Case 6

Before you get a chance to call Roxy's owners again to discuss the results of the UPCR and next step in her workup, they bring Roxy in as an emergency appointment because she has labored breathing. She has refused to eat since yesterday and has been more lethargic. Upon examination, you find that she has severe ascites and is tachypneic. Thoracic radiographs reveal a small amount of pleural fluid but no other abnormalities. The tachypnea is likely due to the pressure on her diaphragm from the abdominal effusion. You perform an abdominocentesis and remove 250 ml of clear fluid from her abdomen.

QUESTION 4

Below are examples of abdominal fluid analyses. Match the results with a likely differential diagnosis.

1. Turbid fluid, specific gravity > 1.025, protein > 3 g/dl, cells > 5,000, predominantly neutrophils and macrophages, phagocytized bacteria

2. Mildly turbid fluid, specific gravity > 1.025, protein > 3 g/dl, cells > 5,000, predominantly neutrophils

3. Milky white fluid, specific gravity > 1.025, protein >3 g/dl, cells > 10,000, predominantly mature lymphocytes

4. Clear fluid, specific gravity < 1.017. protein < 1.5 g/dl, low cellularity

5. Hemorrhagic fluid, specific gravity > 1.025, appears similar to peripheral blood but without platelets

A. Ruptured splenic hemangiosarcoma

B. Cardiac disease

C. Hypoalbuminemia

D. Perforated bowel

E. Chronic hepatitis

a) 1 = B, 2 = E, 3 = D, 4 = C, 5 = A

b) 1 = D, 2 = A, 3 = B, 4 = E, 5 = C

c) 1 = D, 2 = E, 3 = B, 4 = C, 5 = A

d) 1 = A, 2 = B, 3 = C, 4 = E, 5 = D

e) 1 = C, 2 = B, 3 = A, 4 = E, 5 = D

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