Test Case Tuesday: Vince Vomits Valiantly (Case 7)

 

Picture of Professor Pocky taken by Dr. Haus

Click For Explanation of Case Flow

 

Signalment:

Vince is a 4-year-old male neutered Labrador Retriever Dog

🐶

History:

Vince is presenting for vomiting his food after every meal, generalized weakness, and lethargy.  His owners note that for the past few meals (even small ones) Vince will vomit immediately after he eats any food.  ​

Vince has a 2-year-old Labrador Retriever female spayed sister named Vanessa.  Vanessa is showing no signs of illness.

🤮

Physical Exam Findings:

Respiratory:  Raspy lung sounds​ 🫁

Musculoskeletal:  Generalized muscle weakness/atrophy (muscle wasting)​ 🏋️

 

🩺

 

🛑STOP and brainstorm what diagnostic tests you would like to perform on Vince 🛑

 

 

We will be stopping here today.  Before Thursday, think about what question(s) you need to ask Vince's owners to fully understand his history (Hint: Think about vomiting).  We will review an important distinction veterinarians need to make with vomiting patients and what diagnostic testing will be done based on that knowledge.

🧪

Day 1 Conclusion

Before Thoughtful Thursday think about your...

📋 Differentials List

🧪 Further Diagnostic Testing

📚 Review Material Related to Vince's case (i.e. what questions to ask owners of a vomiting patient, questions to ask a vomiting patient (if patient is a human that can communicate), specific diseases of interest, causes of vomiting, types of vomiting, personal interests, confusing points, etc.)

 

Thoughtful Thursday: Vince Vomits Valiantly (link will go live Thursday, 02/15/2024)

 

Test Case Tuesday: Janice is Jinxed (Case 6)

 

Picture of Professor Pocky taken by Dr. Haus

Click For Explanation of Case Flow

 

Signalment:

Janice is a 5-year-old female intact Jersey dairy cow

Janice lives on Jersey Girl Farms which is a 100-cow Jersey dairy herd in rural Texas  

 

🐮

History:

The farmer on Jersey Girl Farms notes that Janice is off-feed (not eating) and is producing less milk than normal.  Janice had her calf, Janette, 5 nights ago with no issues.  Janice had been doing well since the birth of her calf (producing milk and eating okay).  Last night and this morning Janice did not eat any of her food and this morning she produced less milk than she has been producing the past few days.  The farmer wants you to come out and assess Janice to see what is ailing her.​

No other cows in the herd are showing signs of disease.​

🐄 

Physical Exam Findings:

Attitude:  QAR (quiet, alert, and responsive), lethargic​ 🙊

Body Condition Score:  4/5​ 🥩

Ocular:  Eyes sunken back into eye sockets (sign of dehydration) 👀

Abdomen:  Decreased rumen sounds🔈

Rectal Exam:  Decreased rumen fill 🍽️

 

🩺

 

🛑STOP and brainstorm what diagnostic tests you would like to perform on Janice 🛑

 

 

Diagnostic Testing Results:

 

Bloodwork:  Low glucose, high ketones

🧪

Day 1 Conclusion

Before Thoughtful Thursday think about your...

📋 Differentials List

🧪 Further Diagnostic Testing

📚 Review Material Related to Janice's case (i.e. specific diseases of interest, causes of high ketones in cattle, digestive tracts of cattle (ruminants), personal interests, confusing points, etc.)

 

Thoughtful Thursday: Janice is Jinxed (link will go live Thursday, 02/08/2024)

 

Test Case Tuesday: Sick Swinehaus Swine (Case 5)

 

Picture of Professor Pocky taken by Dr. Haus

Click For Explanation of Case Flow

 

Signalment:

Swinehaus Farms is a 100 gilt/sow-farm (intact female pigs) in rural Iowa

🐷

History:

The farmers at Swinehaus Farms woke up early this morning to find 30 dead sows with blood running out of their noses and mouths.  Another 50 or so pigs are showing signs of lethargy, extremely high fevers, inappetence, vomiting, and disorientation.  The farmers called their veterinarian immediately who hurried out to access the extraordinarily concerning situation.​

​
There are about 20 beef cattle, 30 chickens, two farm dogs, and multiple barn cats present on the farm.  The farm will host folks from the general public allowing them to visit the working farm to learn more about farm animals and life.​

🐖 

Physical Exam Findings:

 

Live Animal Exam:

 

