Extensive emphysematous pyelonephritis in a nondiabetic female cat - treatment with unilateral nephroureterectomy

Background: Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and surrounding tissues that results in gas formation in the kidney, collecting system, or surroundings. EPN is a rare condition in veterinary medicine and occurs most frequently in dogs with diabetes mellitus. Although the prognosis of medical management in animals is poor, the standardized treatment protocol according to EPN severity is unclear. This report describes the first case of a nondiabetic female cat with extensive EPN and good prognosis following direct nephroureterectomy (NU). Case: A 10-year-old spayed female cat presented with the chief complaint of an acute loss of weight within 1 week, vomiting, and disorientation including stumbling, discoordination, circling, wobbling, head tilting, and difficulties in standing. At presentation, the patient had a body condition score of 1/9 and weighed 2.6 kg. Blood examination revealed leukocytosis, anemia, and hypoproteinemia. Abdominal radiography revealed severely decreased serosal details. A massive gas silhouette observed in the peritoneal and retroperitoneal cavities, was diagnosed as abdominal free gas. Abdominal ultrasound showed an accumulation of moderately anechoic fluid mixed with gas and cyst-like capsules around the left kidney. Left partial ureteral obstruction and dilation were also observed. Computed tomography (CT) was performed without sedatives or anesthetic drugs. The findings showed severe inflammatory changes in the peritoneum and a loss of the normal inner structure in the left kidney. A pyelogram of the left kidney was not observed after injection of the contrast material. Diffuse fat stranding and free gas observed in the mesentery of the entire abdominal cavity and around the left kidney were considered septic peritonitis. Urinalysis revealed proteinuria and hematuria. Numerous neutrophils with rod-type bacteria were observed in the ascites. Following diagnostic examinations, the patient was diagnosed with extensive left EPN, including inflammatory ascites and abdominal free gas. Therefore, emergency NU of the nonfunctional left kidney and ruptured ureter and thorough abdominal lavage were conducted. Diffuse inflammation and a nephrolith were observed in the section of the harvested kidney. The nephrolith was composed of 100% calcium oxalate monohydrate. The realtime polymerase chain reaction (RT-PCR) test for feline infectious peritonitis (FIP) was negative. Escherichia coli was detected in the ascites, and antibiotic therapy was administered following the antibiotic sensitivity test. The histological findings from the left kidney and ureter included marked chronic inflammation and fibrosis. The patient was discharged 4 days after surgery. During the 8-month follow-up period, the patient's condition improved. Discussion: This was a unique case of EPN in a nondiabetic cat and the first reported case of EPN with a ruptured ureter, including abdominal free gas, inflammatory ascites, and peritonitis. This patient had a bacterial urinary tract infection with E. coli, which is the most frequently isolated pathogen in humans. This gas-forming bacteria produced a massive amount of gas and inflammation that were considered to have ruptured the urinary tract, so that the gas was released into the abdomen. This case corresponded to class 3B, with two risk factors according to the human EPN classification system. Direct NU and abdominal lavage were performed as emergency surgeries. The patient stabilized gradually and showed a good prognosis. Immediate surgical intervention is recommended in animal patients showing the extensive EPN stage.

Biliary peritonitis in a dog after perforation of the gallbladder during laparoscopic cholecystectomy

