Tried this on your own before referring to this key??
Note: italics indicate alternative acceptable answers.
| S | Jack has been eating well and bright since admission |
| O | T= 101.3, P=100, R=24 Abnormal Labs: Neurtophils (12,160), bands (610), HCT (39.7) is on the low end of normal range |
| A | Neurtophilia (12,160) left shift to bands (610) suggests inflammatory process, which may be related to the teeth or may be related to new problem of bacteruria (see problem #4). The presence of toxic change increases our suspicion that the inflammatory process is in fact infectious, possibly from a tooth root abscess. |
| P | no diagnositic and therapeutic plans pending results of further workup of other problems
would also accept symptomatic care of mouth rinses |
| S | see problem 1 |
| O | 300 mls water intake in 8 hours is 5.4 ml/kg/hr, which is 129 ml/kg 24-hour rate. The usg=1.014, which is inappropriate for azotemia, occ rods seen along with active sediment on UA |
| A | The water intake supports that the dog does have PUPD. Azotemia appears to renal in origin. The dog is not clinically dehydrated and the dog does not concentrate his urine. Post renal is not supported because Jack is urinating normally. Problem #2 will be refined to renal failure. The next question is whether the renal failure is chronic or acute. The fact that the owner thought the dog became PUPD 3 weeks ago supports that it is acute or subacute. Because of the bacteruria, hematuria and pyuria (problem #4) pyelonephritis becomes a concern. Chronic renal failure with secondary bacterial UTI is also a possibility. Low normal hematocrit could support anemia of chronic inflammatory disease as would be seen for pyelonephritis or hypoproliferative anemia of CRF. |
| P | Dx. would like to see either ultrasound to look at prostate and kidneys or IVU (intravenous urogram) must see monitor TPR would like to see monitor for signs for gross hematuria, dysuria, or renal pain Rx: would accept none at this time pending culture unless US or IVU supports pyelonephrtitis or start any antibiotic good for rods pending results of imaging studies & culture CE: source of UTI may be low grade prostatic infection, needs further work-up, minimal diagnostic risk. If pyelonephritis prognosis depends on cdgree of renal damage. Would require long-term antibiotic care and follow-up |
| S | No straining to defecate noted. |
| O | UA showed moderate bacteruria, 5 - 8 WBC, 5 - 10 RBCs |
| A | Bacteruria with increased red cells and white cells suggests bacterial urinary tract infection. Need to confirm bacterial UTI and localize as the problem may be confined to the lower urinary tract or also involving the kidneys or prostate. If the dog had prostatitis one would expect the prostate might be painful and it is not. |
| P | Dx. would like to see cystocentesis for UA (to compare with voided) must see aerobic culture from cystocentesis would like to see ultrasound to look at prostate and kidneys, accept semen collection or prostatic wash as alternative must see monitor TPR would like to see monitor for signs for gross hematuria, dysuria, or prostatic pain Rx: would accept none at this time pending culture or start any antibiotic good for rods pending culture CE: source of UTI may be low grade prostatic infection, needs further work-up, minimal diagnostic risk. If prostatis need to treat and consider castration once resolved. |
| S | The technicians report no dysuria when Jack urinates. |
| O | UA showed occ bacteruria, 5- -8 WBC, 5 -10 RBCs |
| A | Need to verify bacteruria seen on free catch reflects actual urinary tract infection. This would be rare in a male dog so we need to look for underlying source such as prostate or kidney. Bacteremia from dental disease (see problem#1) may also be related. The azotemia is supportive of a renal localization (pyelonephritis). Nephroliths or uroliths may also be involved. |
| P | Dx: Aerobic culture with sensitivity (by cysto), need to see either ultrasound of kidneys or IVU, okay is radiograph for nephroliths or uroliths must see monitor TPR would like to see monitor for signs for gross hematuria, dysuria, or renal pain Rx: would accept none at this time pending culture or start any antibiotic good for rods pending culture CE: Advise the client of the of UTI and need to confirm whether it is renal prostatic or LUT in origin. If renal, the short term prognosis once the dog is on appropriate therapy is good. However, the reversibility of the renal failure is unknown, although it may reversible and is relatively mild at this point. |
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Questions about this page may be directed to Dr. James
e-mail: 
JamesK@svm.vetmed.wisc.edu