Attitude:  Disoriented, unable to stand, unaware of surroundings​ 😵

Temperature:  105 degrees Fahrenheit (normal 101.5-102.5 degrees Fahrenheit)​ 🌡️

Respiratory:  Difficulty breathing, breathing rates increased​ 🫁

Integument (Skin):  Redness noted around the ears, snout, and core of the body.  Fluid-filled vesicles noted on the feet and snout 🐗

Autopsy/Necropsy Exam:  

Integument (Skin):  Fluid-filled vesicles noted throughout the body of the deceased animals.  Most vesicles noted on the snout and hooves 🐗

Orifices:  Signs of hemorrhage (bleeding) from the snout, mouth, and anus​ 🩸

Internal Cavities:  Blood noted in the chest and abdominal cavities 🩸

 

🩺

 

🛑STOP and brainstorm what diagnostic tests you would like to perform on the pigs 🛑

 

 

Diagnostic Testing Results:

 

 None at this time (stay tuned for Thursday)

🧪

Day 1 Conclusion

Before Thoughtful Thursday think about your...

📋 Differentials List

🧪 Further Diagnostic Testing

📚 Review Material Related to the pigs' case (i.e. specific diseases of interest, causes of acute death in pigs, types of bleeding disorders, personal interests, confusing points, etc.)

 

Thoughtful Thursday:  Sick Swinehaus Swine (link will go live Thursday, 11/23/2023)

 

Test Case Tuesday: Gaunt Gagging Goats (Case 4)

 

Picture of Professor Pocky taken by Dr. Haus

Click For Explanation of Case Flow

 

Signalment:

Pleasant View Farms is a 40-alpine goat dairy farm in rural Pennsylvania

🐐

History:

The Pleasant View Farms producer calls you to report that his herd of goats are showing signs of coughing and increased respiratory (breathing) rates.  

The farmer says the most affected goats are the younger goats that were put on pasture for the first time at the beginning of this season (about 3-4 months ago).  The younger goats are not eating well and are in poor body condition.  One or two goats are holding their necks out straight, open mouth breathing, and are drooling.  The farmer wants you to come out to help find out what is occurring in his herd.​

😷 

Physical Exam Findings:

 

When you arrive at the  farm you start your exam by observing the farm and the animals from a distance in order to gather as much information as possible.  

 

You notice that the younger animals have body condition scores (BCS) of 2/5 while the older animals have BCS of 3-4/5.  Sex of the goat does not appear to impact presence of clinical signs.  

 

The affected goats are coughing and there is mucopurulent nasal discharge noted.  You do a physical exam on the 3 most affected animals and find the following:​

 

Respiratory:  

Increased lung sounds noted in all lung fields, most prominent at the bronchial bifurcation.  The goats are struggling to move air in and out of their lungs 🫁

 

🩺

 

🛑STOP and brainstorm what diagnostic tests you would like to perform on the goats 🛑

 

 

Diagnostic Testing Results:

 

Radiographs (X-Rays):

Signs of inflammation in the bronchioles of the lungs

 

CBC:

Increased eosinophils

🧪

Day 1 Conclusion

Before Thoughtful Thursday think about your...

📋 Differentials List

🧪 Further Diagnostic Testing

📚 Review Material Related to the goats' case (i.e. specific diseases of interest, eosinophils, causes of cough in goats, types of respiratory disease, respiratory anatomy, personal interests, confusing points, etc.)

 

Thoughtful Thursday:  Gaunt Gagging Goats (link will go live Thursday, 11/09/2023)

 

Test Case Tuesday: Elaine Emits Exhaustion (Case 3)

 

Picture of Professor Pocky taken by Dr. Haus

Click For Explanation of Case Flow

 

Signalment:

Elaine is a 65-year-old female intact elephant living in an elephant sanctuary in Thailand

🐘

History:

Elaine has been living at the sanctuary her whole life because her mother was killed by poachers when she was a calf.  Elaine’s only pertinent medical history is that she had a suspected viral infection that cleared about ten years ago with supportive treatment.  

Over the past few months, it has been noted that Elaine is appearing more lethargic (tired) and has a pot-bellied appearance.  Today, Elaine collapsed in her habitat and the veterinarian was called in to examine Elaine.

None of the other elephants in the habitat are showing any signs of disease.​

🚑 

Physical Exam Findings:

 

Neck:

Jugular vein distension and edema noted in ventral neck 🧨

 

Cardiovascular:

Increased heart rate, arrhythmia noted, weakened pulses 🫀

 

Abdominal:

Ascites noted (fluid in the abdomen) 🫄🏽

 

🩺

 

🛑STOP and brainstorm what diagnostic tests you would like to perform on Elaine 🛑

 

 

Diagnostic Testing Results:

 

Radiographs (X-Rays):

Enlarged heart noted, enlarged vessels leading into the right atrium

 

Echocardiogram:

All four heart chambers dilated with the right atrium being the most dilated.  No abnormalities of the valves, decreased cardiac output

 

Electrocardiogram:

Atrial arrhythmia noted 

🧪

Day 1 Conclusion

Before Thoughtful Thursday think about your...