Background: Iatrogenic gallbladder perforation during laparoscopic cholecystectomy (LC) is a common complication and occurs in at least one third of human patients undergoing LC. This is attributed to the fragility of the gallbladder wall associated with mucocele and cholecystitis, in addition to the need for repetitive gripping and traction of the gallbladder during its manipulation with laparoscopic instruments. As complications from this event are rare in human patients, conversion to laparotomy is not routinely indicated and the adverse consequences of bile spillage are minimized by abundant irrigation of the peritoneal cavity and adequate antimicrobial therapy. On the other hand, there is little information regarding the outcome of laparoscopic management of this complication in laparoscopic cholecystectomies in dogs, particularly since most surgeons indicate conversion in these cases. Thus, we describe a case of biliary peritonitis that developed in a dog after laparoscopic management of iatrogenic perforation of the gallbladder during a laparoscopic cholecystectomy, in a case of gallbladder mucocele. To the best of our knowledge, there are no reports of biliary peritonitis following laparoscopic management of iatrogenic gallbladder perforation during LC in dogs. Case: A 14-year-old Poodle was referred for clinical evaluation with selective appetite, recurrent episodes of hyporexia, and abdominal discomfort. Ultrasound findings characterized chronic liver disease and gallbladder mucocele. The patient was referred for laparoscopic cholecystectomy, during which the gallbladder was iatrogenically perforated, with extravasation of a large volume of bile content. This complication was managed by copious abdominal irrigation via laparoscopic access and antimicrobial therapy. On the second postoperative day, the patient started to present apathy, hyporexia, emesis, and jaundice. The patient remained hospitalized in the intensive care unit for stabilization and monitoring through hematological examinations and serial abdominal ultrasound. Due to progressive worsening of the clinical picture, an exploratory laparotomy was performed ten days after the initial surgical procedure. This examination showed multiple adhesions and the presence of bile residues adhered to numerous points on the peritoneal surface and pancreas. Despite the intensive treatment instituted, death occurred 10 h after the second surgical procedure. Discussion: The high risk of gallbladder perforation during laparoscopic cholecystectomies correlates with the dissection step or repetitive grasping and traction of the gallbladder with laparoscopic instruments. Conversion is not routinely indicated and laparoscopic management is considered effective in humans. However, in this case, the presence of a large volume of extravasated semisolid bile content and its adherence to the mesothelial surface made it impossible to remove it in its entirety despite the abundant irrigation of the abdominal cavity, resulting in a picture of biliary peritonitis in the postoperative period. In view of the reported negative outcome, the authors encourage the adoption of measures that minimize the risk of gallbladder perforation when performing LC in dogs. These include the use of atraumatic instruments or aspiration of bile content before surgical manipulation. Cases in which such a complication is recorded should be carefully monitored to enable early diagnosis and treatment of biliary peritonitis. Furthermore, conversion should be considered when there is extravasation of large volumes of bile, particularly in the presence of gallbladder mucocele, until future studies establish the safety and effectiveness of laparoscopic management of this complication.

Intoxicação acidental por lornoxicam em cão: Relato de caso / Intoxication by lornoxicam in dog: Case report

Lornoxicam é um anti-inflamatório não esteroidal (AINE) de uso exclusivamente humano, pois não existem doses estabelecidas nem indicações para o uso veterinário. Contudo, casos de intoxicação acidental em cães têm sido descritos. Neste estudo relata-se um caso de intoxicação acidental por lornoxicam em um cão atendido num hospital veterinário universitário. Trata-se de um cão, macho, da raça Shih Tzu, de aproximadamente 7 meses de idade, que havia ingerido 6 comprimidos de lornoxicam (Xepa®). Foram realizados exames de imagem e laboratoriais, sendo constatada gastrite medicamentosa e, posteriormente, quadro suspeito de peritonite. O animal foi tratado com antieméticos, protetores gástricos e antimicrobianos.(AU)

Lornoxicam is a non-steroidal anti-inflammatory drug (NSAID) for human use only, since there are no established doses or indications for veterinary use. However, cases of accidental poisoning in dogs have been described. This work aims to report a case of accidental poisoning by lornoxicam in a dog treated at an university veterinary hospital. A male Shih Tzu dog, approximately 7 months old, who had ingested six lornoxicam tablets (Xepa®). Imaging and laboratory tests were performed, and drug gastritis was found and, later, a suspected condition of peritonitis. The animal was treated with antiemetics, gastric protectors and antimicrobials.(AU)

