Hepatic Encephalopathy in a Two-Year-Old Labrador Retriever with an Intrahepatic Portosystemic Shunt
Notice bibliographique
Résumé
A 2-year-old, male castrated Labrador Retriever was presented to Cornell?s Emergency Service for evaluation of a several day history of abnormal mentation and inappetence that progressed to an obtunded mental state. The patient was previously diagnosed with an intrahepatic portosystemic shunt and had been successfully medically managed for two years. On presentation to Cornell?s emergency room, the patient was laterally recumbent, obtunded, and dysphoric. He was tachycardic with bounding pulses, tachypneic, and had an elevated temperature. Melena was noted on the rectal thermometer. Point of care bloodwork revealed a mixed acid-base disturbance, hypernatremia, hyperchloremia, and hyperlactatemia. An intravenous catheter was placed and a fluid bolus reduced the patient?s heart rate and rectal temperature to within the normal range. The dog was hospitalized and his care was transferred to the Critical Care Service. The patient?s mental state progressed to intermittent head-pressing, ataxia, and circling followed by periods of profound obtundation. Neurologic examination revealed an inconsistent menace response. Intravenous mannitol was administered, as well as broad spectrum antimicrobials. Both oral lactulose and lactulose enemas were instituted, and gastroprotectants and anti-emetics were administered. An abdominal ultrasound confirmed the presence of an intrahepatic portosystemic shunt, as well as bilateral renomegaly. Complete bloodwork revealed moderate thrombocytopenia, elevated liver enzymes, and an elevated serum ammonia level consistent with hepatic insufficiency. Serial bloodwork demonstrated a regenerative anemia. Due to the anemia and melena, gastrointestinal hemorrhage was suspected to be the acute inciting cause of hepatic encephalopathy. Over the next several days, the patient?s mentation improved markedly in response to treatment. His anemia initially worsened and then plateaued, though he developed polyuria/polydipsia and profuse diarrhea. The enemas and intravenous therapies were discontinued and his care was transferred to the Internal Medicine Service. He was discharged to the care of his owners after three days in the hospital. This seminar will discuss the etiology, pathogenesis, management, and prognosis for hepatic encephalopathy secondary to portosystemic shunts.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,004 | 0,004 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,002 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,009 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».