Thoughtful Thursday: Vince Vomits Valiantly (Case 7)

  

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Click for Test Case Tuesday:  Vince Vomits Valiantly (Case 7)

 Vomiting or Regurgitation?

The MOST important determination to make in a vomiting patient's case is to make sure the patient is actually vomiting.  Vomiting is NOT the same as regurgitation.  Regurgitation is when food/fluid comes out of the mouth from any structure before the stomach (mouth, pharynx (throat), esophagus (food tube), etc.)  Vomiting is when food/fluid come out the mouth from the stomach or upper small intestines.

🤢

This distinction is extremely important because the causes of vomiting and regurgitation are different and the way we work up the two types of cases are completely different.  It is important to remember that an owner can say their pet is vomiting when they are in fact regurgitating food.  The ways you can differentiate vomiting and regurgitation are noted below:

Vomiting

• Abdominal push (abdominal muscles contract to push the vomitus out of the mouth)
  
• Bile present (green substance)
  
• Active process (you can see the whole body put in an effort to vomit)
  

🤮

Regurgitation

• No abdominal push
• No bile present
• Passive process (the mouth opens and the food/fluid comes out, no pushing seen)

 😵

An important aspect of any veterinary professional is to have your acting skills on point as it is common to see us acting out vomiting versus regurgitation.  The things that happen in an exam room are sometimes bananas (ask your vet med friends to act out reverse sneezing, you won't regret it).

 🎭

The owners describe Vince's "vomiting" as him eating his food and then immediately it "falls" back out of his mouth.  The owners do not see Vince actively retching or "pushing" when he has the "vomiting".  It is determined Vince is regurgitating, not vomiting!

 

Diagnostic Testing Results:

 

Radiographs: Severe megaesophagus (enlarged esophagus, food tube), signs of pneumonia 🩻

 

Specific Disease Testing - Acetylcholine Receptor Antibody Test: Positive ➕

 

🧪

Diagnosis:

🦴Myasthenia Gravis🦴

 

Pathophysiological Point:

Myasthenia gravis is a disease where the acetylcholine receptors between nerves and muscles are destroyed or blocked.  Simply, nerves cannot conduct their signals to muscles.  Muscles are unable to contract (move) without the signals from the nerves.

 

 Questions:

Level 1 Questions:

1. Vince's communication between his nerves and muscles is disrupted, how does that affect the muscles of his body?  Why?
   
   
2. What part of Vince's history and physical exam findings support the diagnosis of a disease that affects communication between the nerves and muscles of his body?
   
   
3. Challenge question, why does Vince have megaesophagus?  How does this cause regurgitation after meals?  (HINT:  Think about Vince's disease and how it would affect the muscles of the esophagus)
   

 

Level 2 Questions:

1. How does myasthenia gravis cause disease (i.e., megaesophagus) in a patient?  Be sure to mention the “normal” esophageal physiology in your answer and explain physiologically where the miscommunication is occurring.  (HINT:  Review normal neuromuscular junction physiology)
   
   
2. How does megaesophagus lead to Vince’s major clinical sign (regurgitation)?  (HINT:  Think about what keeps us from floating away into space)
   
   
3. Challenge question, explain why Vince has pneumonia.  Be sure to explain how his underlying disease predisposed him to this condition.  Be sure to mention the anatomy involved.  (HINT:  Think about what structure sits right next to the esophagus) 
   

    
   

Level 3 Questions:

1. Describe the treatment plan you would recommend Vince and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague. 
   
   
2. Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.
   
   
3. Please describe the different ways Vince's owners could help manage his condition with environmental changes.
   

  

Day 2 Conclusion

Before Conclusion Caturday think about your...

❓Answers to the above questions

📚 Review Material Related to Vince's case

 

Conclusion Caturday: Vince Vomits Valiantly (link will go live Saturday, 02/17/2024)

 

Thoughtful Thursday: Janice is Jinxed (Case 6)

 

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Click for Test Case Tuesday:  Janice is Jinxed (Case 6)

 

Diagnostic Testing Results Reminder:

 

Bloodwork:  Low glucose, high ketones

 

🧪

Diagnosis:

🐮Ketosis🐮

 

Pathophysiological Point:

Ketosis is a condition where the body is breaking down fats at an extremely elevated rate due to a negative energy balance.  This energy imbalance occurs because the body is using more energy than it is taking in through eating.

