BVSc , MANZCVS (Small Animal Internal Medicine)
Veterinarian in Soares Avenue Paws & Claws Clinic,HK
Carnassial tooth fracture – Slab fracture part 2
For this patient, extraction was performed. She made full recovery and pain-free.
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For part 1, click on previous post
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Carnassial tooth fracture – Slab fracture part 1 🦷
Slab fracture is one of the most common traumatic tooth fracture. The most common causes are chewing on hard items such as bones or really hard chew toy. When the dental pulp is exposed, then it is painful and predispose to bacterial infection. Treatment options at that point are either extraction or endodontic therapy (eg root canal therapy).
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Cotton Tip 👂
Cotton tip should never be used for ear cleaning purpose. They can cause damage or even break within the ear canal. This patient was presented to me for second opinion for recurring ear infection. The cotton tip was retrieved from the ear canal and she made full recovery.
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Happy Chinese new year 🐉
Purrfect X-ray positioning
When taking X-ray, good positioning is required to obtain diagnostic X-ray. Some animals are just more compliance than others and some patients might require sedation or general anesthesia to obtain diagnostic X-ray.
P.S She’s my own cat and no animal was harmed
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Mast cell tumor (MCT)
Mast cell tumor is celled the ‘the great pretenders’ because grossly they mimic the look of any lumps on the body. Luckily they look very different under the microscope. Mast cells are round cells which packed with granules and for MCT, there are usually a lot of mast cells. Fine needle aspiration (FNA) is a relatively cheap and minimal invasive procedure. Therefore FNA should be perform in almost every abnormal lumps around the body. It is important to note that MCT cannot be graded based on cytological findings alone. Biopsy is required for histologic grading which provide information about the prognosis and how aggressive the tumor is.
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What did she eat?
Duck🦆
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Strangulation –Rubber band injury
Rubber band can cause compression and strangulation of body parts. This patient was presented for left hind limb limping for the past 24 hours. On close examination, there was a rubber band around the left hock causing strangulation of the leg. This prevented blood from entering and exiting that region, hence decreased oxygen level and increased waste product. In severe cases, tissue will become necrotic (dead) and patient could potentially experience metabolic derangement. Luckily for this patient, there was no permanent damage and he made full recovery.
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Pericardial effusion ❤🩸
Pericardial sac is a fibrous sac that surround the heart for mechanical protection and provide lubrication to reduce friction between the heart and the surrounding structures. Abnormal buildup of fluid within the sac (Pericardial effusion) will restrict the ability for the heart to pump blood. When the pressure within the pericardial sac exceed the pressure within the heart, it will decrease the amount of blood returning to the heart hence decrease the amount of blood being pumped out (Cardiac tamponade). In these cases, removal of the pericardial fluid (pericardiocentesis) is required.
Pericardial fluid usually looks like blood. However, unlike blood from the heart/vessels, pericardial fluid usually doesn’t clot.
It is important to further investigate for the cause/s of pericardial effusion. The most common causes are cardiac neoplasia and idiopathic pericardial effusion
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Bladder Diverticulum
This patient was presented for recurrent cystitis. A double contrast retrograde cystogram was performed and the bladder diverticulum was highlighted. This can predispose patients to recurrent and/or persistent urinary tract infections due to urine stasis and incomplete emptying of urine.
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Metatarsal fracture
This lovely puppy was presented for sudden onset of right hind limb lameness. Xray was taken and revealed all the metatarsal bones were fractured. Most of these cases can be managed with external coaptation (bandage) especially in a young animal. Bandage change and xray was taken periodically and the puppy had fully recovered by week 6.
Bone will heal if there’s adequate stability and it usually takes 6-8 weeks to heal in an optimal environment.
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Brachycephalic obstructive airway syndrome (BOAS) in cat
BOAS can happen in cats too.
For part 1, click here
https://www.instagram.com/p/CyLWIGmxln0/?img_index=1
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Hyperdontia
Hyperdontia refers to an excess number of teeth🦷🦷
What hurts more than getting bitten by 4 canine teeth?
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Tongue ulceration
Oral/dental lesion is relatively common therefore I always perform an oral examination as part of the clinical examination.
Some of the causes included over-grooming, physical trauma, chemical burn (acidic/alkaline agent), extreme temperature (hot or cold), infectious and neoplasia.
