1. Practical Clinical Pathology Cases - Outside Lab Tests
Wendy Blount, DVM
Nacogdoches TX

2. Greta 10 yr old SF Chesapeake Bay Retriever CC: weight loss, lethargy
She stinks really bad
History – repeated pyoderma
Exam – T 98.3Fo, P 66, R 24
Papules, scaling – generalized
Seborrhea and hair loss around the eyes and on the ventral neck
She falls asleep on the exam table

3. Greta Skin Scraping – negative Skin Cytologies Thyroid Panel
Crusts – many cocci bacteria
Seborrheic areas – many yeast
Thyroid Panel
TT4 - >7 mcg/dl (normal )
fT4 – 20 pmol/L (normal 12-33)
TSH – 0.6 ng/ml (normal )

4. Greta fT4ED, TAb Diagnosis: Hypothyroidism
fT4ED 3 pmol/L
(normal 12-33)
T4Ab 29 (normal <20)
T3Ab 9 (normal <10)
TGAb 1912% (normal <200)
Diagnosis: Hypothyroidism
<1% of hypothyroid dogs have normal to elevated TT4 (RIA) due to Auto Ab

5. Maddie 2 yr old F Doberman Wants thyroid screen for breeding
Exam – T 101.3Fo, P 96, R 24
No significant abnormal findings
Michigan State Premium Thyroid Panel

6. Maddie 2 yr old F Doberman Wants thyroid screen for breeding
Exam – T 101.3Fo, P 96, R 24
No significant abnormal findings
Michigan State Premium Thyroid Panel
normal
normal
high
high
high

7. Maddie Diagnosis: Treatment: Follow-up:
Stage 2 – Subclinical Hypothyroidism
Treatment:
None at this time
Follow-up:
Recheck TSH, TT4, fT4 once to twice yearly, or sooner if symptoms of hypothyroidism develop

8. Maddie Breeding Recommendation:
Delay breeding until 3-4 years old, if no signs of hypothyroidism have developed
Screen for other genetic predispositions
DCM – echocardiogram for FS
Neurologic exam for Cervical Vertebral Instability and Degenerative Myelopathy
CERF eye certification
OFA or Penn Hip certification
VWDz Testing (Cornell)
DNA for VWDz, DCM, DM + Narcolepsy (

9. Eli 2 year old neutered male Great Pyrenees – Chow mix
CC – “Sometimes he looks at me like he doesn’t know me.”
Also, he laid
down in Lowe’s
the other day
and would not
get up.

10. Eli Exam Cardiovascular exam Neurologic exam
overweight
Cardiovascular exam
NSAF – HR 80-90
Neurologic exam
Cranial nerves, spinal nerves, postural reflexes normal
CBC, panel (HW Test current)
Cholesterol 385 (not fasted)

11. Eli In House TT4, send out Thyroid panel
TT4 < 0.5 mcg/dl (undetectable)
TSH normal, TT4 0.3 mcg/dl, fT4 0.2 ng/dl
Eventually settled on 1.0 mg PO BID
Behavior returned to normal
Died at 8 years of age of adrenal neoplasia
The Story of Eli

12. Trauma to the right inguinal area
Benji Boy
3 year old neutered male papillon
Hx – never been sick before, except got stepped on by a cow 6 weeks ago, and he hasn’t been right since
Wheezes in the lungs
Trauma to the right inguinal area
Healed with time
CC – anorexia and lethargy, vomits 1-2x a week
Exam – NSAF

13. Benji Boy
CBC – WBC 22,450/ul
Neutrophil 16,390/ul
Monocytes 2,360/ul
Basophils 140/ul
Electrolytes – normal
Panel – SAP 262 U/L
Fecal flotation – negative
Abdominal x-rays & US – NSAF Tx
Denosyl 90 mg PO SID
Clavamox 62.5 mg PO BID x 7d

14. Benji Boy
5 days later – not eating or drinking, still does not feel good, in pain
Exam – mild to moderate discomfort on abdominal palpation, grunts
Temp 104.7oF
cPL - >400
Abdominal US

15. Benji Boy
5 days later – not eating or drinking, still does not feel good, in pain
Exam – mild to moderate discomfort on abdominal palpation, grunts
Temp 104.7oF
cPL - >400
Abdominal US

16. Benji Boy
5 days later – not eating or drinking, still does not feel good, in pain
Exam – mild to moderate discomfort on abdominal palpation, grunts
Temp 104.7oF
cPL - >400
Abdominal US

