PENYAKIT DENGAN TANDA KUNING (JAUNDICE /ICTERUS) PADA KUCING

 PENYAKIT  DENGAN TANDA KUNING (JAUNDICE /ICTERUS) PADA KUCING

Oleh: drh. Cucu K. Sajuthi

 

Berbeda penyakit kuning antara anjing yang dicurigai leptosipira, kucing sangat jarang dilaporkan terjangkit leptospirosis.

Jaundice atau kuning yang terlihat pada mucosa/selaput lendir sclera, telinga, gusi dan kulit .

Penyakit kuning bisa timbul akibat kerusakan pada organ sebelum hati (prehepatic), pada hati itu sendiri (hepatic) dan setelah organ hati (posthepatic).

IctericCat3a (www.avmi.net)

 Kucing yang mengalami Jaundice, terlihat kekuningan pada gusi.

(courtesy: www.avmi.net)

Bilirubin yang berlebihan dalam darah menimbulkan warna kuning pada bagian tubuh sebagaimana terlihat pada daerah daerah tersebut diatas, Bilirubin adalah pecahan dari molekul heme (warna darah dalam sel darah merah), umumnya  jaundice prehepatic terjadi akibat terlalu banyak kerusakan pada sel darah merah yang tiba tiba menimbulkan hemolisis biasanya harus dicurigai dengan kondisi Immune –mediated.

Immune mediated hemolytic

Pada hewan sehat, system ketahanan tubuh (immune system) berfungsi mengusir segala macam benda asing seperti bakteri  yang masuk dalam tubuh. Pada hewan dengan masalah autoimmune immune system menyerang sel dalam pembuluh darah , proses ini akan berakibat intravascular hemolysis, salah satu tanda akan terlihat plasma menjadi agak pink sampai merah.urine positif hemoglobinuria, tanda lain dengan kecurigaan tersebut adalah  dalam pemeriksaan ulas darah ditemukan spherocyte  ( bentukan seperti bola dan lebih kecil dari RBC normal), ditemukan sel anisocytosis.

Obat obatan (acetaminophen, benzocain, propylene glycol)  juga dapat menimbulkan autoimmune mediated, bilamana obat menempel pada RBC dan menggertak terjadinya kerusakan pada RBC itu sendiri, penyebab lain adalah infeksi parasit darah (haemobartonela felis, Cytauxzoon felis dan babesia sp). Beberapa literature mengatakan kucing dengan positiuf Fe leukemia Virus (FeLV) atau Feline Immune mediated Virus (FIV) sangat beresiko tinggi untuk kontak dengan infeksi parasit diatas.

Untuk itu setiap kucing yang jaundice disarankan  ambil darah lengkap termasuk PCV dan ulas darah, bilamana PCV rendah sebaiknya dilakukan test terhadap virus FeLV dan FIV pula.

Penyebab lain hemolisis pada kucing adalah pemberian transfusi darah. Berbeda dengan anjing secara alam ia tidak mempunyai antinbody pelawan (alloantibodies), pada kucing secara alam sudah mempunyai antibody (alloantibodie) melawan grup diluar  tipe darah nya .  Kucing mempunyai golongan darah tipe A,  B dan AB. Golongan darah AB sangat jarang dan tidak memiliki alloantibodies.. Mayoritas adalah golongan darah A yang mempunyai anti-antibody B yang lemah, sedangkan golongan darah B mempunyai anti-antibody A yang kuat, sehingga semua kucing dengan golongan darah B akan mempunyai antibody pelawan tipe A-  RBC. Kondisi ini yang memudahkan terjadinya jaundice setelah transfusi darah.

Kadangkala terjadi pada anakan kucing usia 2 – 3 hari menjadi jaundice dan kematian dini.  kondisi ini disebabkan anak kucing golongan darah A lahir dari induk golongan darah B. disebut neonatal isoetythrolysis atau neonatal hemolytic. . disarankan kucing betina dengan golongan darah B tidak dikawinkan dengan jantan golongan darah A.

Sayangnya test untiuk golongan darah baik kucing maupun anjing belum masuk test kitnya di Indonesia, jika terpaksa terjadi, sebaiknya anakan tidak disusui oleh induknya.

Jaundice pada kucing ada kaitan nya dengan HEPATITIS / CHOLANGITIS /CHOLANGOHEPATITIS atau peradangan sel hati dan saluran empedu dan  penyakit  LIPIDOSIS.

