Peritonite infecciosa felina-Relato de caso
Background: Emphysematous cystitis is a rare inflammatory disease of the lower urinary tract characterized by the accumulation of gas within the wall and lumen of the urinary bladder. The clinical manifestations of emphysematous cystitis resemble those of bacterial cystitis, often hindering the differentiation between the two. In this work, we report a case of emphysematous cystitis in a diabetic dog. The diagnosis of cystitis was followed by ultrasonography for the early detection of emphysematous cystitis, which showed the presence of multifocal and irregular hyperechoic interfaces forming a distal reverberation artifact. Case: A 9-year-old female dog was referred to VETCLINIC Veterinary Hospital 24 hours with a history of urinary incontinence, polydipsia, polyuria, and diabetes mellitus. At first, the blood glucose was measured and found to be 376 mg/dL. Blood count, biochemical measurements of alkaline phosphatase (AF), urea, creatinine, and alanine aminotransferase (AAT), urinalysis, urine culture with antimicrobial susceptibility testing, and abdominal ultrasonography were performed. The hematological exams showed that the serum was lipemic and with hemolysis; the values of AAT, AF, and total plasma proteins were above the reference values; hematocrit was below the normal level; erythrocyte rouleaux and thrombocytosis with platelet aggregates were present. Urinalysis showed the presence of traces of proteins, glucose, and occult blood as well as granular and hyaline cylinders and transitional epithelial cells. In urine culture, growth of the aerobic bacteria Klebsiella pneumoniae was observed, being sensitive to most of the antimicrobials. Ultrasonography showed the presence of gas in the wall of the urinary bladder, besides a discrete thickening of the wall, compatible with the diagnosis of emphysematous cystitis. Discussion: The first report of emphysematous cystitis in dogs was made in 1926 in a diabetic dog. Emphysematous cystitis is complicated, characterized by the presence of gas in the wall and lumen of the urinary bladder. It is usually reported in patients with diabetes mellitus. The patient presented with a very high glycemic index (376 mg/dL), in addition to having a history of urinary obstruction and presence of bladder stones, which may have acted as predisposing factors for the onset of emphysematous cystitis. In the present case, ultrasonography was the examination of choice. Hyperechoic reverberation-forming lines, identified as gas present in the topography of the urinary bladder, were easily visualized, as described in the literature. For the treatment of this condition, adequate management of the diet and the correct use of antimicrobials are of fundamental importance since the presence of diabetes mellitus in this patient can present serious complications in the future. This report shows the importance of the use of a combination of diagnostic tools to arrive at the correct diagnosis of the patient.
RESUMOO hiperaldosteronismo é um distúrbio endócrino caracterizado por excesso na secreção de mineralocorticoides na circulação sanguínea, principalmente, da aldosterona pela zona glomerulosa da glândula adrenal. Tumores de córtex adrenal ou hiperplasia nodular são frequentemente as causas do hiperaldosteronismo em felinos, podendo ser observado ocorrência uni ou bilateral. A aldosterona é responsável pela absorção de sódio e, consequentemente, aumento da volemia. Portanto, a apresentação inicial pode ser decorrente de uma diversidade de problemas relacionados à fisiopatologia do processo, como por exemplo, a hipertensão, retinopatia hipertensiva , sintomas neurológicos em decorrência de hemorragias cerebrais secundárias a hipertensão. Além de sinais clínicos relacionados à hipocaliemia , como fraqueza, flexão ventral do pescoço e mioalgia secundária a miopatias hipocalêmicas. A remoção cirúrgica da(s) glândula(s) adrenal(is) acometida(s) (adrenalectomia uni ou bilateral) é o tratamento de escolha para hiperaldosteronismo primário. Este trabalho teve como objetivo fazer uma revisão bibliográfica sobre o Hiperaldosteronismo felino, um distúrbio endócrino que pode ocasionar graves alterações no gato e pode estar sendo subdiagnosticado. Por conseguinte, se faz necessária uma maior atenção dos Médicos Veterinários aos sinais clínicos, achados laboratoriais e métodos de diagnóstico para que um correto diagnóstico seja realizado e um tratamento eficaz e imediato seja executado.Palavras-chave: hiperaldosteronismo; aldosterona; hipertensão sistêmica; adrenalectomia; felinos. ABSTRACTThe aldosteronism is an endocrine disorder characterized by excess in mineralocorticoid secretion into the bloodstream, mainly aldosterone by the zona glomerulosa of the adrenal gland. Adrenocortical tumors or nodular hyperplasia are often the aldosteronism causes in cats and can be observed occurrence unilateral or bilateral. Aldosterone is responsible for sodium absorption and hence increased volume. Therefore, the initial display can be due to a variety of problems related to the physiopathology of the process, such as hypertension, hypertensive retinopathy, neurological symptoms due to cerebral haemorrhage secondary to hypertension. In addition to clinical signs related to hypokalaemia, such as weakness, ventral neck flexion and mioalgia secondary to myopathies hypokalaemics. Surgical removal (s) of the gland (s) Adrenal (s) affected (s) (uni-or bilateral adrenalectomy) is the treatment of choice for primary hyperaldosteronism. This study aimed to do a review on the aldosteronism feline, an endocrine disorder that can cause severe changes in the cat and may be being underdiagnosed. Therefore, a greater attention of veterinarians is necessary to clinical signs, laboratory findings and diagnostic methods for a correct diagnosis is made and an effective and immediate treatment is performed.
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