17. Benji Boy
5 days later – not eating or drinking, still does not feel good, in pain
Exam – mild to moderate discomfort on abdominal palpation, grunts
Temp 104.7oF
cPL - >400
Abdominal US

18. Benji Boy
5 days later – not eating or drinking, still does not feel good, in pain
Exam – mild to moderate discomfort on abdominal palpation, grunts
Temp 104.7oF
cPL - >400
Abdominal US
Pancreas enlarged and mottled in echotexture, ascites in the cranial abdomen 2-3mm lines, Corrugation of the duodenum

19. Benji Boy
Dx - Pancreatitis
Hospitalized to treat for pancreatitis
IV fluids
Continue Denosyl
Cerenia®
Buprenex for pain
Ampicillin and enrofloxacin
Eating in a few days, fever down, sent home on antibiotics, Cerenia, and Denosyl®

20. Benji Boy
2 weeks later
CC - Did well for awhile, now there is straining to defecate and fresh blood and mucus on the stool, eating well.
Wt - 6 months ago 14 pounds, 1 month ago 12 pounds, now 11.5 pounds
Exam – no pain on abdominal palpation, rectal exam and rest NSAF
Fecal – negative
Rx – metronidazole 62.5 mg PO BID x 7 days

21. Benji Boy
3 weeks later
CC – got better for awhile, but now worse - anorexia, vomiting, diarrhea
Wt – 9 lbs
Exam – NSAF
Fecal – negative
rectal scraping – no fungal organisms seen
Tx – Cerenia and Tylan while awaiting GI lab results

22. Benji Boy
5 days later – appetite better
GI panel – B12, PLI, TLI normal
Folate low
Proximal small intestinal disease
Recommend intestinal biopsies
Declines referral for flexible endoscope
Diagnostic surgery for multiple biopsies
liver, stomach, duodenum, jejunum, ileum
Rigid scope colon biopsies

23. Benji Boy
Histopath
Moderate suppurative hepatitis
Inflammatory bowel disease (EP inflammation in the duodenum and jejunum, villous blunting, crypt lesions)
Tx – prednisone 5 mg PO BID x 2 weeks, then 5 mg PO SID
3 weeks later – Benji doing great
10.2 lbs
Owner - “Dr. Blount is the smartest vet in the universe”

24. Benji Boy
1 week after that (8 weeks after 1st visit)
CC - not feeling well
GI signs have stopped, but Benji cries out when you pick him up
Owner – “Dr. Blount, are you sure you know what you are doing?”

25. Benji Boy
Exam
Wt 11.5 lbs (way up)
Mucopurulent discharge from the eyes
Cranial drawer sign both stifles
Pain on palpation of the muscles and long bones
T – 104.7oF
What’s the catch?

26. Benji Boy
CBC – WBC 52K – segs, monos
Panel – SAP 1132 U/L
Lytes - normal
Radiographs
Pelvis
Front limbs
Rear limbs

27. Benji Boy

28. Benji Boy

29. Benji Boy
DDx Periosteal proliferation
Pulmonary hypertrophic osteopathy
Hepatozoon spp.
Thoracic radiographs – normal
Abdominal ultrasound – normal
MiraVista Histoplasma Ag – negative (tests)
Hepatozoon PCR – positive (order kit)
Clindamycin 25 mg/kg PO BID x 2 weeks
Albon 25 mg/kg PO BID x 2 weeks
decoquinate 50 mg/kg once daily

30. Benji Boy
Benji did well as long as he took decoquinate
He needed an occasional round of Albon and clindamycin – 2-3x a year
Did well for several years, until he had a severe episode
Referred to TAMU for re-evaluation, and they made no new diagnosis
Benji was euthanized at 8 years of age

31. Lessons from Benji Boy
IBD is not a disease, it is a lesion description
IBD can be secondary, even when evidence of chronicity is on histopath
IBD almost never causes fever
Pancreatitis is often not primary
Immunosuppressive therapy for one disease can unmask infectious disease that is present
Pay attention to symptoms unexplained by Dx
Just because someone says you are the smartest vet in the universe, doesn’t mean you are

32. Acknowledgements
Richard Nelson. Small Animal Clinical Diagnosis by Laboratory Methods, 5th Edition. Ch 12 – Endocrine, Metabolic and Lipid Disorders. Eds. Michael Willard, Harold Tvedten.
Mark C Johnson. Small Animal Clinical Diagnosis by Laboratory Methods, 5th Edition. Ch 12 – Immunologic and Plasma Protein Disorders. Eds. Michael Willard, Harold Tvedten.