Sclerosing encapsulating peritonitis in a dog

Sclerosing encapsulating peritonitis (SEP) is a rare condition which consists of reactive fibrous tissue proliferation with mixed inflammatory infiltration within the abdominal cavity. The present report describes an additional case of SEP affecting a mixed-breed immature female dog presented with persistent vomiting, progressive weight loss, and ascites. Abdominal radiographic and ultrasonographic findings suggested abdominal neoformation resulting in gastric displacement, in addition ascitic fluid was evaluated and cytology showed large numbers of inflammatory effusion. An exploratory laparotomy was performed and were detected multiple thick peritoneal adhesions which restricted mobility of abdominal viscera. Biopsy specimens of these lesions were submitted for histopathological examination. Microscopically, the external serous surfaces of the abdominal organs were covered with dense fibrous connective tissue characterized by intense mature collagen deposition and moderate angiogenesis. The animal was euthanized due to poor prognosis and sent for necropsy. The clinical, imaging, gross and microscopic findings were compatible with SEP.(AU)

Peritonitis and necrotizing hepatitis in Ara ararauna caused by a foreign body

Background: The ingestion of foreign bodies in parrots has already been described and associated with the curious behaviorof the birds or with stressful conditions. Foreign bodies in the gastrointestinal tract are usually diagnosed through clinicalsigns, laboratory tests, and radiographic findings in the historical data. Foreign bodies are usually metallic and can lodgein any segment of the gastrointestinal tract, commonly found in the proventricle and gizzard. This study investigated acase of necrotizing hepatitis due to a foreign body in Ara ararauna (Linnaeus, 1758).Case: An approximately 9-month-old specimen of caninde macaw, had sudden death and was referred for autopsy. Themacroscopic examination revealed a fibrous, thick, reddish membrane involving the left hepatic lobe and partially the gizzard in continuity with the peritoneum. Inside the capsule, the liver had a friable and necrotic appearance and the gizzardhad a focal perforation area containing a foreign body (gavage tube feeding). We performed the histopathological examination of the liver and gizzard and observed that the membrane surrounding the liver and partially the gizzard had a chronicinflammatory process with a marked proliferation of fibrous tissue and fibrin deposition. The hepatic parenchyma of theleft lobe showed diffuse and marked necrosis, with signs of ischemic necrosis. In the region of transmural perforation ofthe gizzard, the mucosa showed a focal area of extensive necrosis accompanied by the presence of intralesional bacteria.The lesions observed are attributed to the perforation of the organs by the foreign body. It is not known whether the birdingested the object accidently during food handling as a young or due to the curious behavior of the bird or even the stressit may have been exposed to. The post mortem examination revealed localized peritonitis...

Peritonitis and necrotizing hepatitis in Ara ararauna caused by a foreign body

Background: The ingestion of foreign bodies in parrots has already been described and associated with the curious behaviorof the birds or with stressful conditions. Foreign bodies in the gastrointestinal tract are usually diagnosed through clinicalsigns, laboratory tests, and radiographic findings in the historical data. Foreign bodies are usually metallic and can lodgein any segment of the gastrointestinal tract, commonly found in the proventricle and gizzard. This study investigated acase of necrotizing hepatitis due to a foreign body in Ara ararauna (Linnaeus, 1758).Case: An approximately 9-month-old specimen of caninde macaw, had sudden death and was referred for autopsy. Themacroscopic examination revealed a fibrous, thick, reddish membrane involving the left hepatic lobe and partially the gizzard in continuity with the peritoneum. Inside the capsule, the liver had a friable and necrotic appearance and the gizzardhad a focal perforation area containing a foreign body (gavage tube feeding). We performed the histopathological examination of the liver and gizzard and observed that the membrane surrounding the liver and partially the gizzard had a chronicinflammatory process with a marked proliferation of fibrous tissue and fibrin deposition. The hepatic parenchyma of theleft lobe showed diffuse and marked necrosis, with signs of ischemic necrosis. In the region of transmural perforation ofthe gizzard, the mucosa showed a focal area of extensive necrosis accompanied by the presence of intralesional bacteria.The lesions observed are attributed to the perforation of the organs by the foreign body. It is not known whether the birdingested the object accidently during food handling as a young or due to the curious behavior of the bird or even the stressit may have been exposed to. The post mortem examination revealed localized peritonitis...(AU)