📋 Differentials List

🧪 Further Diagnostic Testing

📚 Review Material Related to Elaine's Case (i.e. specific diseases of interest, arrhythmias, causes of ascites, heart anatomy, types of heart disease, personal interests, confusing points, etc.)

 

Thoughtful Thursday:  Elaine Emits Exhaustion (link will go live Thursday, 11/02/2023)

Test Case Tuesday: Florence Feels Feeble (Case 2)

Picture of Professor Pocky taken by Dr. Haus

Click For Explanation of Case Flow

 

Signalment:

Florence is a 10-year-old female intact cheetah living in a sanctuary in Africa

🐱

History:

Over the past few months, the sanctuary workers have noticed that Florence is losing weight and showing signs of muscle atrophy (her muscles are wasting/thinning).  For the past week, Florence has been eating much less and she vomited twice.  Florence will sit at the side of her watering hole and drink a lot of water multiple times a day (she never did that before).  It is hard to say if Florence is urinating more as she is in an open living situation with multiple other cheetah friends.​

None of the other cheetahs in the habitat are showing any signs of disease.​

🌊 

Physical Exam Findings:

 

Attitude:

Lethargic (tired and blah) 🥱

 

Body Condition Score (BCS) ☠️

3/9

 

Gum Color (Mucus Membrane Color):

Pale (light pink) 🩷

 

🩺

 

🛑STOP and brainstorm what diagnostic tests you would like to perform on Florence 🛑

 

 

Diagnostic Testing Results:

 

CBC (Complete Blood Count)

Red Blood Cells - Low (Anemia)

 

CHEM (Chemistry)

Renal values consistent with a renal (intrarenal) injury

Calcium - Low (hypocalcemia)

 

Urinalysis (UA)

Electrolyte values consistent with a renal (intrarenal) injury

Extremely dilute urine 

🧪

Day 1 Conclusion

Before Thoughtful Thursday think about your...

📋 Differentials List

🧪 Further Diagnostic Testing

📚 Review Material Related to Florence's Case (i.e. blood cell types, specific diseases of interest, categories of kidney disease, causes of increased drinking (polydipsia), anemia, personal interests, confusing points, etc.)

 

Thoughtful Thursday:  Florence Feels Feeble (link will go live Thursday, 10/26/2023)

 

Test Case Tuesday: Ruby Requests Rest (Case 1)

 

Picture of Professor Pocky taken by Dr. Haus

Click For Explanation of Case Flow

 

Signalment:

Ruby is a 5-year-old female spayed English Springer Spaniel

🐶

History:

Over the past week Ruby's owners have noticed that she seems very tired and does not want to get up.  She will not go out on her normal 3-mile walks and is not eating very well.  Ruby's owners were concerned so they brought her in for a check-up today and had to lift her into the car which is abnormal - Ruby always jumps into the car as she normally loves going on long hikes with her owners.

There are no other pets in the house and Ruby has not gotten into any toxic substances or the trash according to her owners.

⛰️ 

Physical Exam Findings:

 

Gum Color (Mucus Membrane Color):

Icteric (yellow) 🟨

 

Sclera (white part of the eye):

 Icteric (yellow) 🟨👀🟨

 

Cardiac (heart):

Increased heart rate (heart beating faster than normal) 🫀

 

Respiratory (lungs):

Increased respiratory rate (breathing faster than normal) 🫁

 

Abdomen (belly):

Spleen is enlarged and painful 🤕

 

🩺

 

🛑STOP and brainstorm what diagnostic tests you would like to perform on Ruby 🛑

 

 

Diagnostic Testing Results:

 

CBC (Complete Blood Count)

Red Blood Cells - Low (Anemia)

Reticulocytes - Low

 

CHEM (Chemistry)

Bilirubin - High

🧪

Day 1 Conclusion

Before Thoughtful Thursday think about your...

📋 Differentials List

🧪 Further Diagnostic Testing

📚 Review Material Related to Ruby's Case (i.e. blood cell types, specific diseases of interest, bilirubin, causes of lethargy, anemia, personal interests, confusing points, etc.)

 

Thoughtful Thursday:  Ruby Requests Rest (link will go live Thursday, 10/19/2023)