VMII -- Nephrology & Urology Practice Case
Hx: Jack has been feeling well since his last visit 1 1/2 years ago. The owner has noted that Jack has had bad breath for the last several months and perhaps that he's been asking to go outside to urinate more for about the last 2-3 weeks. Because he was eating and playful, she elected to wait for his pre-boarding visit to address these problems. Jack had a negative heartworm test 2 years ago and has been on preventative since he was a puppy. Jack is primarily an indoor dog, although he does spend some time confined in a fenced yard. Jack is eating about 75% ALPO and 25% table scraps. Vaccines are current. No coughing/sneezing/vomiting/diarrhea.
PE: 7 kg. bright, responsive, and hydrated, T=101.0, P=110, R=28, mm-pink, CRT=1-2 sec
severe dental tartar with right upper P3 loose, no oral ulcerations
no abnormalities on palpation of the abdomen or ascultation of the chest
prostate-mildly enlarged, but symmetrical and nonpainful on rectal exam
the testicles are normal in size and symmetrical
no other significant findings
The following initial problem list and initial plans were generated. Based on the attached laboratory results write the first evening SOAP for the patient. You may assume there have been no changes in Jack's attitude since he was admitted in the morning. He is eating. The technicians have measured how much water they have put in his bowl and he drank about 300 mls in 8 hours. He has been outside once to urinate and defecate and no dysuria or straining to defecate was noted.
IPL:
1. dental disease with severe tartar and a loose upper R P3
2. PUPD
3. mild prostatomegaly
| PROBLEMS | DxR/O | DxPlans | RxPlans | CE |
| 1. dental disease | chronic poor dental hygiene possible tooth root abscess | CBC, dental exam w/ radiograph under general anesthesia once other problems worked up | none at this time | rec. dental tx and care minimal dx/tx |
| 2. PUPD | verify then consider: Cushings | UA (USG) to verify owner observ. urine glucose chemistry panel monitor H2O intake | none | pending results |
| 3. prostatomegaly | prostatic hyperplasia less likely: prostatitis, | UA by free catch | none | most likely PDH prognosis good unless gets larger |
| signature |
Data collected:
UA
| free catch | 5 ml spun for sediment |
| yellow | clear |
| USG=1.014 | pH=7.5 |
| glucose neg | bili trace |
| ketones neg | occult blood trace |
| protein trace | |
| Sediment: | |
| RBC 5-10/hpf | WBC 5-8/hpf |
| casts 0 | epi cells 0 |
| bacteria occ. rods | yeast 0 |
| fat 0 | sperm moderate |
| crystals 0 |
CBC
| WBC | 15.2 x 10-3 | *** | 80% segs | 12,160 |
| RBC | 5.65 x 10-6 | *** | 4% bands | 610 |
| Hgb | 13.6 g/dl | *** | 7% lymphs | 1,060 |
| HCT | 500 U/L | *** | 6% monos | 910 |
| MCV | 70UM3 | *** | 3% eos | 460 |
| MCH | 24.1 UUG | *** | ||
| MCHC | 34.3% | *** | slight toxic change | |
| platelets | 347 10-3 | *** | ||
Chemistry Panel
| ALB | 3.1 mg/dl | *** | BUN | 46 mg/dl |
| ALP | 99 U/L | *** | Creat | 2.3 mg/dl |
| ALT | 54 U/L | *** | Na | 146 mmol/L |
| AMY | 500 U/L | *** | Cl | 119 mmol/L |
| TBili | 0.3 mg/dl | *** | K | 4.2 mmol/L |
| CK | 80 U/L | *** | TCO2 | 17.2 mmol/L |
| Mg | 2.1 mmol/L | *** | Glucose | 106 mg/dl |
| TP | 6.9 mg/dl | *** | Tcalcium | 10.7 mg/dl |
| *** | Phos | 5.5 mg/dl |
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Questions about this page may be directed to Dr. James
e-mail: 
JamesK@svm.vetmed.wisc.edu