13 Pancreatitis and alimentary lymphoma in a dog
Case history
The dog presented with a week long history of vomiting and decreased appetite. The vomitus contained food and bile and occurred at least once a day. The frequency of vomiting had increased over the past month. He had had a similar episode 5 months earlier which had responded to treatment with oral electrolyte solutions and antibiotics.
The owners thought that he had lost weight, but were unsure of how much. He was lethargic, although the owners reported that he was usually a quiet dog. His stools had been soft and somewhat dark in colour during the last couple of weeks, although also scant as he had not been eating well.
The dog had last been de-wormed 3 months previously, but had not been vaccinated for about 3 years. His previous diet was a dry food bought at the grocery store, plus snacks and treats of human food. He was being tempted to eat small amounts of chicken and ham at presentation. He was on no current medication.
Physical examination
The dog’s demeanour was dull but responsive. He was estimated to be about 6% dehydrated. His body condition score was good at 5/9, although there was evidence of muscle loss over his epaxial, lumbar and temporal muscles. Mucous membrane colour was pink and capillary refill time was less than 2 seconds. Peripheral lymph nodes were unremarkable.
Thoracic auscultation revealed normal heart and lung sounds, with a heart rate of 96 beats per minute and respiratory rate of 16 breaths per minute. There was evidence of mild to moderate pain on palpation of the cranial abdomen. Rectal temperature was decreased at 36.7° C.
Problem list and discussion of problems
Differential diagnosis
Vomiting was the dog’s main problem and it was the one initially addressed. Differential diagnoses for vomiting in this dog include the following disorders:
Most dogs with intussusception are less than 1 year of age, although it was still a possibility in a dog of this age. He did not have any other signs of renal disease, so uraemia was an unlikely cause of the vomiting.
Differential diagnoses for cranial abdominal pain in this dog included:
Low rectal temperature may be due to decreased ambient temperature, (which was not the case here) shock or other disorders of peripheral circulation, hypothyroidism, or to placement of the thermometer within a faecal ball in the rectum. One of the latter two differential diagnoses was thought to be most likely in this case.
Case work-up
The dog was admitted to the hospital for diagnostic investigation and fluid therapy to correct the dehydration.
Minimum data base
Haematology, serum chemistry and routine urinalysis were performed. Haematology results showed an elevation in white blood cell with a neutrophil count of 23.5 × 109/l (reference range 3.6–12.0 × 109/l), band or meta neutrophils of 1.4 × 109/l (reference range 0 for this laboratory) and monocytes of 2.24 × 109/l 9 (reference range 0–1.5 × 109/l). His packed cell volume (PCV) was 0.54 l/l, within the reference range of 0.39 to 0.55 l/l, but high for a dog not of the sighthound breeds.
Clinical tip on PCVs
While the upper end of the range of PCV for most laboratories is above 0.50 l/l, the upper end of the reference range is more typically seen in greyhounds and other sighthounds. When values above 0.50 l/l are seen in other breeds, haemoconcentration should be considered, which is often due to dehydration. Values above 0.60 l/l may even be due to secondary polycythaemia or polycythaemia vera.
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