 

 Questions:

Level 1 Questions:

1. Why do you think Janice is suddenly breaking down more fat?  In other words, why would Janice have a negative energy balance?  (HINT:  Think about Janice's history and physical exam findings)
   
   
2. What is the pathway that is occurring at an increased rate in Janice's body?  Please write out all the steps of the process and include what molecule there will be more of in Janice's bloodstream.  (HINT:  Click here)
   
   
3. Challenge question, what information in Janice's history AND physical exam findings put her at increased risk for developing ketosis?  Why do those factors increase her risk for ketosis?  What ways could the farmer have reduced Janice's chance for developing ketosis?  (HINT:  Think about the underlying cause of the disease in Janice's case)
   

 

Level 2 Questions:

1. Explain why Janice has low glucose concentrations and high ketone concentrations in her bloodstream.  Do not forget to name the process that is occurring at an increased rate in Janice's body and the steps of this process.  (HINT:  Click here)
   
   
2. High ketone concentrations in the bloodstream lead to inappetence.  How does this information affect Janice's disease process?  (HINT:  Think about how inappetence is affecting Janice's body and her ability to overcome this disease process)
   
   
3. Challenge question, explain why ketosis is very common in dairy cattle, more common in dairy cattle that birth twins, and more common in dairy cattle that are overweight.  (HINT:  Think about what dairy cattle were bred to do and the underlying cause of this disease) 
   

    
   

Level 3 Questions:

1. Describe the treatment plan you would recommend Janice and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague. 
   
   
2. Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.
   
   
3. Please create and describe a ketosis prevention plan for this farm to decrease the incidence of ketosis on this farm (both clinical and subclinical ketosis).  Explain the importance of subclinical ketosis and why it is extremely important to prevent this disease process on dairy cattle farms.
   

  

Day 2 Conclusion

Before Conclusion Caturday think about your...

❓Answers to the above questions

📚 Review Material Related to Janice's case

 

Conclusion Caturday:  Janice is Jinxed (link will go live Saturday, 02/10/2024)

Thoughtful Thursday: Sick Swinehaus Swine (Case 5)

 

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Click for Test Case Tuesday:  Sick Swinehaus Swine

Given the concerning clinical signs and differentials list, the veterinarian immediately calls the state veterinarian to report a disease outbreak and to send samples from the pigs to Plum Island for analysis.  

🧫

Plum Island is an island off the state of New York that has an Animal Disease Center that studies and tests samples for foreign animal diseases such as Foot and Mouth Disease and African Swine Fever.  

🦠

Plum Island allows for studying these diseases that historically were not allowed to be studied on the mainland due to the fear of the diseases accidentally being brought out of the facility and infecting our animals.

🔬

Plum Island is slated to be closed as a new facility is being built in Manhattan, Kansas to study foreign animal diseases.  The goals of these facilities is to diagnose, research, and educate about foreign animal diseases that pose a risk to the United States agriculture and economy. 

🥽

African Swine Fever and Foot and Mouth Disease are NOT present in the United States.  Foot and Mouth Disease was eradicated from the United States in 1929 and African Swine Fever has never been reported in the United States.   

⚗️

All of our livestock are susceptible to these fatal diseases if they were to enter the country.

The results from this testing are below:

 

Diagnostic Testing Results:

Positive for African Swine Fever 😨

😱

Diagnosis:

🐽African Swine Fever🐽

 

Pathophysiological Point:

African Swine Fever (ASF) is an extremely fatal viral disease of domestic swine.  The ASF virus mostly infects the macrophages/monocytes of the pigs.  This causes a huge depletion in the immune cells of the animals.  The presentation of ASF is similar to Ebola in humans where the pigs have high fevers and start bleeding from different orifices.

 

 Questions:

Level 1 Questions:

1. Explain why the veterinarian contacted the state veterinarian to report the disease outbreak.  (HINT:  Think about the severity of the pigs' sickness and the information given at the start of this post)
   
   
2. Explain why the pigs are dying so quickly.  (HINT:  Think about the physical exam findings and the major finding that was found in the dead pigs' autopsies/necropsies)
   
   
3. Challenge question, what do you think should be done on the farm now that African Swine Fever has been diagnosed?  (HINT:  This disease is 100% fatal in American domestic pigs, there is no vaccination, the disease has never been on American soil, and there is no way to treat this disease.  The full answer to this question will be multiple different approaches)
   

 

Level 2 Questions:

1. Affected pigs are showing the signs of redness throughout their skin.  The severe redness noted in these pigs tells us that they are undergoing what process at an increased rate?  (HINT:  The other signs of this process are heat, swelling, pain, and loss of function)
   
   
2. Pathophysiologically explain the steps of the above disease process that leads to redness in these pigs.  Be sure to mention all molecules, substances, and changes that occur in each step.
   
