Diagnostic Imaging and Lab Interpretation in a Vomiting Dog
A 5-year-old female spayed Border Collie (18 kg) presents with acute vomiting, lethargy, and abdominal pain. The veterinarian orders a complete blood count (CBC), serum biochemistry, urinalysis, and abdominal radiographs. The technician performs venipuncture, runs the in-house CBC and chemistry, and takes orthogonal abdominal radiographs. Results: CBC shows neutrophilia (18,000/µL; reference 3,000–11,500) with a left shift (bands 1,200/µL). Biochemistry shows elevated ALP (450 U/L; reference 20–150), ALT (200 U/L; reference 10–100), and amylase (2,500 U/L; reference 200–1,200). Urinalysis: USG 1.030, pH 6.0, no crystals. Radiographs: two views (right lateral and ventrodorsal) show a gas-filled stomach and a focal area of increased opacity in the mid-abdomen, but no clear obstruction.
1. Interpret the lab results and explain their significance in this patient. What further diagnostic imaging or tests might be indicated?
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The neutrophilia with left shift indicates inflammation or infection, possibly related to pancreatitis, gastroenteritis, or sepsis. Elevated ALP and ALT suggest hepatobiliary involvement or secondary hepatic changes from systemic illness. Increased amylase is not specific for pancreatitis in dogs but, along with vomiting and abdominal pain, raises suspicion. Urinalysis is unremarkable. Radiographs show a gas-filled stomach and a focal opacity, which could be a foreign body, intussusception, or pancreatitis-related changes. Further diagnostics: abdominal ultrasound is more sensitive for pancreatitis, foreign bodies, and intussusception. A canine pancreatic lipase immunoreactivity (cPLI) test or Spec cPL should be performed to confirm pancreatitis. Also consider a barium series if obstruction is suspected but not seen. Recheck electrolytes and hydration. Monitor for sepsis. The technician should ensure proper sample handling and prepare for ultrasound.
2. What are the technician's responsibilities for ensuring quality control and safety when performing the radiographs and laboratory tests?
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For radiographs: ensure proper patient positioning (right lateral and ventrodorsal views), use of appropriate exposure settings, and collimation to reduce scatter. Use personal protective equipment (lead gloves, apron, thyroid shield) and dosimetry badges. Minimize repeat exposures. Restrain the patient safely, using sandbags or ties rather than manual restraint when possible. For laboratory tests: follow standard operating procedures for venipuncture, sample handling, and storage. Run quality control samples for CBC and chemistry analyzers daily or as required. Check expiration dates of reagents and controls. Properly label samples and ensure they are analyzed within the appropriate timeframe. Maintain the analyzer according to the manufacturer's instructions. Document results accurately and report critical values to the veterinarian immediately. Dispose of sharps and biohazard waste properly. Maintain a clean work area.