatic sialenopathy with sialadenomegaly (right>left), right sided exophthalmus and tonsilitis
Situation: emergency initial
Medical history: The dog was presented to us on the 05.11.2024. From Saturday 02.11 to Sunday 03.11 the dog started vomiting food (vomited 2x), having a 3rd eyelid prolapse on the right, and Sunday afternoon she cried when she opened her jaw and was very apathetic. Yesterday (04.11) morning they went to the private vet. The dog ate very little this morning, seems to be swallowing well but otherwise she has not been eating well / atealmost nothing since Sunday. In July she had a wound on the back left paw. She is a bit more stressed than usual. The private vet had the suspicion of Tetanus and started therapy with Meloxicam and Co-Amoxi. At our clinic, the neurologists were not convinced of the suspicion of tetanus. An ophthalmologic examination was done and the day after a CT of the had was performed. CT report (06.11): Bilateral moderate cavitary zygomatic sialenopathy, sialadenomegaly (right>left), leading to a right sided exophthalmus; Right sided tonsilitis; Mild right mandibular and medial retropharyngeal lymphadenomegaly; Mild lung lobe atelectasis- anesthesia related; Small stone like material in the stomach; Mild gastric lymphadenomegaly; Mild intervertebral disc disease L7/S1, non compressive; Gall bladder wall oedema and periportal halo --> Most likely differential is a zygomatic gland sialadenitis, less-likely consider a phenobarbital-responsive sialadenosis, although no CT changes have been reported in the cases reported by date; Adenoma or other neoplasia of the salivary glands appear very less-likely due to the bilateral changement; The small stones in the stomach may lead to a chronic irritation of the gastric wall, which may lead to a gastritis; Lymphadenomegaly is likely reactive; Gall bladder wall oedema and periportal halo are unspecific but may indicate hepatic or gall bladder disease. The dog stayed hospitalzed and then was sent home on the 07.11.
Medication: Started the day before presentation: Meloxicam, Amoxicillin & clavulanic acid. Before observation 2: Ondansetron 0.3 mg/kg IV, Methadon 0.1 mg/kg IV. After observation 2: Methadon 0.1 mg/kg IV continued q4h, Ondansetron 0.3 mg/kg IV continued TID, Trazodon 5 mg/kg PO 1x at 21. 06.11 (nothing given before observation 3): Ondansetron 0.3 mg/kg IV TID, Methadon 0.2 mg/kg IV 1x at 09 then switch to Buprenorphin 0.015 mg/kg TID, Omeprazol 1 mg/kg IV BID, Metoclopramid 0.3 mg/kg IV TID, Sucralfat 10 ml PO TID, Trazodon 5 mg/kg PO TID. 07.11 (nothing given before observation 4): Ondansetron & Omeprazol & Metoclopramid & Sucralfat & same as on 06.11.
Neurologic exam: On 05.11.2024. Mentation and behaviour: alert. Posture: erected ears, mild valgus in the right pelvic limb, otherwise can open and close the mouth normally. Gait: unremarkable. Cranial nerves: lateral strabismus, mild exophtalmus and mild to moderate third eye lead protrusion in the left eye. Postural reactions: unremarkable. Spinal reflexes: unremarkable. Palpation: uncomfortable during wide mouth opening.
Pain type: acute, nociceptive, inflammatory
Pain origin: head, eyes
Pain duration: 24 hours to 7 days
Estimated pain severity: 34