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-Cystitis Part 2.5 – Crystalluria
Acidic urine will promote calcium oxalate formation
These are examples of calcium oxalate crystals.
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Click here for Part 1
https://www.instagram.com/p/Ck0eNMKAXMb/?utm_source=ig_web_copy_link
Click here for Part 2
https://www.instagram.com/p/Comg7QYrFKQ/?img_index=1
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Brachycephalic obstructive airway syndrome (BOAS)
Short faced dog breed (brachycephalic) have a compressed face, narrow nostrils and distorted nasophaynx which result in restricted airflow and airway obstruction. These causes increased airway resistance during inspiration. To overcome this resistance, brachycephalic animals must exert increased respiratory effort by producing higher negative pressure in the airways (sucking more air). With increased negative airway pressure, the airway become swollen and over time, the affected airway tissue may become thicken further worsening the airway obstruction. Ultimately, permanent structural damage (e.g. laryngeal collapse), airway failure or hypoxemia can occur. Additionally, chronically increased negative airway pressure may predispose brachycephalic animals to several other comorbid conditions.
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Buccal Mucosal Bleeding Time (BMBT)
BMBT is a diagnostic test to evaluate the function of the platelets.
A shallow small cut at the upper inner lip mucosa and the time it takes to stop bleeding is the BMBT.
Normal BMBT is
Ear mites
Ear mite infestation is very common and highly contagious in cats and dogs. They cause ears itchiness, ears discharge and odor, scratching ears and head shaking. Lucky there are various topical and systemic therapy which are highly effective.
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Mammary gland tumors
This patient was presented for a rapid growing large mammary mass which extended from the left mammary glands to the right side. Surgical removal of this mass was challenging due to the size of the mass and the skin availability for primary closure after the mass removal. Luckily feline skin is relatively elastic therefore the defect was able to close with primary closure with minimal tension. It is important to have a backup plan prior to the procedure. I was prepared to perform skin flaps if required and fortunately it’s not needed in this case. The mass was sent out for histopathology and came back as benign tumor.
Most feline mammary tumors are 90% malignant and 10% benign. (She was the lucky one!)
For Canine, 50% of mammary tumors are malignant and 50% are benign.
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Bladder/Urethral stones🪨
Urethral blockage due to bladder stone/s is relatively common in cats and dogs. In this case, there was a bladder stone found in the bladder and another stone within the urethra. Urinary catheterization was performed to push the urethral stone back into the bladder and negative contrast was used to highlight the number of stones. Surgical removal of the stones was then performed.
Placement of urinary catheter provides a guideline of the position of the urethra and it can assist to locate lesion/s within the urethra
Negative/positive constrast is useful to highlight pathology within the bladder and urethra .
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Transitional cell carcinoma
Hematuria is a very common clinical sign and there are many causes including feline idiopathic cystitis, bacterial cystitis, bladder stones🪨, bladder mass etc. Urinalysis and imaging🔬🩻 (X-ray and ultrasound) are essential diagnostic tools to differentiate them. Unfortunately for this patient, there is a bladder mass at the bladder trigone. Traumatic catheterization was then performed to collect cytology sample🔬. Cytology reveals anisocytosis (variation of cell size) and anisokaryosis (variation of nuclear size) with some cells that are multinucleated. Diagnosis of transitional cell carcinoma (TCC) was made
TCC is most commonly located in the trigone and often extends into the urethra. Surgical resection is rarely warranted as a sole treatment due to the location of the tumor. There are few medical treatment which can prolong median survival time (MST) for the patients. These treatments include chemotherapy, NSAIDS and Tyrosine kinase inhibitors (eg Palladia). 💊
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Jaundice
Jaundice, also known as icterus, is a yellow pigmentation of mucous membrane due to increased level of bilirubin within the blood. Causes of high bilirubin goes into 3 category.💛
1️⃣ Prehaptic : When the rate of production of bilirubin exceeds the ability for the liver to excrete it. Hemoglobin in the red blood cells (RBC) is the main source of bilirubin, hence excessive destruction of red blood cell can cause elevation of bilirubin.
