clinical cases focus on respiratory and cardiology dusty w. nagy, dvm, ms, phd dacvim university of...

Clinical CasesFocus on Respiratory and Cardiology

Dusty W. Nagy, DVM, MS, PhD DACVIM

University of Missouri

Food Animal Medicine, Surgery, and

Production Medicine

Case Workup

Signalment

History

Physical Examination

Problem List

Differential Diagnoses– Prioritized list– Avoid zebras

particularly the pink and chartreuse ones

Case Workup

Initial diagnostic and treatment plan– Prioritize tests

Utility – rule in or rule out differentials

Need to know info for treatment

– Analyze test results

Changes to the plan

Outcome

Reflection

Case 1

Chief complaint: weak, appears drunkSignalment: 9-year-old black crossbred cowHistory: Cow was seen off by herself this morning. They assumed that she was trying to calve. When no calf was noted by noon they went to check on her. She rushed the owner and rammed several farm vehicles while taking her to the barn.Environment: August in central Missouri. Cow is one of 32 in a cow calf herd. They are housed on 80 acres of mostly fescue grass subdivided into 3 pastures.

University of Missouri #


AppearanceBody condition score 5/9Normal abdominal contour

BehaviorBelligerentAggressive

Gait and postureWeakStands base wide on all 4Sways while walking

Urine analysisyellow/orange colorNo analysis done

TPRTemperature – 104.2 ºFPulse – 92 bpmRespiratory rate – 52 bpm

Physical Examination – left side

RumenDecreased content

Poor stratification

PingsNo pings

Lymph Nodesprefemoral – normal

prescapular - normal

Lung auscultationnormal breath sounds

Heart auscultationRhythm – regular, fast

Intensity – normal

Sounds – no murmurs or arrhythmias

Jugular veinNormal

Cervical skin tent< 2 seconds

Physical Examination – right side

PingsNo pings

SeccussionNo fluid sloshing

Ballotmentnormal

Lymph nodesPrefemoral – normalPrescapular - normal

Lung auscultationNormal breath sounds

Heart auscultationRhythm – regular, fastIntensity – normalSounds – no murmurs or

arrhythmias

Jugular veinNormal



Abdominal painNone present

Skinnormal

Extremitiesnormal

Musculoskeletalnormal

HeadOcular discharge - none

Eye examination - normal

Nasal discharge - none

Mucous membrane color - yellow

Teeth - normal


Mammary glandInflammation

none present

Strip cup

no abnormalities

California mastitis test

Rectal palpationThird trimester fetus

FecesDry/firm

Large amount in rectum

Problem list

Problem list

Tachycardia

Tachypnea

Fever

Jaundice

Abnormal behavior, posture and gait

Abnormal fecal consistency

Prioritized list of differentials

Differential diagnosisTachycardia/Tachypnea– Cardiac disease– Respiratory disease– Disease that affects oxygen carrying capacity – Pain– Stress

Jaundice– Liver failure– Hemolysis

IntravascularExtravascular

Differential diagnosis

Fever– Infection– Inflammation

Abnormal posture and gait– Neurologic disease– Musculoskeletal disease– Disease that affects oxygen carrying capacity

Abnormal fecal consistency– Gastrointestinal disease– Dehydration

Initial diagnostic and treatment plan

Diagnostic plan Treatment plan

CBC– PCV/TP

Arterial blood gas

Serum biochemistry

Urinalysis

Complement fixation/PCR

Antibiotics– Oxytetracycline 9mg/lb

SQ EOD

Low stress environment

InterpretationCBCAnemia – lossAnisocytosisPolychromasia Erythrocyte basophilic stipplingPeripherally located erythrocyte parasites

Update – after 2 days the cow is picking at hay and drinking some water. She is sticking close to the barn, but is moving around the lot.

Do you want to do any additional diagnostics orchange treatments?

The rest of the bunch…..

Do you want to do anything for the rest of the herd?

Does geography matter?

Does herd type matter?

Can you clear the carrier state?

What if’s………

What if the cow was down with a PCV of 8?– Would you transfuse her?– Would you treat her?– Would you euthanize her?

Any considerations before?

CASE 2

Problem: drooling, respiratory noiseSignalment: 6-month-old crossbred steerHistory: 10 calves (including patient) were weaned, vaccinated, castrated, and dehorned if necessary approximately 2 weeks prior. The calf did not eat as well as expected yesterday. Today it is anorexic and honks on inspiration.Environment: June in central Missouri. Herd composed of 50 cow/calf pairs on fescue pasture. Calves get some supplemental grain.



AppearanceBody condition score

4/9Normal abdominal

contour

BehaviorMildly distressed

Gait and postureHead and neck

extended

Urine analysis– None caught

TPRTemperature – 104.8 ºFPulse – 80 bpmRespiratory rate – 56

bpm


RumenNormal stratification

PingsNo pings


prescapular – normal

Lung auscultationDifficult to auscult

Honking on inspiration

Open mouth breathing

Heart auscultationRhythm - regular

Intensity - normal


Jugular veinNormal



PingsNo pings


Ballotmentnormal


Lung auscultationDifficult to auscult

Honking on inspiration


Heart auscultationRhythm – regularIntensity – normalSounds – no murmurs or

arrhythmias

Jugular veinNormal




Skinnormal

Extremitiesnormal



Eye examination – mild scleral injection

Nasal discharge – whitish/yellow, fetid

Mucous membrane color - pale

Mouth

Teeth – normal

Hypersalivation

Neck – large, painful larynx



NA

Strip cup

NA


NA

Rectal palpationNA

Fecesnormal

Problem list

Problem list

Fever

Tachypnea

Inspiratory noise

Head and neck extended


Fetid breath

Nasal and oral discharge

Scleral injectionPrioritized list of differentials


Tachypnea, inspiratory noise, head and neck extended, open mouth breathing, fetid breath, nasal discharge, salivation, swollen larynx with pain– Upper airway disease