Infecção verdadeira por Capillaria hepatica em cão / True infection by Capillaria hepatica in a dog

Background: Capillaria hepatica is a nematode, zoonotic, with worldwide distribution. The main hosts are rodents, nevertheless other mammals can be affected. Although the parasite has high affinity for the liver, it rarely causes a hepaticdisease in domestic animals and humans. The diagnosis is difficult and usually a biopsy is required. The treatment is difficult and is based in anti-helminthic and corticoid, but prevention is the best strategy against the disease. The aim of thepresent report is to describe a case of hepatic capillariosis in a dog approaching the clinical signs, diagnosis and therapeutic.Case: A 12-year-old Brazilian Terrier bitch, with a history of visit to the farm and regular hunting of rats, frogs, birds andother wild animals, was attended with hyporexia and apathy. At the physical exam the dog presented elevation of rectaltemperature, intense jaundice and abdominal pain. In the biochemical exams was noticed a slight increase in globulins anda sharp increase in alkaline phosphatase (AP), total, direct and indirect bilirubin, suggesting a liver injury. In the ultrasonographic exam, hepatomegaly with dispersed hyperechoic areas were observed, suggesting hepatic steatosis. The patientwas treated with ursodesoxicolic acid and S-adenosil metionin for 30 consecutive days, showing a clinic improvement.Two months after the end of the treatment the animal worsened, showing jaundice, ascites, motor incoordination, weakness, difficulty in food and water ingestion and changes in the mental state. In the complete blood count was observed amacrocytic hypochromic regenerative anemia, leukocytosis with neutrophilia and monocytosis and thrombocytopenia.In biochemical exams was detected decrease in creatinine and albumin and increase in alanine aminotransferase and AP,suggesting hepatopathy by biliary obstruction. There were performed exams for leishmania and ehrlichiosis that testednegative. In the ultrasonographic exam it...

Infecção verdadeira por Capillaria hepatica em cão / True infection by Capillaria hepatica in a dog

Background: Capillaria hepatica is a nematode, zoonotic, with worldwide distribution. The main hosts are rodents, nevertheless other mammals can be affected. Although the parasite has high affinity for the liver, it rarely causes a hepaticdisease in domestic animals and humans. The diagnosis is difficult and usually a biopsy is required. The treatment is difficult and is based in anti-helminthic and corticoid, but prevention is the best strategy against the disease. The aim of thepresent report is to describe a case of hepatic capillariosis in a dog approaching the clinical signs, diagnosis and therapeutic.Case: A 12-year-old Brazilian Terrier bitch, with a history of visit to the farm and regular hunting of rats, frogs, birds andother wild animals, was attended with hyporexia and apathy. At the physical exam the dog presented elevation of rectaltemperature, intense jaundice and abdominal pain. In the biochemical exams was noticed a slight increase in globulins anda sharp increase in alkaline phosphatase (AP), total, direct and indirect bilirubin, suggesting a liver injury. In the ultrasonographic exam, hepatomegaly with dispersed hyperechoic areas were observed, suggesting hepatic steatosis. The patientwas treated with ursodesoxicolic acid and S-adenosil metionin for 30 consecutive days, showing a clinic improvement.Two months after the end of the treatment the animal worsened, showing jaundice, ascites, motor incoordination, weakness, difficulty in food and water ingestion and changes in the mental state. In the complete blood count was observed amacrocytic hypochromic regenerative anemia, leukocytosis with neutrophilia and monocytosis and thrombocytopenia.In biochemical exams was detected decrease in creatinine and albumin and increase in alanine aminotransferase and AP,suggesting hepatopathy by biliary obstruction. There were performed exams for leishmania and ehrlichiosis that testednegative. In the ultrasonographic exam it...(AU)

