scott@vtx-cpd.com
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Replying to austeja Zykute 11/03/2022 - 19:52
Hello Austeja.
Thank you so much for your kind words. We are so happy to have you as part of our community.
These are really tricky cases. The patient clearly needs the medication you have prescribed for the underlying condition. The ulceration is most likely to be due to the prednisolone. With the secondary immunosuppression on board, is there any option to reduce the prednisolone more quickly? I would absolutely start omeprazole at 1mg/kg 2x daily and monitor very carefully. The melena may not always be obvious, so I would also keep a close eye on what the haematology is doing.
Hope that helps.
Scott 🙂
Replying to Emma S. 09/03/2022 - 14:57
No problem!
Let me know if I can do anything to help!
Scott 🙂
Replying to Nathalie Cunha 10/03/2022 - 05:36
Cool!
Keep us posted with the final diagnosis!
Scott 🙂
Replying to Nathalie Cunha 09/03/2022 - 12:38
Hello again!
This is another interesting paper. Basically, the time to ulcer formation can vary, but can be quite quick. Again, it depends a bit on the comorbidities:
https://pubmed.ncbi.nlm.nih.gov/34596276/
Regarding the spinal patients… we will crack that open in lesson three!
Scott 🙂
Replying to Ursula Lanigan 01/03/2022 - 16:06
Hello Ursula.
Thank you for this brilliant thoughts. I think you are right, totally depends on the case. If there are persistent symptoms then it would definitely move forward your decision to do to surgery.
I often see cases that have eaten a variety of chicken bones (that are asymptomatic) for endoscopic retrieval. I think many of them could be left alone and would dissolve just fine.
Scott 🙂
Replying to Nathalie Cunha 09/03/2022 - 12:38
Hello.
I hope you are well. Thank you so much for the questions. Regarding the NSAIDs. I think I depends a little. It can happy within a few days, and this might be associated with co-morbidities. I actually found this recent case series which I think is really interesting. I never think of colonic perforation as a possibility. In all of these cases the perforation happened quite quickly after starting NSAIDs:
Colonic perforation in 4 dogs following treatment with meloxicam
Mark J Longley 1, Stephen J Baines 2, Guillaume Chanoit 3Abstract
Objective: To describe the clinical findings and treatment of 4 dogs that developed colonic perforation shortly after meloxicam administration.Series summary: Three cases were treated with meloxicam for variable nonspecific signs including lethargy and pyrexia. Hemorrhagic diarrhea developed following meloxicam administration in 2 cases. Gastrointestinal perforation was suspected on diagnostic imaging leading to exploratory celiotomy in all 3 cases. Partial colectomy was performed in 2 cases and suture repair with serosal patching in 1 followed by broad spectrum antimicrobials. All 3 dogs recovered from surgery well. One dog that had undergone perineal herniorrhaphy and received meloxicam perioperatively collapsed and died 7 days postsurgery. Postmortem examination revealed ulceration and perforation of the ascending colon with resultant generalized septic peritonitis. Histopathologic findings in all cases showed full thickness infiltration of the colonic wall with inflammatory cells along with ulceration and perforation. Thrombosis of vessels underlying the ulcerated areas was also noted.
New or unique information provided: This report suggests that colonic perforation may be a complication of nonsteroidal anti-inflammatory drug use in some cases. To the authors’ knowledge, this has not previously been described in dogs. Colonic perforation associated with NSAIDs administration may be more commonly identified in dogs with concurrent morbidities. Caution may be warranted when using NSAIDs in dogs with colonic pathology or possible risk factors to develop such pathology. Prompt diagnosis and treatment is essential for a positive outcome.
Replying to Ursula Lanigan 06/03/2022 - 22:51
Interesting!
Your comment regarding the gagging is interesting. They will not always do this, but the repeated swallowing is really suggestive.
Scott 🙂
Replying to Julie S. 08/03/2022 - 13:00
Thank you for joining us Julie.
We are really thankful for you supporting the course. Please let me know if you have any questions at any time.
Scott 🙂
Replying to Francois Ravier 08/03/2022 - 12:03
Francois,
Lovely to see you here. Thank you so much for supporting vtx and joining another course. Hope life in general practice is not too hectic!
Scott 🙂
Replying to Nathalie Cunha 08/03/2022 - 17:31
Of course! Brilliant thoughts everyone!
I think based on the brilliant videos and the clinical presentation i would be cricopharyngeal dysphagia, especially as you have ruled out a cleft palate. A bit more information:
Cricopharyngeal dysphagia is a congenital or acquired neuromuscular disorder of the upped oesophageal sphincter characterized by failure of the sphincter to relax (achalasia) or a lack of coordination between sphincter relaxation and pharyngeal contraction (asynchrony). Affected dogs have abnormal transport of bolus from the hypopharynx to the proximal oesophagus. Affected animals demonstrate progressive dysphagia (typically worse when drinking water) at the time of, or shortly after, weaning. Clinical signs are characterized by repeated attempts to swallow, gagging, retching, and nasal regurgitation. The clinical signs of dogs with cricopharyngeal achalasia are indistinguishable from cricopharyngeal asynchrony. Physical examination may reveal evidence of aspiration pneumonia (coughing, moist crackles on auscultation, fever).
Dogs suspected of having cricopharyngeal dysphagia should be thoroughly evaluated prior to surgical intervention to ensure that systemic disorders (myopathies, polyneuropathies) have been ruled out with AChR antibody titers, CK level, electromyography, and muscle biopsy. In addition, ensure that aspiration pneumonia is properly managed. Thoracic radiographs help rule out structural causes of dysphagia (foreign body, mass); however, a videofluoroscopic swallow study is the diagnostic procedure of choice. Most affected dogs with cricopharyngeal achalasia have a prominent thickened cricopharyngeus muscle (cricopharyngeal “bar”) visible on videofluoroscopy or endoscopy causing severe obstruction to propulsion of the bolus through the upper oesophageal sphincter. Static contrast radiographs may demonstrate barium retention in the pharynx or aspiration into the trachea; however, static studies do not allow the functional integrity of the upper oesophageal sphincter or the coordinated contraction of the pharynx and relaxation of the upper oesophageal sphincter to be evaluated.
I do think fluoroscopy is next sensible step.
Hope that helps.
Scott 🙂
Replying to Emma S. 06/03/2022 - 09:59
Emma!
Welcome. The PDSA in Edinburgh was one of my first jobs as a VS. Such good memories of the PDSA and such amazing memories of the amazing city that is Edinburgh.
Hope we can chat about Alfie at some stage too.
Scott 🙂
Replying to carly w. 05/03/2022 - 22:17
Hello Carly!
Lovely to have you on board! Thank you so much for your kind words regarding the first lecture. I really hope the course is useful to you.
Scott 🙂
Replying to Amanda-Jane Rogers 04/03/2022 - 11:44
Amanda!
Hello to you. We are so pleased to have you join us. Thank you so much for all of your lovely support on social media.
I hope you are enjoying the course.
Scott 🙂
Replying to Claire L. 03/03/2022 - 20:52
Hello Claire!
There seems to be a common theme here with Labrador puppies! Really pleased to have you on the course.
Please let me know if you have any questions at any time.
Scott 🙂
Replying to Morag Y. 03/03/2022 - 12:52
Hello Morag.
I am so pleased to see you back for more CPD with us. The support is truly appreciated.
I have no idea how people juggle everything! There really are not enough hours in the day!
Hope you enjoy the course.
Scott 🙂
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