   
3. Challenge question, explain how African Swine Fever is similar to the Ebola virus in humans.  Be sure to note the pathophysiology, source of infection, physical exam findings, etc. that are similar between the two diseases.  (HINT:  For this one take the time to find reputable sources to learn more about each disease) 
   

    
   

Level 3 Questions:

1. Describe your recommended plan and why you are recommending each part of your plan.  Please answer this question as if you are explaining it to a the farmer or the general public without a scientific background.  (Remember, this will be a sensitive conversation for most folks)
   
   
2. Please describe the different potential sources of ASF on this farm.
   
   
3. Please describe the different ways ASF can be prevented from entering into farms, regions, countries, etc.
   

  

Day 2 Conclusion

Before Conclusion Caturday think about your...

❓Answers to the above questions

📚 Review Material Related to our pigs' case

 

Conclusion Caturday:  Sick Swinehaus Swine (link will go live Saturday, 11/25/2023)

Thoughtful Thursday: Gaunt Gagging Goats (Case 4)

 

 

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Click for Test Case Tuesday:  Gaunt Gagging Goats

Diagnostic Testing Results Reminder:

 

Radiographs (X-Rays):

Signs of inflammation in the bronchioles of the lungs

 

CBC:

Increased eosinophils

 

Further Diagnostic Testing Results:

 

Fecal Exam (Poop Sample):

TNTC (too numerous to count) Dictyocaulus filaria eggs

🧪

Diagnosis:

🪱PARASITIC INFECTION:  DICTYOCAULUS FILARIA🪱

 

Pathophysiological Point:

Dictyocaulus filaria (D. filaria) is a parasitic infection.  The D. filaria larvae are ingested by the goat and penetrate through the small intestines into the blood stream.  The larvae arrive at the lungs where they develop into adult lung worms.  As the larvae develop, they block bronchioles and lead to eosinophils, lymphocytes, and plasma cells entering the bronchioles causing an inflammatory state.  Some larvae/eggs fall into the alveoli leading to inflammation in the alveoli.  The eggs/larvae are coughed up, swallowed, pooped out, and the cycle continues.

 

 Questions:

Level 1 Questions:

1.  Explain what the lungs do and why they are important.
   
   
2.  Why do you think the goats are having trouble breathing?  (HINT:  Think about the effect a parasite in the lungs would have on breathing)
   
   
3.  Challenge question, why do you think the goats are losing weight?  (HINT:  There are multiple answers to this question.  Think about what parasites do to the body and how a parasite that makes it hard to breathe would affect the goats)
   

 

Level 2 Questions:

1. Explain how inflammation in the alveoli affects the exchange of oxygen and carbon dioxide in the body.  Why does this lead to an increased respiratory rate in the goats?
   
   
2. How will this disease affect the compliance of the affected goats' lungs later in life?  (HINT:  Compliance is how well the lungs can expand to accommodate air.  Think about how the body heals injuries and how this might affect lung compliance)
   
   
3. Challenge question, explain the pulmonary mechanism that allows the parasite to spread between hosts in the fecal-oral route.  In other words, what mechanism allows the eggs produced by the adult lung worms to enter the gastrointestinal tract?
   

    
   

Level 3 Questions:

1.  Describe the treatment plan you would recommend for the goats and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague.
   
   
2.  Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.
   
   
3.  How does this disease affect these goat's V/Q ratio (ventilation/perfusion ratio)?
   

  

Day 2 Conclusion

Before Conclusion Caturday think about your...

❓Answers to the above questions

📚 Review Material Related to our goats' case

 

Conclusion Caturday:  Gaunt Gagging Goats (link will go live Saturday, 11/11/2023)

Thoughtful Thursday: Elaine Emits Exhaustion (Case 3)

 

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Click for Test Case Tuesday:  Elaine Emits Exhaustion

Diagnostic Testing Results Reminder:

 

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 
 

🧪

Diagnosis:

✨DILATED CARDIOMYOPATHY✨

 

Pathophysiological Point:

Elaine is suffering from a disease where her body's heart is stretching and weakening.  As the heart stretches and weakens, her heart is having a harder time pumping blood throughout her body.

 

 Questions:

Level 1 Questions:

1.  Explain what the heart does and why it is important.
   
   
2.  Why do you think Elaine's echocardiogram showed that all four (4) of her heart chambers are dilated compared to normal?  (HINT:  Think about Elaine's diagnosis)
   
   
3.  Challenge question, why do you think Elaine collapsed in her habitat?  (HINT:  Think about the heart's job and how Elaine's heart is a diseased heart that is not working properly)
   

 

Level 2 Questions:

1. Explain why Elaine has an atrial arrhythmia.  (HINT:  Heart conduction system)
   
   
2. How could Elaine’s viral infection from 10 years ago lead to heart disease (HINT:  How might a viral infection in the blood affect the heart?)
   