2️⃣ Hepatic : When liver function is compromised to the extent that it is no longer able to clear the normal daily bilirubin load
3️⃣ Post-hepatic: Liver is able to clear the normal daily bilirubin load into the biliary system but the biliary system is unable to excrete it via the GI tract. This may be seen with biliary obstruction.
It is essential to find the cause/s as marked elevation of bilirubin usually indicates significant pathology/s.
🩸🔬Blood test and ultrasound are excellent diagnostic tools for further investigation
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Cross-matching
Cross-matching is one of the test performed prior to blood transfusion to minimize transfusion reaction. Major cross-match and minor cross-match are usually performed.🩸
-Major cross-match = Mixing a drop of donor red blood cells and patient plasma/serum
-Minor cross-match = Mixing a drop of donor plasma/serum and patient red blood cells
If the blood product isn’t compatible then autoagglutination might occur (see pic abnormal)
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Anaemia -blood transfusion
One of the key vital we check during clinical examination is mucous membrane (MM) colour .
The MM for this kitten was very pale which is suggestive of severe anaemia 🩸 and later confirmed with blood test. She certainly felt much better and energetic after blood transfusion. 😻
Usually anaemia will accompany with other physiological changes such as tachycardia 💗 therefore it’s important to look at the patient as a whole instead of just one parameter.
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It has been a while since I last posted.
Thanks everyone for your continuous support. ❤
I will start posting regularly again and hopefully everyone can learn something from them. If you do learn and appreciate these posts, please give them a like and share 👍
as that will motivate me to post even more in the future.
Stay safe everyone
Saline agglutination test (SAT)
Steps to perform SAT:
1) Prepare a clean slide on the flat surface
2) Put one drop of patient blood onto the slide🩸
3) Put 1-2 drop of saline and mix it together.💧
4) Swirl the slide around😵💫
5) Observe for ‘clumping’ macroscopically and microscopically.🔬
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IMHA Part 1 – Saline agglutination test
Immune-mediated hemolytic anemia (IMHA) 🩸 is characterized by immune system dysregulation that leads to destruction of the red blood cells (RBC). IMHA is either primary or secondary to another disorder.
Saline agglutination test (SAT) is a very easy test to perform and require minimal equipment 💉. A positive result indicates autoagglutination (Clumping) of the red blood cells (RBC) 🩸 caused by anti-RBC antibodies, hence immune-mediated destruction of RBC. A positive result doesn’t differentiate between primary and secondary causes therefore it is important to do a full investigation. Also, IMHA should never be diagnosed solely based on SAT test.
Steps to perform SAT:
1) Prepare a clean slide on the flat surface
2) Put one drop of patient blood onto the slide🩸
3) Put 1-2 drop of saline and mix it together.💧
4) Swirl the slide around😵💫
5) Observe for ‘clumping’ macroscopically and microscopically.🔬
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Facial paralysis
This patient came in with unilateral conjunctivitis and superficial corneal ulceration. However there’s more to it. This animal can’t blink 👀properly hence the secondary damage to the eye. 👁
There are 12 cranial nerves and they all have different functions including sensory function, motor function, gland secretion and many more. Facial nerve paralysis is the inability to move the muscles of facial expression (Eg eyelids, lips, ears, nose) 👅👃👂because of dysfunction of the motor component of cranial nerve (CN) VII, the facial nerve.
An idiopathic form of the disease is the most common cause in dogs (up to 75%) and can also occur in cats (25%). Other potential causes include:
-Extra-cranial causes (eg. otitis media, otitis interna, head trauma, surgery of ear and face)
-Facial nerve (neoplasia, inflammation, metabolic disease, toxin)
-Intra-cranial causes 🧠 (eg inflammation and brainstem neoplasia)
Diagnosis is based on clinical signs and cranial nerve reflex testing. The diagnosis of idiopathic facial paralysis is made by exclusion. In majority of cases, the condition is unilateral. Some of my favourites cranial nerve reflex testing included menace reflex, palpebral reflex, pupillary light reflex (PLR) and dazzle reflex
Medical tips:
It is important to perform neurological examination. It is easy to do and it only takes an extra 30 seconds
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If you wish to learn more about these cranial nerve reflex, please comment below
[It will be quite technical]
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Atlantoaxial instability (AAI) /subluxation/luxation
AAI occurs most commonly in small and toy breeds; majority are due to congenital malformations. Signs related to congenital malformations usually occur before 2 years of age👶. Occasionally signs develop in an older animal.