Necrotic laryngitis – Fusobacterium necrophorum

Laryngeal trauma – abscess or edema

Viral laryngitis – IBR

Actinobacillosis

Fever, scleral injection– Inflammation, infection



No diagnostics– Save money for treatment

Endoscopy

Radiographs

CBC

Antibiotics– Florfenicol

9 mg/lb IM EOD

Anti inflammatory– Flunixin meglumine

1.1mg/kg IV SID – BID

Update – After 48 hours the steer is no longer honking and less dyspneic. The respiratory rate is still elevated and the breath is still somewhat foul smelling.


Drug Options

Florfenicol

Ceftiofur

Tulathromycin

Tilmicosin

Danofloxacin

Tetracycline

Penicillin

Sulfonimides

Case 3

Problem: respiratory distressSignalment: Weaned crossbred beef steerHistory: Calf was purchased at a sale barn in northern Missouri with 49 other calves. It was transported to a small feedlot in west central MO where it was vaccinated on arrival. Previous health and vaccine information unknown. Calf pulled for treatment this morning. Environment: 1000 animal feedyard. No testing done. Calves are routinely purchased and combined into muti-source pens.


Dyspnea



5/9Gant

BehaviorDepressed

Gait and postureHead and neck

extended

Urine analysisNone caught


bpm


RumenNormal stratification

PingsNo pings


prescapular - normal

Lung auscultationLoud and harsh

Crackles and wheezes

Rapid, shallow breaths

Heart auscultationRhythm - regular

Intensity - normal


Jugular veinNormal

Cervical skin tent4 seconds


PingsNo pings


Ballotmentnormal


Lung auscultationLoud and harshCrackles and wheezesRapid, shallow breaths

Heart auscultationRhythm – regularIntensity – normalSounds – no murmurs or

arrhythmias

Jugular veinNormal




Skinnormal

Extremitiesnormal


HeadOcular discharge -

mucopurulent


Nasal discharge - mucopurulent

Mucous membrane color - pale

Teeth - normal



NA

Strip cup

NA


NA

Rectal palpation

NA

Fecesnormal

Problem list

Problem list

Fever

Tachypnea

Ocular and nasal discharge

Head and neck extended

Rapid shallow breathing

Abnormal lung sounds


Differential diagnosisTachypnea; ocular and nasal discharge; head and neck extension; rapid, shallow breathing; abnormal lung sounds– Pneumonia

Viral– BRSV, IBR, PI3

Bacterial– Manheimia haemolytica, Histophilus somnii, Pasturella

multocida

Fever– Inflammation, infection



None save money for treatment

Arterial blood gas

CBC

Radiographs

Antibiotics and

Anti inflammatory– Resflor gold

Florfenicol– 40 mg/kg

Flunixin meglumine– 2.2 mg/kg IV

Dosed at 6ml/100 lbs SQ

Interpretationshould you so choose to run tests

CBCNeutrophilia – inflammatory diseaseNeutropenia – inflammatory disease, endotoxemiaLeft shiftToxic change in neutrophilsHyperfibrinogenemia – inflammatory disease

Update – six hours after the initial treatment the calf is noticeably improved. The calf’s temperature is 102.0 F, respiratory rate and effort are within normal limits. The calf is starting to eat and drink. Auscultation still reveals abnormal lung sounds.


Case 4

Problem: SickSignalment: 7-year-old Holstein bullHistory: ADR for approximately 2 weeks. Treated with antibiotics (several), flunixin meglumine, and several additional substances with no response.Environment: Bull resides on Amish farm. Used to breed cows for the owner and several neighbors.




3/5

BehaviorQAR

Gait and postureSlight arch to back

Urine analysisNone caught


bpm


RumenDecreased fill

PingsNo pings


prescapular – sl. enlarged

Lung auscultationnormal breath sounds

Heart auscultationRhythm - UTD

Intensity - UTD

Sounds – abnormal

Jugular veinDistended with pulses



PingsNo pings


Ballotmentnormal

Lymph nodesPrefemoral – normalPrescapular – sl. enlargement

Lung auscultationNormal breath

sounds

Heart auscultationRhythm – UTDIntensity – UTDSounds – abnormal

Jugular veinDistended with

pulses



Abdominal painElbows abducted

Skinnormal

Extremitiesnormal




Nasal discharge - none

Mucous membrane color - pink

Teeth - normal

Venous Distention

Jugular Pulses

Cardiac Auscultation new

Venous Pulsation



NA

Strip cup

NA


NA

Rectal palpation

weak aortic pulse

Feces

normal

Problem list

Problem list

Increased pulse rate

Abnormal cardiac auscultation

Distended jugular veins with pulses

Abducted elbows

Arched back



Increased pulse rate, abnormal cardiac auscultation, distended jugular veins, jugular pulses– Heart failure

PericarditisValvular endocarditisLymphosarcoma

Abducted elbows, arched back– Pain

Cranial abdominal/caudal thoracic



Serious talk with owner

Echocardiogram ????

CBC

BLV serology/PCR– Cancer hunt

Euthanasia

Septic Pericarditis

clinical cases focus on respiratory and cardiology dusty w. nagy, dvm, ms, phd dacvim university of...

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