Lipidosis  suatu  kondisi terganggunya pengaturan metabolisme distribusi lemak menimbulkan penumpukan trigeliserid dalam sel hati lebih cepat . masalah ini sering terjadi pada kucing yang semula sangat gendut (obese lalu tidak nafsu makan berhati hari, kucing yang tenderita diabetes, kucing dengan gangguan pencernakan, efek keracunan obat dan racun makanan). Secara laboratorium akan memperlihatkan tingginya kadar ALT, ALP, Bilirubin dan WBC bisa normal  sampai naik. Membedakan dari keduanya selain melihat sejarah dan anamnesenya ,yang terbaik dan akurat dilakukan biopsy hati dan USG (memerlukan keterampilan dari drh  berpengalaman). Pada biopsy akan ditemukan banyak neutrofil infiltrasi pada parenchym hati.

Pengobatan untuk kasus lipidosis dengan memutus siklus energy intake yang tidak cukup dan mobilisasi lemak dengan makan paksa ( bisa diilakukan oesophagustomy selama  7 hari maksimum 10 hari) sambil tetap dilihat ada kemauan makan sendiri.

Peradangan  pada hati  sering dijumpai pada kucing muda dan usia tua (> 8 th)biasanya diikuti dengan gejala klinis tidak nafsu makan, depresi, dan demam. Dengan kimia darah sama dengan pada kasus lipidosis, tetapi kebanyakan lekocytosis. Peradangan hati dapat juga disebabkan efek obat griseofulvin, ketokonazole, alfatoxin dan phenol.

Infeksi bakteri bisa diobati dengan antibiotik amoxilin, ampicilin  atau metronidazole. Disarankan diberikan sampai 6-8 minggu. Urdafalk (ursodeoxycholoic acid) adalah suatu obat untuk menstimulasi  aliran cairan empedu, tetapi sangat kontradiksi jika diberikan untuk kasus obstruksi pada saluran empedu. Berikan juga force feeding , berikan infus dan juga beri sedikit penghangat.

Penyebab lain jaundice adalah Feline Infectious Peritonitis (FIP).

Virus corona dapat menginfeksi sebagian besar organ, meliputi hati sehingga terjadi pyogranuloma dengan tingkat  keparahan yang bervariasi dari permukaan sampai parenchyma hati itu sendiri sehingga menimbulkan pada fungsi hati dan penyumbatan pada saluran empedu. Penyakit FIP sangat fatal dan cenderung menular, sebaiknya diisolasi.

Neoplasia juga dapat menyebabkan jaundice, namun kasus neoplasia atau tumor jarang terjadi pada kucing.

Post hepatic jaundice berasal dari pengeluaran bilirubin itu sendiri yang mengalami hambatan dari saluran empedu, biasanya karena ada sumbatan bisa karena urolito atau batu atau ada massa tumor, atau penekanan dari organ hati yang menekan  saluran empedu  se[perti tumor pada duodenum atau tumor pada páncreas.

Gejala klinis kucing yang menderita post hepatic selain kuning , tidak nafsu makan, depresi, sakit pada abdomen, dan demam. Namun demikian kejadian obstuksi empedu pada kucing sangat jarang. Yang paling sering terjadi karena hepatolipidosis, infeksi FIP dan kelaianan darah  (autoimmune hemolitic).

Pustaka:

  1. D.A and Sparkes. H, ARKES: Feline Immunodeficiency virus in Feline Medical & therapy 3rd edition, Blackwell, 2007, hal 612 -613
  2. stonehewer j; the liver and pancreas in feline medical 7 therapy 3rd edition, Blackwell 2007, hal 442-450
  3. nelson RW, Couto CG (eds): anemia,in small animal Internal medicine,ed 2, st Louis. Mosby,1988,pp 1160-1173
  4. Paul Crawford Bvetmed, Causes of icterus in cats, Veterinary Technician vol 22, Feb 2001.

 

 


PULMONARY METASTASIS OF CANINE MAMMARY TUMOR IN A GOLDEN RETRIEVER

PULMONARY METASTASIS OF CANINE MAMMARY TUMOR

IN A GOLDEN RETRIEVER

 

S.R Rotoro1, Royama Sari1, Erni Sulistiawati1, Cucu K. Sajuthi1

1. 24 HRS Veterinary Clinic Drh. Cucu K. Sajuthi and Associate

Ruko Nirwana Sunter Asri Tahap III Blok J-1 no.2 Sunter, North Jakarta-Indonesia

Keywords: Canine Mammary Tumor, Dog, Golden Retriever, Lungs, Metastasis

 

INTRODUCTION

 

Mammary neoplasms in dogs are second in frequency after skin tumors and they are the most common types of tumors in the bitch. According to the histological diagnosis, between 41 and 53 % of the mammary tumors that occur in the bitch are considered malignant5. Mammary neoplasms primarily affect older animals with a mean age of about 10 years. Most affected animals are intact females or females that have undergone ovariectomy late in life. Mammary tumors are rare in males and in young animals of either sex3.