Clinical signs are due to pinching of the spinal cord hence C1-C5 myelopathy which included ataxia, weakness and paralysis.
This patient had ataxia since young however one day, she suddenly became paralysed.
Xray revealed dorsal displacement of vertebrae C2 relative to vertebrae C1 🩻. Due to the severity of this case, surgery was recommended to stablise C1 and C2. After a thorough risk and benefit discussion, owner elected conservative treatment with external bandage stabilization. As you can see, the love increases with each bandage change❤
Medical tips :
If you suspect AAI, avoid ventroflexion of the neck during radiography because it can worsen subluxation/luxation (pic 3)
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Carnassial tooth fracture – Slab fracture part 1 🦷 . Slab fracture is one of the most common traumatic tooth fracture. The most common causes are chewing on hard items such as bones or really hard chew toy. When the dental pulp is exposed, then it is painful and predispose to bacterial infection. Treatment options at that point are either extraction or endodontic therapy (eg root canal therapy). -- If you learnt something from this post, please like / share 👍👍 -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺 #veterinarymedicine #veterinarian #vetxray #dentalxray #vetdentisty #pethk #hkcat #hkpet #hkdog #medvetlife #veterinaryeducation #獸醫 #manzcvs #medicinaveterinaria #veterinario #vetlife #vet #veterinary #hkvet #vettechlife #veterinarytechnician #vetschool #vetstudent #vetmedstudent #vetmedworld #vetmedicine #vetmed #veterinarianhongkong #teethfracture #carnassialtooth
Saline agglutination test (SAT) . Steps to perform SAT: 1) Prepare a clean slide on the flat surface 2) Put one drop of patient blood onto the slide🩸 3) Put 1-2 drop of saline and mix it together.💧 4) Swirl the slide around😵💫 5) Observe for ‘clumping’ macroscopically and microscopically.🔬 -- If you learnt something from this post, please like / share 👍👍 -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺 -- #pethk #hkcat #hkpet #hkdog #medvetlife #veterinaryeducation #獸醫 #manzcvs #veterinario #medicinaveterinaria #vetlife #vet #veterinary #hkvet #vettechlife #veterinarytechnician #vetschool #vetstudent #vetmedstudent #vetmedworld #vetmedicine #vetmed #veterinarianhongkong #veterinarian #imha #salineagglutination #autoagglutination #anaemia #vet #vetmed
Facial paralysis . This patient came in with unilateral conjunctivitis and superficial corneal ulceration. However there’s more to it. This animal can’t blink 👀properly hence the secondary damage to the eye. 👁 . There are 12 cranial nerves and they all have different functions including sensory function, motor function, gland secretion and many more. Facial nerve paralysis is the inability to move the muscles of facial expression (Eg eyelids, lips, ears, nose) 👅👃👂because of dysfunction of the motor component of cranial nerve (CN) VII, the facial nerve. . An idiopathic form of the disease is the most common cause in dogs (up to 75%) and can also occur in cats (25%). Other potential causes include: -Extra-cranial causes (eg. otitis media, otitis interna, head trauma, surgery of ear and face) -Facial nerve (neoplasia, inflammation, metabolic disease, toxin) -Intra-cranial causes 🧠 (eg inflammation and brainstem neoplasia) . Diagnosis is based on clinical signs and cranial nerve reflex testing. The diagnosis of idiopathic facial paralysis is made by exclusion. In majority of cases, the condition is unilateral. Some of my favourites cranial nerve reflex testing included menace reflex, palpebral reflex, pupillary light reflex (PLR) and dazzle reflex Medical tips: It is important to perform neurological examination. It is easy to do and it only takes an extra 30 seconds -- If you learnt something from this post, please like / share 👍👍 If you wish to learn more about these cranial nerve reflex, please comment below [It will be quite technical] -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺 -- #pethk #hkcat #hkpet #hkdog #medvetlife #veterinaryeducation #獸醫 #manzcvs #veterinario #medicinaveterinaria #vetlife #veterinarymedicine #vet #veterinary #veteducation #vettechlife #veterinarytechnician #vetschool #vetstudent #vetmedstudent #vetmedworld #vetmedicine #vetmed #veterinarianhongkong #facialparalysis #c