   
3. Challenge question, explain pathophysiologically why Elaine has jugular vein distention, edema in the neck, and ascites on physical exam.  (HINT:  Think about the heart's anatomy and how Elaine's heart chambers are NOT able to pump blood effectively)
   

    
   

Level 3 Questions:

1.  Describe the treatment plan you would recommend for Elaine and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague.
   
   
2.  Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.
   
   
3.  Explain the pathophysiology of at least TWO (2) different etiologies of Dilated Cardiomyopathy.
   

  

Day 2 Conclusion

Before Conclusion Caturday think about your...

❓Answers to the above questions

📚 Review Material Related to Elaine's Case

 

Conclusion Caturday:  Elaine Emits Exhaustion (link will go live Saturday, 11/04/2023)

Thoughtful Thursday: Florence Feels Feeble (Case 2)

 

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Click for Test Case Tuesday:  Florence Feels Feeble

Diagnostic Testing Results - Reminder: 

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

🧪

Diagnosis:

✨CHRONIC KIDNEY DISEASE (FAILURE)✨

 

Pathophysiological Point:

Florence is suffering from a disease where her body's nephrons (kidney cells) are slowly dying.  This means her kidneys are slowly shutting down.

 

 Questions:

Level 1 Questions:

1.  Explain what the kidneys do and why they are important.
   
   
2.  If Florence has dilute urine, what does she need to have access to AT ALL TIMES?  (HINT:  Dilute urine means Florence is peeing out more water than normal)
   
   
3.  Challenge question, why does Florence have a low number of red blood cells in her body?  (HINT:  For this one you will need to do some information gathering on the kidneys' different jobs)
   

 

Level 2 Questions:

1.  Explain pathophysiologically why Florence has pale gums on physical exam and is anemic on blood work.  Be sure to explain all the steps of the process that is NOT occurring in Florence due to her chronic kidney disease.
   
   
2.  Urea is a waste product that is normally urinated out of a patient's body via their kidneys and is an acid.  What acid-base status would you expect in Florence's bloodstream?
   
   
3.  Challenge question, what TWO compensatory mechanisms are activated in Florence's body (there are two – assume the juxtaglomerular cells are still functional)?  (HINT:  Think about Florence's dilute urine)
   

    
   

Level 3 Questions:

1.   Describe the treatment plan you would recommend for Florence and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague.
   
   
2.  Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.
   
   
3.  Explain the pathophysiology of at least TWO (2) different etiologies of Chronic Kidney Disease.
   

  

Day 2 Conclusion

Before Conclusion Caturday think about your...

❓Answers to the above questions

📚 Review Material Related to Florence's Case

 

Conclusion Caturday:  Florence Feels Feeble (link will go live Saturday, 10/28/2023)

Thoughtful Thursday: Ruby Requests Rest (Case 1)

 

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Click for Test Case Tuesday:  Ruby Requests Rest

 

Diagnostic Testing Results:

CBC:

Red Blood Cells - LOW

Reticulocytes - LOW

 

Direct Coombs Test:

Positive

🧪

Diagnosis:

🌌IMMUNE-MEDIATED HEMOLYTIC ANEMIA🌌

 

Pathophysiological Point:

Ruby is suffering from a disease where her own body is producing antibodies AGAINST her own red blood cells.  This means her own body is destroying her red blood cells.

 

 Questions:

Level 1 Questions:

1.  Explain why Ruby has a low number of red blood cells on her CBC.  (See Pathophysiological Point above for a hint)
   
   
2.  Why is having a low number of red blood cells in the body bad for a patient?
   
   
3.  Challenge question, why is Ruby icteric on physical exam?  (Hint:  Icterus)
   

 

Level 2 Questions:

1.  Given Ruby's disease process (see above), describe what is occurring at a cellular level to both the immune system cells and Ruby’s red blood cells.  Please be sure to address in your answer:
   
   • All blood cells involved in Ruby’s disease process (and how they are involved)
   • How the cellular changes are leading to her large and painful spleen
   
   
2.  Explain pathophysiologically why Ruby is icteric on physical exam.
   
   
3.  Challenge question, explain why Ruby has both low red blood cells AND low reticulocytes.  (HINT:  Think about her disease process)
   

    
   

Level 3 Questions:

1.   Describe the treatment plan you would recommend for Ruby and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague.
   
   
2.  Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.
   
   
3.  Explain the pathophysiology of at least TWO (2) different etiologies of Immune-Mediated Hemolytic Anemia.
   

  

Day 2 Conclusion

Before Conclusion Caturday think about your...

❓Answers to the above questions

📚 Review Material Related to Ruby's Case

 

Conclusion Caturday:  Ruby Requests Rest (link will go live Saturday, 10/21/2023)