Early ovariohysterectomy is strongly protective against the development of mammary tumors2,3. Bitches neutered before the first estrous cycle are at no greater risk for mammary tumor than are males. After 2.5 years of age or after the second estrous cycle, ovariohysterectomy is no longer protective in bitches3.

 

MATERIALS AND METHODS

 

       The observation was done on a 10 years old, intact female Golden Retriever dog which had mammary tumor metastasized to the lungs. Signalment and medical history of the dog were evaluated.  Physical examination was performed, supported by laboratory test including complete blood count (CBC) and serum biochemical profile (SBP). Radiographic examination was also performed to evaluate the presence of metastatic tumors to the lungs. The positioning of the dog was right lateral recumbent and dorsoventral (sternal recumbent) Diagnostic images of the thorax confirmed pulmonary metastasis of mammary tumor that was suspected on the basis of the history and physical examination. Therapy chosen for the dog was palliative. The dog’s condition was observed for two months before the dog died. Then, a necropsy and histopathology examination were performed.

 

RESULTS AND DISCUSSION

 

A 10 years old, intact female Golden Retriever dog was examined at the 24 HRS Veterinary Clinic Drh. Cucu K. Sajuthi and Associate on January 21st 2009. The third left mammary gland was firm and enlarged less than 5 cm in diameter. Cytologic evaluation revealed mammary lobular hyperplasia. This condition is common in intact bitches without any significant symptoms and can develop to be malignant.

A year later on February 25th 2010, the dog was brought again to the clinic. The caudal mammary glands including 3 mammary glands on the left and 1 on the right, were significantly enlarged. Complete blood count (CBC) and serum biochemical profile (SBP) were analyzed, and showed all values within reference range. The surgical excision was chosen to remove the tumor and also the four mammary gland adjacent to the tumor. The surgery was performed on March 13th 2010.

The tumor was noticed to regrow very rapidly within three months, followed with locally suppurative inflammation (pus) and some ulceration (Fig. 1). Abdominal respiration was also observed in this dog, and we then decided to redo the diagnostic test including thoracal radiograph (Fig. 2), CBC and SBP, as shown in Table 1. Based on the thoracal radiograph, known that the tumor metastasized to the lungs and led to worse prognosis.

The dog survived for 5 months post surgery before the animal condition declined slowly and the animal died on August 4th 2010. A necropsy was performed and we found masses of tumor in the lungs (Fig. 3). Histopathology examination revealed papillary cystadenocarcinoma which spread to the lungs and the spleen. This case study reported that the progression of canine mammary tumor can be very aggressive.

Canine mammary tumor is very related with hormonal factors. It is well established that dogs spayed before their first estrous cycle have a greatly reduced risk of developing mammary tumor. The risk of developing mammary tumors, approximately 50% of which are malignant, rises from nearly 0% in dogs spayed prior to their first estrus to 26% for dogs that are spayed after their second estrus1. Mammary tumors primarily affect middle-aged (9 to 11 years) female intact dogs, with an increased incidence beginning at approximately 6 years of age. Sexual steroid hormones (estrogen and progesterone) are thought to have their primary effect on target cells during the early stages of mammary carcinogenesis in dogs4. Early ovariohysterectomy is strongly protective against the development of mammary tumors2,3.

pulmonary1

Fig.1. Mammary tumor was notice to regrow very rapidly within 3 months, followed with locally suppurative inflammation (pus) and some ulceration

Table 1

Result of diagnostic tests including thoracal radiograph, CBC and SBP

Date

Features

Abnormal Result

June 24th 2010

CBC Leukocytosis (WBC 51.0 x 109/L), nonregenerative anemia (RBC 4.59 x 106/µL, Hb 10.7 g/dL, HCT 32.2%), granulocytosis (46.4 x 109/L)
SBP AST 71 U/L, total protein 8.3 g/dL, ALP 536 U/L
Radiograph Pulmonary metastasis suspected

June 28th 2010

CBC Leukocytosis (WBC 33.8 x 109/L), nonregenerative anemia (RBC 4.19 x 106/µL, Hb 9.2 g/dL, HCT 28.5%), granulocytosis (23.2 x 109/L)
SBP Total protein 7.9 g/dL

