Species: dog
Breed: Yorkshire Terrier
Sex: m, neutered
Weight: 7.65 kg
Birth date: 2013-03-17 00:00:00
Primary diagnosis: Pancreatitis (and known diabetes mellitus & eye problems)
Situation: emergency initial
Medical history: The dog was presented to our clinic on 22.11.2024. Bobby has had diabetes mellitus since the summer of 2023, which has been well controlled with insulin for six months and is stable. The last glucose curve, carried out at home a month ago, showed stable values with a nocturnal peak. After the administration of Librela one month ago, hypoglycaemia occurred for one week, but no further incidents since then. The patient is fed BARF, which has led to an improvement in stool consistency and a reduction in insulin requirements. Vomiting occurred once the week before presentation, and again after a short period of normalisation. The night before presentation there were three episodes of brown vomiting, with a good general condition and appetite. The morning of presentation, however, the patient showed apathy, was unable to walk and was anorectic. No further vomiting in the morning, but tenesmus and mucous faeces without blood. The dog has polydipsia without polyuria. The morning insulin dose was skipped due to the anorexia. (An episode of cystitis was diagnosed one year ago. Bilateral cataract surgery was performed in January 2024. The post-operative phase went well and the patient is currently receiving Acular and cyclosporine. There is occasional slight reddening, but this is well under control. The patient has undergone two orthopaedic operations in the past for dislocation of the hind limbs, once ten years ago and again five years ago. The second operation did not achieve a satisfactory result, which is why movement activity is restricted. There is significant muscle atrophy with intermittent lameness and osteoarthritis. The patient is receiving Librela and osteopathic treatment and is currently not taking any other painkillers.) The dog was hospitalized and the same day an abdominal ultrasound was perfomred --> ultrasound report (22.11): Marked pancreatopathy, particularly affecting the left pancreatic lobe and pancreatic body, with surrounding mild anechoic fluid and marked steatopathy; Diffuse mildly hyperechoic hepatopathy; Mild hepatic lymphadenomegaly/-pathy; Multiple round organized structures in the gall bladder; Bilateral adrenomegaly; Bilateral mild chronic nephropathy, with some mild cystic changes --> Findings suggestive of an acute pancreatitis; Although there are no clear abcessation at this stage, the changes are marked, and it remains possible that it would evolve into necrosis; Free fluid, lymphadenomegaly and steatitis likely reactive; Structures in the gall bladder might represent organized sludge balls, or non-mineralized choleliths; Diffuse hyperechogenicity of the liver most consistent with vacuolar hepatopathy secondary to the know diabetes; Ddx include other vacular hepatopathy (e.g. cushing disease), hepatitis, much less likely round cell infiltration; Bilateral adrenomegaly may be reactive, although pituitary hyperadrenocorticism may also be considered; Correlate with the clinical findings.
Medication: Before presentation: Insulin detemir (Levemir) 3 UI BID (last time evening before presentation), Acular and Cyclosporin eye drops BID. Before observation 2: Methadon 0.2 mg/kg IV, Ondansetron 0.5 mg/kg IV, Maropitant 1 mg/kg IV. 24.11: Ondansetron 0.3 mg/kg IV TID, Paracetamol 10 mg/kg TID IV, Maropitant 1 mg/kg IV SID, Methadon 0.2 mg/kg IV q4h, Insulin detemir 2 UI SC BID, Acular eye drops in both eyes BID, Cyclosporin eye drops in both eyes BID, Prokolin according to weight PO BID, Ampicillin 30 mg/kg IV TID started at 17, Gabapentin 10 mg/kg PO 1x at 20, Trazodon 3 mg/kg PO 1x at 02 (25.11). 25.11: Ampicillin & Ondansetron & Paracetamol & Maropitant & Insulin detemir & eye medication & Prokolin same as 24.11, Methadon 0.2 mg/kg IV at 09 then switch to Buprenorphine 0.015 mg/kg IV TID from 13. 26.11: Ampicillin & Ondansetron & Paracetamol & Maropitant & Insulin detemir & eye medication & Prokolin same as 25.11, Buprenorphin 0.015 mg/kg IV 1x at 09 then stopped.
Pain type: acute, inflammatory, visceral
Pain origin: abdomen
Pain duration: Less than 24 hours
Estimated pain severity: 66