Case 9

Tupper has a mild neutrophilia and monocytosis, which may be consistent with inflammation or a stress response. The elevations in BUN, creatinine, and albumin concentrations reflect dehydration; there are no obvious metabolic disturbances that would explain his signs.

The elevation in the alkaline phosphatase activity is mild and likely not of any clinical significance at this time.

Tupper received intravenous fluids overnight and is now better hydrated and seems more energetic. He readily eats a small amount of a low-residue diet that you offer (e.g. Iams Veterinary Formula Intestinal Low-Residue, Royal Canin Veterinary Diet Canine Gastrointestinal High Energy HE). He has a semi-solid bowel movement that afternoon; no blood is noted.

QUESTION 3

How would you like to proceed with Tupper at this point? (There is more than one correct answer.)

a) Continue the dietary therapy alone long-term and see how he does.

b) Perform a trypsin-like immunoreactivity (TLI) test to rule out exocrine pancreatic insufficiency (EPI) and measure serum cobalamin and folate concentrations to evaluate him for small intestinal bacterial overgrowth (SIBO).

c) Recommend an upper intestinal endoscopic examination with biopsies.

d) Recommend abdominal ultrasonography.

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