Splenic mass . This is an incident finding of a splenic mass on ultrasound scan examination. These patients don’t usually have clinical signs unless the mass is ruptured and causes internal bleeding. Therefore I do recommend abdominal ultrasound to be included into a comprehensive checkup because we get a lot of health information about your pets that can’t be obtained via blood test and x-ray. -- If you learnt something from this post, please like / share 👍👍 -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺 -- #pethk #hkcat #hkpet #hkdog #medvetlife #veterinaryeducation #獸醫 #manzcvs #veterinario #medicinaveterinaria #vetlife #veterinarymedicine #vet #veterinary #hkvet #veteducation #vettechlife #veterinarytechnician #vetschool #vetstudent #vetmedstudent #vetmedworld #vetmedicine #vetmed #veterinarianhongkong #ultrasound #vetultrasound #splenicmass #mass
Part 3 Pregnancy – Ultrasound --- Heartbeat 💗 . During a pregnancy ultrasound assessment, we look for foetal heart beat and heart rate.🫀 Foetal heart rate gives us a lot of valuable information. . Normal foetal heart rates range from 190-220bpm. 💖 When it drops to <190bpm, it indicates foetal distress. 💛 When it drops to <160bpm, it is an emergency and warrants immediate intervention. ❤️🩹 A heart rate <130bpm are associated with poor survival rates if the kitten isn’t delivered within a few hours. 💔️ -- If you learnt something from this post, please like / share 👍👍 -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺
This mynah imitating the phone ringing doesn’t help with my cortisol level during my ER shift. -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺
-Heartworm – Part 1 This is a drop of blood under the microscope. This patient had heart worm and the arrow is pointing to a heart worm larvae (baby heart worm). . Heart worm life-cycle:🪱♻️ Heart worm is transmitted by mosquito🦟. When a mosquito bites a heartworm infected dog, it ingested the larvae. The larvae then develops into infective stage within the mosquito and transmits to other dogs/cats during feeding. The larvae takes about 6-7 months in the tissue and bloodstream to mature, and it ends up becoming an adult worm in the heart of the patient hence the name heartworm. Usually a few heartworms in dogs don’t cause significant clinical signs but when the worm burden increases, the clinical signs become more severe. Clinical signs included exercise intolerance, shortness of breath, cyanosis, fluid buildup in the abdomen or even sudden death. . -Medical tips- Heartworm antigen test is testing for heartworm female reproductive tract antigen and can give false positive and negative. I always do microfilaria test to double confirm my diagnosis as it’s very easy to do. Microfilaria test🩸 - Put a drop of blood on the microscope slide and put a cover slide on top, then look at it under the microscope. . *Although it is rare, cats can get heartworm disease and they usually present with different clinical signs. I will explain more in depth in future post *😿 . -- If you are interested in Part 2, please let me know by liking/sharing this post 👨⚕️👍. -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺 --
-Heart worm – Part 1 This is a drop of blood under the microscope. This patient had heart worm and the arrow is pointing to a heart worm larvae (baby heart worm). Heart worm life-cycle:🪱♻️ Heart worm is transmitted by mosquito🦟. When a mosquito bites a heartworm infected dog, it ingested the larvae. The larvae then develops into infective stage within the mosquito and transmits to other dogs/cats during feeding. The larvae takes about 6-7 months in the tissue and bloodstream to mature, and it ends up becoming an adult worm in the heart of the patient hence the name heartworm. Usually a few heartworms in dogs don’t cause significant clinical signs but when the worm burden increases, the clinical signs become more severe. Clinical signs included exercise intolerance, shortness of breath, cyanosis, fluid buildup in the abdomen or even sudden death. -Medical tips- Heartworm antigen test is testing for heartworm female reproductive tract antigen and can give false positive and negative. I always do microfilaria test to double confirm my diagnosis as it’s very easy to do. Microfilaria test🩸 - Put a drop of blood on the microscope slide and put a cover slide on top, then look at it under the microscope. *Although it is rare, cats can get heartworm disease and they usually present with different clinical signs. I will explain more in depth in future post *😿 -- If you are interested in Part 2, please let me know by liking/sharing this post 👨⚕️👍. -- -- 👨⚕️Follow https://www.instagram.com/drvictorpoon/ for more🩺
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