Cecal dilatation and distension in a Holstein calf

Cecal dilatation and distention is an important disorder in early lactation dairy cows, however, reports describing the anatomical pathology findings of this condition are scarce in the literature. Etiopathogenesis of cecal dilatation and distention is often attributed to high concentrate feeds, but there is also evidence of myoelectrical dysfunction contributing to its occurrence. Diagnosis is often made based on physical exam findings, with the contribution of ancillary exams. This paper aims to describe a case of cecal dilatation with clinical, laboratorial and pathology findings of a 5-month-old Holstein calf that presented abdominal distension, positive succussion of the right flank and mild dehydration. Clinical pathology findings included neutrophilic leukocytosis with regenerative left shift and elevated ruminal chloride. Ultrasonographic examination of the right abdomen showed distended and hypomotile intestinal loops. Despite that, due to the patient’s age, which prevented rectal palpation, and lack of some characteristic clinical and clinical pathology findings, diagnosis was only possible post mortem. Macroscopical and microscopical findings demonstrated cecum dilatation with edema, hemorrhage and thrombi. Despite being well known by large animal clinics, anatomical pathologists must be aware of this condition.

Cecal dilatation and distension in a Holstein calf

Cecal dilatation and distention is an important disorder in early lactation dairy cows, however, reports describing the anatomical pathology findings of this condition are scarce in the literature. Etiopathogenesis of cecal dilatation and distention is often attributed to high concentrate feeds, but there is also evidence of myoelectrical dysfunction contributing to its occurrence. Diagnosis is often made based on physical exam findings, with the contribution of ancillary exams. This paper aims to describe a case of cecal dilatation with clinical, laboratorial and pathology findings of a 5-month-old Holstein calf that presented abdominal distension, positive succussion of the right flank and mild dehydration. Clinical pathology findings included neutrophilic leukocytosis with regenerative left shift and elevated ruminal chloride. Ultrasonographic examination of the right abdomen showed distended and hypomotile intestinal loops. Despite that, due to the patients age, which prevented rectal palpation, and lack of some characteristic clinical and clinical pathology findings, diagnosis was only possible post mortem. Macroscopical and microscopical findings demonstrated cecum dilatation with edema, hemorrhage and thrombi. Despite being well known by large animal clinics, anatomical pathologists must be aware of this condition.(AU)

Primary gastric rupture in 20 horses from Midwestern Brazil: case report / Ruptura gástrica primária em 20 equinos no Centro-Oeste do Brasil: relato de caso

An 11-year (2007-2018) survey of epidemiological, clinical and pathological findings of horses with primary gastric rupture (PGR) was conducted. Twenty horses presented PGR, nine (45%) horses were clinically evaluated, eleven (55%) were sent dead, and all animals were necropsied. PGR contributed to a prevalence of 0.31% (9/2,868) of all equid attendances, 1.83% (9/491) of colic cases, and 4.1% (20/487) of all equid necropsies. Highly fermentable feed (n=7), gastric impaction (n=4), and perforating gastric ulcer (n=1) were the main causes of PGR; whilst eight horses presented idiopathic gastric rupture. Clinically evaluated horses were tachycardic, tachypneic, febrile, dehydrated, with increased abdominal tension, abnormal mucous membranes and reduced to absent intestinal borborygmi. Improper dietary management, such as the ingestion of low-quality roughage and highly fermentable feedstuffs were detected as the main factors associated with PGR in Midwestern Brazil. It is important to raise awareness in horse owners about proper feed management to minimize PGR.(AU)

