Case 1. The Vomiting Dog

Jack is a 4½-year-old female spayed Yorkshire-Terrier mix with a history of multiple episodes of dietary indiscretion, with one episode less than 24 hours ago. She now is vomiting acutely and is depressed and anorectic. Upon presentation she weighs 7.0 kg and is depressed. She has temperature of 39.7°C, a heart rate of 132 beats per minute, a respiratory rate of 42 breaths per minute, and appears to be mildly dehydrated at around 5%. She also responds to mild abdominal pressure with vocalization and retraction and is thus judged to have abdominal pain.

Based on the history and the clinical examination the following problem list is generated for Jack:

1.  Acute vomiting

2.  Abdominal pain

3.  Mild dehydration

4.  Fever

5.  Anorexia

6.  Depression

The owner agrees to a full clinical evaluation of Jack.

Questions

 What are the possible causes of acute vomiting in Jack (list both primary and secondary causes)?

 What are the possible causes for the abdominal pain in Jack?

 What are the possible causes for the mild dehydration in Jack and how would you manage it?

 What are the possible causes for the fever in Jack?

Case 2. The Young Dog with an Elevated alt

Gucci is a healthy 8-month-old female intact Shih Tzu that was presented for an ovariohysterectomy. The physical examination was normal. Gucci is receiving monthly heartworm preventive, is current on vaccinations and has been dewormed in the past. The diet is Royal Canin Poodle Puppy Food. She is not receiving supplements and there is no exposure to any known toxins. A preanesthetic blood work (i.e., CBC, UA, limited biochemical profile) was performed, the only abnormality being an elevated ALT activity:

The surgery was postponed and the owners were advised by their veterinarian to seek a second opinion on the increased ALT activity as they suspected the dog had a portosystemic shunt. Gucci was evaluated by you approximately 4 weeks later. At that time the owner considered her dog to be normal. She agreed to a second expanded biochemical profile including bilirubin, ALT, AST, ALP, and GGT. The only abnormality was:

The owner was very concerned and wanted further explanation for the elevated ALT. Finances was not a limitation.

Questions

 What are your differentials for the elevated ALT activity in this dog?

 What additional diagnostics would you consider?