Case Review: Acute abdominal trauma in a puppy
by Jennifer Jellison, DVM
A five month old poodle mix named Scottie presented for evaluation of acute trauma. The pup was current on all vaccines as well as heartworm prevention. He had a history of Coccidia infection a month prior. The puppy was reported as a rescue from a shelter 3 months ago.
Scottie was quiet and uncomfortable whether standing or sitting. He had a temperature of 101.5, heart rate of 144 and an increased respiratory rate of 45 breaths/ minute. He clinically appeared approximately 6% dehydrated. His upper canine on the left side was missing. CRT was 2 sec and gums were slightly pale. He had swelling above the right eye and visible bruising and swelling across his abdomen just caudal to his rib cage on the left side. Pulses were strong and regular. No other visible signs of trauma were present. Abdominal palpation was assessed as normal.
Differential diagnosis include acute trauma, respiratory distress cause unknown.
Chest radiographs– mild pulmonary infiltrates present
Abdominal radiographs– food in stomach, suspect enlargement of liver- difficult to assess due to distended stomach. Diaphragm intact. Linea appeared intact.
ALB: 2.8g/dl-range 2.2-3.9
ALKP: 2900 U/L-range 14-192
ALT: 1000 U/L-range 12-115
AMYL: 700U/L- range 500-1400
BUN: 7.0 mg/dl-range 16-33
CHOL: 183 mg/dl-range 62-191
CREA: 0.500mg/dl-range 0.6-1.6
GLU: 118 mg/dl- range 77-153
PHOS: 6.3 mg/dl-range 4.5-10.4
TBIL: 0.10mg/dl-range 0-0.9
TP: 5.6g/dl-range 5.2-8.2
GLOB: 2.8 g/dl-range 2.8-4.8
WBC: 15.770 10^3/ul -range 6-17
RBC: 5.02 10^6/ul -range 5.5-8.5
HGB: 11.450g/dl-range 12-18
HCT: 33.930% range 37-55
MCV: 68.000fl -range 60-72
MCH: 22.79pg- range 19.5-24.5
MCHC: 33.74g/dl-range 34-38
RDW: 13.92% -range 12-16
PLT: 254 10^3/ul
MPV: 8.71 fl -range 6.1-10.1
Discussion points to consider
Based on the bloodwork what additional tests would you recommend?
The owner is visibly distraught about the dog's condition and tells you her husband had an altercation with the dog. What are your legal and moral obligations at this point?
Financially the owner is limited. What treatment would you recommend for this pet?
Is there any link between pet abuse and any other dangerous habits?
The owner asks you what she should do as she is afraid of her husband. How do you respond to her questions?
At this point the main concern is liver trauma and possible internal bleeding due to liver damage as well as splenic damage leading to rupture. The owner could not afford hospitalization for the dog. Owner declined a clotting panel. The dog should have been placed on IV 0.9% NaCl at a rate of 1.5 times maintenance with TPR and lung auscultation every 15 minutes as the dog stabilized. The dog was monitored closely at the hospital for 6 hours. TPR remained stable as did CRT and hydration status. Dog was given torbugesic as pain management and sent home with clavamox 2ml bid for one week. The pup was placed on severe exercise restriction to try to avoid any bleeding complications.
The owner was an elementary education teacher and was aware of the relationship between pet abuse and child/spousal abuse.1 The need to report abuse was discussed with the owner. The owner was very fearful of her husband being reported. She claimed this was the first time this had happened. She was given the opportunity to relinquish the puppy to the hospital and declined. The owner's father had worked with puppies in the past and offered to take the puppy. The owner agreed to give up the pup and her father agreed to sign up for puppy training classes and individual consults to reduce any psychological damage to the pup. Both the owner and her father (new owner) agreed if any classes were missed or any more alleged abuse occurred then the information would be turned over immediately to the proper authorities. The client was instructed to seek counseling from a human expert regarding her relationship with her husband.
The puppy left with the father and attended puppy classes for 4 weeks. At that point the original owner returned to the hospital with the puppy for a second time. She informed us they had gone to visit the puppy and her husband claimed it had fallen off of a brick fence when he was left unattended with the dog. Clinically the dog had facial bruising but otherwise appeared normal. The owner relinquished the puppy and he was placed in a foster home through the hospital and recovered uneventfully. The wife reported the two incidences to animal control. To date there has been no additional incidents of abuse.
Acute abdominal trauma can be dangerous in the dog. In this case the dog's injuries were related to extreme pressure applied to the abdomen by the spouse's knee while he was holding the dog on the ground. Splenic and liver enlargement due to inflammation can result in acute abdominal bleeding.2 Studies have shown a direct correlation between pet abuse and child abuse. Practitioners should use discretionary caution when making allegations of abuse either verbally or in the medical records. Medical records could become discoverable in a court of law if legal action was taken by the authorities or the family members. It best to state medical facts and observation in the medical notes and leave subjective assumptions out of the record.
Hanna J, Jellison J. Childhood League-Save Our Children Foundation. Public service announcement. 2004.
2. Tilley L, Smith F. The 5 Minute Veterinary Consult 1997; 184-185.