July 6th 2010

CBC Leukocytosis (WBC 24.6 x 109/L), nonregenerative anemia (RBC 3.9 x 106/µL, Hb 8.7 g/dL, HCT 26.9%), granulocytosis (20.5 x 109/L)

July 7th 2010

Radiograph Diffuse miliary pulmonary metastasis

pulmonary2

Fig. 2.  Diagnostic images of the thorax; (A). Dorsoventral; (B). Right lateral recumbent Fig. 3. Pathological finding revealed masses of tumor nodules in the dog’s lungs

 

REFERENCES

 

[1]   Henry CJ. 2007. Chemical, Physical, and Hormonal Factors. In: Withrow and Macewen’s Small Animal Clinical Oncology. Anthony Winkel, Shelly Stringer, editor. St. Louis: Saunders Elsevier Inc.p16.

[2]   Misdorp W. 2002. Tumors of the mammary gland. In: Tumors in Domestic Animals. Meuten DJ, editor. New York: Iowa State Pr.

[3]   Nelson RW, Couto CG. 2003. Small Animal Internal Medicine. 3rd ed. St. Louis: Mosby Inc.

[4]   Perez Alenza MD, Pena L, del Castillo N et al. 2000. Factors influencing the incidence and prognosis of canine mammary tumours, J Small Anim Pract 41:287.

[5]   Rezaie A, Tavasoli A, Bahonar A, Mehrazma. 2009. Grading in canine mammary gland carcinoma. J. Biol. Sci. 9:333-338.


SMALL BOWEL INTUSSUSCEPTION SECONDARY TO PARVOVIRUS INFECTION IN A DOG

SMALL BOWEL INTUSSUSCEPTION SECONDARY TO

PARVOVIRUS INFECTION IN A DOG : CASE REPORT

 

Endang Yuli A., Royama Sari,

Herlina, Cucu K. Sajuthi

24 HRS Veterinary Clinic Drh. Cucu K. Sajuthi and Associate

Ruko Nirwana Sunter Asri Tahap III Blok J-1 no.2 Sunter, North Jakarta-Indonesia

Keywords: Dog, Intussusception, Parvovirus, Small Bowel

 

INTRODUCTION

 

Intussusception is a telescoping of one intestine segment into an adjacent segment. Intussusception is associated with active enteritis, especially in young animals5. The exact cause is unknown. It is considered a sign of underlying disorder, such as parvovirus infection, severe intestinal parasitism, and intestinal obstruction2. Diagnosis of intussusception was based most often on clinical signs of bowel obstruction in association with the palpable abdominal mass3.

Intestinal intussuception is the most serious sequela that may develop during treatment for viral gastroenteritis. Altered intestinal motility is implicated. Careful abdominal palpation for the presence of an abdominal mass should be performed daily. Persistent vomiting after apparent clinical recovery should prompt a careful search for intussusception6.

 

MATERIALS AND METHODS

 

       The observation was done to a three-month-old female dog of mixed race. The dog was diagnosed of gastroenteritis due to parvovirus infection. Signalment and medical history were evaluated. Physical examination, diagnostic test (including plain abdominal radiograph, complete blood count, and serum biochemical profile), laparotomy exploration of the abdominal cavity and blood transfusion were performed. The dog died 7 days after surgery and the case was reviewed.

 

RESULTS AND DISCUSSION

 

A three-month-old female dog of mixed race was examined at the 24 HRS Veterinary Clinic Drh. Cucu K. Sajuthi and Associate. The dog was presented with a pale mucous membrane, abdominal pain, anorexia, depression, nausea, severe vomiting, and diarrhea to bloody diarrhea. A parvovirus test kit revealed positive result. The dog was diagnosed with gastroenteritis due to parvovirus infection and hospitalized for intensive treatment but the symptoms were prolonged. The treatment consisted of intravenous (IV) Lactated Ringer’s solution , enrofloxacin , ampicillin, ondansetron and sucralfate.

After a week of treatment, the dog showed clinical recovery, but began to vomit again the next five days. Persistent vomiting after apparent clinical recovery should prompt a careful search for intussusception6. Abdominal palpation of the dog evinced pain and revealed a firm tubular mass (sausage-like mass) inside. Diagnosis of intussusception was based most often on clinical signs of bowel obstruction in association with the palpable abdominal mass3. Plain abdominal radiograph showed gas accumulation and were suggestive of intussusception (Fig. 1). Plain abdominal radiographs allow the diagnosis of intussusceptions because they usually cause minimal intestinal gas accumulation. Intussusception must be treated surgically5. The dog was premedicated with atropine sulphate (0.025 mg/kg body weight SC) and diazepam (0.5 mg/kg body weight). Anesthesia was induced and maintained with isoflurane. Laparotomy exploration of the abdominal cavity revealed intussusception of the jejuno-jejunal segment (Fig. 2). The intussuception could not be reduced manually and the intestinal segment was not viable. The non-viable intestinal segment was resected (Fig. 3) and an end-to-end anastomosis of the viable segments was performed.

