Page 192 - Cote clinical veterinary advisor dogs and cats 4th

Ascites 79

PEARLS & CONSIDERATIONS tachyarrhythmias on baseline or 24-hour ARVC, proper ECG electrode placement
Holter ECG. and patient positioning (right lateral recum-
VetBooks.ir • ARVC is a diagnosis of exclusion. Presump- with type III dogs having the worst prognosis. • Genetic testing may be performed by whole Diseases and Disorders
Comments
bency) are important when evaluating a dog
• There is a broad spectrum of disease severity,
with suspected ARVC.
tive diagnosis is made based on signalment
Dogs with severe ventricular arrhythmias on
and right-sided VPCs (complexes that are
upright in lead II) after other causes of ECG are at high risk for sudden death. blood sample (EDTA) or buccal swab. If
buccal swabs are used, ensure that the patient
ventricular arrhythmias have been ruled out. Prevention has not eaten for 60 minutes before swabbing
• Genetic testing can support a diagnosis of All breeding boxers should be tested for the to avoid contamination with food proteins.
ARVC and has important prognostic value mutation. Dogs that test homozygous positive
because homozygous positive dogs have a for the striatin mutation can be detected before SUGGESTED READING
more severe disease type. they display characteristics of the disease and Meurs KM, et al: Natural history of arrhythmogenic
• Not all dogs with ARVC require treatment, should not be bred. Avoidance of breeding right ventricular cardiomyopathy in the boxer dog:
and many that do will live normal lives on striatin mutation heterozygous positive dogs a prospective study. J Vet Intern Med 28:1214-
ventricular antiarrhythmic drugs as long as to each other will gradually reduce the disease 1220, 2014.
clinical signs (e.g., syncope) are controlled. prevalence while preserving genetic diversity AUTHORS: Joshua A. Stern, DVM, PhD, DACVIM;
• There are no clear guidelines on when to within the boxer breed. Maureen Oldach, DVM
treat dogs with ARVC, but the decision of EDITOR: Meg M. Sleeper, VMD, DACVIM
whether or not to treat should be primar- Technician Tips
ily based on the presence of clinical signs • Because the morphology of the VPCs is
and evidence of malignant ventricular helpful when establishing a diagnosis of

Ascites Client Education
Sheet

BASIC INFORMATION • Cough DIAGNOSIS
• Hyporexia or anorexia
Definition If ascites is secondary to gastrointestinal or Diagnostic Overview
Accumulation of transudate effusion within the hepatic disease, presenting complaints may also Abdominocentesis with fluid analysis and
abdominal cavity include cytology are required to determine fluid type
• Diarrhea (transudate or modified transudate vs. exudate).
Synonyms • Vomiting Other tests are aimed at determining the cause
Abdominal or peritoneal effusion can be used • Hyporexia or anorexia of ascites, with the choice of test determined
to refer to any fluid (transudates or exudates) by history and examination findings.
accumulation in the abdominal cavity PHYSICAL EXAM FINDINGS
• Abdominal distention Differential Diagnosis
Epidemiology • Palpable fluid wave See Abdominal Distention (p. 1192).
SPECIES, AGE, SEX • Tachypnea ± respiratory effort due to pressure
Depends on underlying disease process on diaphragm Initial Database
• Heart murmur and jugular distention if • Abdominocentesis: clear fluid with low
GENETICS, BREED PREDISPOSITION right-sided heart failure protein, low cellularity (pp. 1056 and 1343)
• Lymphangiectasia (p. 600) • Muffled heart sounds if cardiac tamponade • CBC: normal, anemia of inflamma-
• Protein-losing nephropathy (p. 390) • Icterus possible if cirrhotic liver disease tory disease, or suggestive of infection/
inflammation (e.g., eosinophilia with
RISK FACTORS Etiology and Pathophysiology heartworm infection)
Vector-borne infections (e.g., heartworm, Ascites can occur secondary to a number of • Serum biochemistry: albumin < 1.5 g/dL
Lyme) underlying disease conditions associated with identifies low oncotic pressure
• Increased hydrostatic pressure: portal ○ Cirrhotic liver disease/liver failure: may
GEOGRAPHY AND SEASONALITY hypertension demonstrate high or normal alanine
Heartworm common in southeastern United ○ Cirrhotic liver disease aminotransferase (ALT), alkaline phos-
States ○ Budd-Chiari syndrome: obstruction of phatase (ALP), gamma-glutamyltransferase
hepatic venous outflow (GGT), bilirubin; low cholesterol, blood
ASSOCIATED DISORDERS ○ Right-sided heart failure urea nitrogen (BUN), glucose
Abdominal distention, increased respiratory ■ Caval syndrome ○ Protein-losing nephropathy: may demon-
effort, tachypnea, hyporexia ■ Cardiac tamponade strate high cholesterol, BUN, creatinine,
• Decreased oncotic pressure: hypoalbuminemia phosphorous
Clinical Presentation ○ Liver failure ○ Protein-losing enteropathy: may demon-
HISTORY, CHIEF COMPLAINT ○ Protein-losing enteropathy strate low globulins, cholesterol
Abdominal distention may be the primary ○ Protein-losing nephropathy • Urinalysis: proteinuria suggests protein-losing
complaint, with insidious or acute onset. If • Increased vascular permeability nephropathy
ascites is secondary to right-sided heart failure, ○ Vasculitis • Thoracic radiographs: rule out right-sided
presenting complaints may also include • Transudate related to portal hypertension cardiomegaly, globoid heart due to tampon-
• Syncope or vasculitis often has a higher protein ade, enlarged pulmonary arteries due to
• Exercise intolerance (modified transudate) heartworm, and pleural effusion

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