Comment when you see the problem…

dog-lateral-xray

Sometimes you see really cool things, this is one of those times. A dog presented to a vet clinic in America after trauma and the doctors there shared these scans in a private group – I think they are so cool I asked permission to share them with you… (answer at the bottom if you scroll down)

Comment when you spot the problem…

Lateral viewdog-lateral-xray

Dorsal view

dog-dv-xrayP.S. The dog is doing fine.

 

 

 

 

 

 

 

 

ANSWER

The is a part of the intestines in the area around the dogs knee. This is because there was a traumatic abdominal wall rupture with herniation of the intestines into the space under the skin around the leg. In surgery the rupture was found to be in the left abdominal gutter. The “doll” like bone between the back legs here is the penile bone as it is a male dog.

Poultry with a slice of emergency surgery

First GDV of 2016 xray

Thursdays for me is either protection of the environment which is about cleaning things so I am confused as to why it is in my 5th year of vet school or poultry medicine which is more what I think 5th year should be like.

This Thursday was a poultry day and spent in the exotics department learning about chickens. Something I know a little about but still have a ton to learn. The chicken industry is big business with the only economical operations being industrial – however that is a topic for another day.

After finally getting home and sitting down to read up on stuff for tomorrow my phone goes – its emergency surgery for a GDV. Now a GDV is Gastric Dilation and Volvulus – often referred to as bloat or twisted stomach in dogs. The body of the stomach twists around so that the contents are trapped in a pocket of the stomach with no entrance or exit channels. As gas is produced from the breakdown of food material this pocket then starts to swell.

The swelling stomach then starts to squash other organs within the abdomen due to its increase in size – it has nowhere else to go and the abdomen is a limited space so this can also put pressure on the diaphragm and limit the lung space. This includes the blood vessels and finally the vessels and tissues that make up the stomach wall and lining are compressed as well. This leads to what is called pressure necrosis which is where tissue doesn’t get enough blood supply because all the blood vessels inside have been squashed so the tissue starts to die and turn black.

I’ve been in surgeries where pressure necrosis has been so great that the entire stomach is black and there is no way for us to fix the patient so it can survive.

The second complication of the increased pressure inside the abdomen is for the distribution of blood in the body. When we release the pressure from the stomach we need to have fluids ready so that we can help the body rebalance its blood fluid to fill the now empty blood vessels where the stomach was compressing them.

However tonight’s patient is a weird presentation. It was referred from a private vet for a suspected GDV, however there was no dilation when it arrived – and the dog was relatively stable. However when it made it into xray it would not lie on its side so the only radiograph we could get was the one with it on its back (ventral-dorsal position) which is here.

On this xray you can see that it is like a shape of a 8 with loads of gas (dark areas) within the abdomen. This line going across splitting the image is common with GDV presentations.

Taking the dog into surgery it was a successful repair to the stomach, however we found some haemorrhage around the spleen vessels so performed a partial splenectomy as well. The dog recovered very well.

Heading into the bleeding abdomen…

A beautiful evening going into surgery

My Friday night plans of studying with a film in the background after visiting the balloon festival vanished a few hours ago with a single phone call asking me to assist in an emergency surgery for a dog bleeding into the abdomen.  14 minutes later I arrived at the surgery to help prep the operating theatre and patient.

Now a bleeding abdomen is an emergency, as if untreated the animal can lose all its blood into the abdomen and die from blood loss (even though the blood is still insider the body). Generally this occurs from trauma, however there are circumstances where it occurs for other reasons such as the rupture of a tumour or complications after a surgery.

Generally our goal is to control the bleeding, and so anything we have that can tell us where the bleeding is coming from is good. Before I arrived the doctor had already done a ultrasound exam to confirm that there was indeed fluid in the abdomen, and was just finishing in x-ray, which is our case showed changes on the spleen so we were pretty certain this was where the bleeding was located.

Usually in a bleeding abdomen once you open it is a race against the clock to find and stop the bleeding. This is not easy when the entire abdomen is filled with blood and you cannot see much at all so have to rely on feel and knowledge of anatomy. In our case because we had localised it to the spleen this made surgery easier, as when you open the abdomen the spleen is one of the first things that you can see.

The blood vessels supplying the spleen were ligated (tied) and the spleen was removed from the body. The blood that had leaked into the abdomen was removed by suction and then we proceeded to flush the abdomen with sterile saline.

Sadly however there are only a couple of reasons for rupture of a tumour of the spleen, and here we still do not know which we are looking at. Proceeding to stabilise the patient post-surgery, we knew they were still alive because of us, and were given the best chance. However looking forward we do not know for how long as if the tumour is malignant then 2 month survival time is very low.