After surgery, the blood test was performed. Complete blood count (CBC) revealed severe leukocytosis, severe anemia, and thrombocytosis, and serum biochemical profile (SBP) revealed severe hypoproteinemia and hypoalbuminemia, as shown in Table 1. Whole blood transfusion was administered to treat severe anemia. The dog survived for 7 days after surgery and died because of serious complication.

 

Table 1

Result of blood test including complete blood count and serum biochemical profile

 

Parameter

Result

Unit

Reference Range

CBC :
WBC

58.2

109 /L

6.0-17.0

RBC

2.93

106 //µL

5.50-8.50

Hemoglobin

5.5

g/dL

12.0-18.0

HCT

16.4

%

37.0-55.0

MCV

56

fL

60.0-77.0

MCH

18.8

Pg

19.5-24.5

MCHC

33.5

g/dL

32.0-36.0

PLT

869

109 /L

200-500

Lymphocyte

17.4

%

12.0-30.0

Monocyte

5.3

%

3.0-10.0

Eosinophil

2.2

%

2.0-10.0

Granulocyte

75.1

%

60.0-80.0

Lymphocyte

10.1

109 /L

1.0-4.8

Monocyte

3.1

109 /L

0.15-1.35

Eosinophil

1.3

109 /L

0.01-1.25

Granulocyte

43.7

109 /L

3.5-14.0

RDW

14.7

%

12.0-16.0

PCT

0.49

%

0.00-2.90

MPV

5.6

fL

6.7-11.0

PDW

16.0

%

0.0-50.0

SBP :
AST / SGOT

70

U/L

8.9-48.5

ALT / SGPT

37

U/L

8.2-57.3

Ureum (BUN)

10

mg/dL

10-20

Creatinine

0.4

mg/dL

1-2

Total Protein

2.6

g/dL

5.4-7.5

Albumin

0.8

g/dL

2.6-4.0

Total Bilirubin

0.246

mg/dL

0.07-0.61

GGT

3

U/L

1.0-9.7

ALP

328

U/L

10.6-100.7

PARVOVIRUS

Figure 1 – Plain abdominal radiograph revealed gas accumulation (arrow) : (A) Ventrodorsal; (B) Left lateral recumbent

PARVOVIRUS3

Figure 2 – Laparotomy exploration of the abdominal cavity revealed intussusception of the jejuno-jejunal segment (arrow)

PARVOVIRUS2

Figure 3 – The resected of non-viable intestinal segment

Intussusception is a telescoping of one intestine segment into an adjacent segment. Intussusception is associated with active enteritis, especially in young animals5. The exact cause is unknown. It is considered a sign of underlying disorder, such as parvovirus infection, severe intestinal parasitism, and intestinal obstruction2. Intestinal infection of canine parvovirus destroyed intestinal crypts and may produce villus collapse, diarrhea, vomiting, intestinal bleeding, and subsequent bacterial invasion5. Altered intestinal motility is implicated6. The common site in dogs is the ileocolic junction and jejuno-jejunal segments and dogs less than one year age were mostly affected4. Intussusception caused venous obstruction leading to necrosis of intestinal wall and variety of life threatening electrolyte disturbance; endotoxic and septic shock1.

 

 

REFERENCES

[1]   Burrows CF, Merritt AM. 1992. Assessment of Gastrointestinal Function. In Anderson: Veterinary Gastroenterology. 2nd ed. Philadelphia: Lea and Febiger. p16-42.

[2]   Harari J. 2004. Small Animal Surgery Secrets. 2nd ed. Philadelphia : Hanley & Belfus, Inc. p164.

[3]   Levitt L, Bauer MS. 1992. Intussusception in Dogs and Cats: A Review of Thirty-Six Cases. J. Can. Vet. 33: 660-664.

[4]   Lewis DD, Ellison GW. 1987. Intussusception in dog and cat, Comp Contin. 9: 523.

[5]   Nelson RW, Couto CG. 2003. Disorder of The Intestinal Tract. In: Text Book of Small Animal Internal Medicine.  3rd ed. St. Louis: Mosby Inc. p433-434 and p455-456.

[6]   Tams TR. 2003. Handbook of Small Animal Gastroenterology. 2nd ed. St. Louis: Saunders Elsevier Science. p204-205.


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