07/05/2024
今天要來分享一個需要立即手術處理的急診病例-Skippy
Today I'm going to share an emergency case that requires immediate surgery - Skippy. Please scroll down for English version
有需要治療協助的主人歡迎聯絡
Paws and Tails Veterinary Hospital 詢問或預約
☎️28322836
WhatsApp: 98705711
www.pawsandtailshk.com
Skippy 是一隻14歲已絕育的公科基犬，主人發現他前一晚突然變得很虛弱而且不願意吃飯，於是隔天早上馬上來診所就診，檢查時發現Skippy 非常虛弱、呼吸急促而且牙肉非常蒼白，懷疑有嚴重的貧血；中老年狗狗急性的貧血其中一個可能是肝臟或脾臟腫瘤破裂，在跟主人討論了可能的原因之後，主人同意馬上進行了驗血還有全腹腔的超聲波檢查，驗血雖然顯示僅有輕微的貧血，血容比33% 只比正常的低了4%，以及血小板數量中度至嚴重的不足，其他器官功能指數則大部分正常，然而在超聲波下卻發現腹腔有大量的積液，而且脾臟有一顆腫塊，將腹腔的液體抽出來確認是鮮血，強烈懷疑是脾臟腫塊破裂造成的急性出血，如果不緊急手術控制出血的位置Skippy可能隨時會休克死亡，在經主人同意下，Skippy開始了大量輸液治療，穩定血壓及血液循環後在一小時內安排緊急開腹手術。
開腹後發現Skippy肚子裡冒出大量的鮮血，並確認是因為脾臟的腫塊破裂，在緊急摘除脾臟的同時，肚子內總共抽出了400-500ml的鮮血。術後Skippy繼續住院治療，雖然隔天還是稍微虛弱，但是出血的狀況已經受到控制，在第三天後回家繼續休養。
脾臟的病理報告診斷是血管肉瘤(Hemangiosarcoma) 在狗狗非常的惡性，由於是血管來源的腫瘤，可以轉移到身體的任何地方，通常平均壽命也較其他腫瘤短，術後若想延長狗狗的壽命，往往會建議開始化療。
雖然脾臟的腫塊大概只有不到2cm 然而卻造成嚴重的出血，主要是因為腫瘤是惡性的血管肉瘤，在臨床統計上顯示，越大的脾臟腫瘤反而常常是良性的，主要原因是良性的腫塊通常會緩慢的長大往往在沒有破裂前不會造成動物不適，而惡性的腫瘤常在還沒有長到很大時就已經造成不適甚至破裂。
⚠️在遇到類似的狀況有些主人或醫生往往會有一些顧慮而不知道如何做決定，但是如果沒有明確及迅速的判斷及處置，往往會造成無法挽回的悲劇。
📌狗狗出血這麼嚴重，麻醉手術的風險這麼大，是否應該等狗狗出血穩定再考慮手術？
通常腹腔器官破裂造成的出血，往往不會自行停止，而最終導致狗狗嚴重失血而死亡，如果不盡快的處理出血的源頭，狗狗狀況通常只會越來越差。
📌狗狗的血小板這麼低，手術不會有出血不止的問題嗎？
血小板是身體止血用的細胞，如果是因為體內器官或是腫塊破裂的出血，身體會用掉大量的血小板，所以血小板通常數值會偏低，然而如果源頭持續出血，血小板會持續耗盡，所以仍然需要儘快將出血源頭控制，術中則需要儘可能的使用不同的工具設備止血。
📌Skippy腹腔內大量出血，為何當時驗血紅血球比例只有輕微的下降？
由於Skippy的脾臟腫瘤是突然的急性破裂，身體血液循環的血量跟腹腔的失血量尚未平均分佈，若是再過數小時未受到控制，驗血的數值勢必會顯著下降，並且對器官及生命造成更嚴重的影響。
Skippy is a 14-year-old neutered male Corgi. The owner noticed that he suddenly became weak and refused to eat the previous night. So they immediately brought Skippy to the clinic the next morning for examination. During the examination, Skippy was found to be very weak, with rapid breathing and very pale gums, indicating possible severe anemia. One possible cause of acute anemia in middle-aged and older dogs is the rupture of a liver or spleen tumor.
After discussing the possible reasons with the owner, they agreed to proceed with blood tests and an abdominal ultrasound examination immediately. Although the blood test showed only mild anemia with a hematocrit level of 33% (4% lower than normal) and a moderate to severe decrease in platelet count, most of the other organ function numbers were normal. However, the ultrasound revealed a large amount of fluid in the abdomen and a mass in the spleen. The fluid extracted from the abdomen confirmed it to be fresh blood, strongly suggesting acute bleeding caused by a ruptured spleen tumor. Without urgent surgery to control the bleeding, Skippy could go into shock and die at any moment. With the owner's consent, Skippy started intensive fluid therapy to stabilize blood pressure and circulation, and an emergency laparotomy was performed within an hour.
During the surgery, a large amount of fresh blood was found in Skippy's abdomen, and it was confirmed to be due to the rupture of the spleen tumor. While the spleen was being urgently removed, a total of 400-500ml of blood was drained from the abdomen. After the surgery, Skippy continued to stay in the hospital for treatment. Although he was still slightly weak the next day, the bleeding was under control. After the third day, Skippy was discharged and allowed to continue recovering at home.
The pathological report of the spleen diagnosed it as hemangiosarcoma, which is a highly malignant tumor in dogs. As it originates from blood vessels, it can spread to any part of the body. On average, dogs with hemangiosarcoma have a shorter lifespan compared to other tumors. After surgery, chemotherapy is often recommended to prolong the dog's life.
Although the size of the spleen mass was less than 2cm, it still caused severe bleeding. This is mainly because the tumor was a malignant hemangiosarcoma. Clinical statistics have shown that larger spleen tumors are often benign. The main reason is that benign masses usually grow slowly and do not cause discomfort in the animal until they rupture. On the other hand, malignant tumors often cause discomfort or rupture even before they grow large.
⚠️ When encountering similar situations, some owners or doctors may have some following concerns and not know how to make decisions. However, without clear and prompt judgment and intervention, irreversible tragedies can often occur.
📌 In a case where the dog is bleeding so severely and the risks of anesthesia and surgery are high, should the surgery be considered only after the bleeding stabilizes?
In general, bleeding caused by the rupture of abdominal organs does not stop on its own and eventually leads to severe blood loss and death in dogs. If the source of bleeding is not promptly addressed, the dog's condition usually worsens.
📌 With such low platelet count in the dog, won't there be a problem of excessive bleeding during surgery?
Platelets are the cells responsible for blood clotting. In cases of bleeding caused by organ rupture or tumor, a large number of platelets are consumed. Therefore, platelet counts are often low. However, if the source of bleeding continues, platelets will continue to be depleted. Therefore, it is still necessary to control the bleeding source as soon as possible, and during the surgery, various tools and devices are used to achieve hemostasis.
📌 Skippy had a large amount of intra-abdominal bleeding. Why did the blood test show only a slight decrease in red blood cell ratio at that time?
Since Skippy's spleen tumor ruptured suddenly, the blood volume in the body had not yet been evenly distributed with the amount of blood lost from the abdomen. If left uncontrolled for a few more hours, the values in the blood test would have significantly decreased, causing more serious effects on organs and life.
⚠️ If you need veterinary assistance, please contact:
Paws and Tails Veterinary Hospital for inquiries or appointments
☎️ 28322836
WhatsApp: 98705711
www.pawsandtailshk.com
#脾臟腫瘤
#急性出血
#獸醫診所
#寵物診所