Foi realizado um levantamento de 11 anos (2007-2018) dos achados epidemiológicos, clínicos e patológicos de equinos com ruptura gástrica primária (RGP). Vinte equinos apresentaram RGP, dos quais nove (45%) foram avaliados clinicamente e 11 (55%) foram enviados mortos, sendo todos os animais necropsiados. A RGP contribuiu com prevalência de 0,31% de todos os atendimentos de equídeos (9/2.868), 1,83% (9/491) dos casos de cólica, e 4,1% (20/487) das necropsias em equídeos. Alimentos altamente fermentáveis (n=7), compactação gástrica (n=4) e perfuração de úlcera gástrica (n=1) foram as principais causas de RGP, enquanto oito equinos tiveram ruptura gástrica idiopática. Os equinos avaliados clinicamente apresentaram-se taquicárdicos, taquipneicos, febris, desidratados, com mucosas anormais, aumento da tensão abdominal e motilidade intestinal reduzida. O manejo inadequado da dieta, como a ingestão de forragens de baixa qualidade e alimentos altamente fermentáveis, foi o principal fator de risco associado à RGP no Centro-Oeste do Brasil. É importante aumentar a conscientização dos proprietários de equinos sobre o manejo alimentar adequado para minimizar a RGP.(AU)

Primary gastric rupture in 20 horses from Midwestern Brazil: case report / Ruptura gástrica primária em 20 equinos no Centro-Oeste do Brasil: relato de caso

An 11-year (2007-2018) survey of epidemiological, clinical and pathological findings of horses with primary gastric rupture (PGR) was conducted. Twenty horses presented PGR, nine (45%) horses were clinically evaluated, eleven (55%) were sent dead, and all animals were necropsied. PGR contributed to a prevalence of 0.31% (9/2,868) of all equid attendances, 1.83% (9/491) of colic cases, and 4.1% (20/487) of all equid necropsies. Highly fermentable feed (n=7), gastric impaction (n=4), and perforating gastric ulcer (n=1) were the main causes of PGR; whilst eight horses presented idiopathic gastric rupture. Clinically evaluated horses were tachycardic, tachypneic, febrile, dehydrated, with increased abdominal tension, abnormal mucous membranes and reduced to absent intestinal borborygmi. Improper dietary management, such as the ingestion of low-quality roughage and highly fermentable feedstuffs were detected as the main factors associated with PGR in Midwestern Brazil. It is important to raise awareness in horse owners about proper feed management to minimize PGR.(AU)

Foi realizado um levantamento de 11 anos (2007-2018) dos achados epidemiológicos, clínicos e patológicos de equinos com ruptura gástrica primária (RGP). Vinte equinos apresentaram RGP, dos quais nove (45%) foram avaliados clinicamente e 11 (55%) foram enviados mortos, sendo todos os animais necropsiados. A RGP contribuiu com prevalência de 0,31% de todos os atendimentos de equídeos (9/2.868), 1,83% (9/491) dos casos de cólica, e 4,1% (20/487) das necropsias em equídeos. Alimentos altamente fermentáveis (n=7), compactação gástrica (n=4) e perfuração de úlcera gástrica (n=1) foram as principais causas de RGP, enquanto oito equinos tiveram ruptura gástrica idiopática. Os equinos avaliados clinicamente apresentaram-se taquicárdicos, taquipneicos, febris, desidratados, com mucosas anormais, aumento da tensão abdominal e motilidade intestinal reduzida. O manejo inadequado da dieta, como a ingestão de forragens de baixa qualidade e alimentos altamente fermentáveis, foi o principal fator de risco associado à RGP no Centro-Oeste do Brasil. É importante aumentar a conscientização dos proprietários de equinos sobre o manejo alimentar adequado para minimizar a RGP.(AU)

Biomarcadores sanguíneos e no líquido peritoneal de bovinos acometidos com enfermidades intestinais e reticulites traumáticas / Biomarkers blood and peritoneal fluid of bovines with intestinal diseases and traumatic reticulitis

O objetivo deste estudo foi avaliar simultaneamente biomarcadores no sangue e no líquido peritoneal (LP) de bovinos com enfermidades intestinais (GI n=14) e reticulites traumáticas (GII n=13). O exame clínico e a coleta de sangue e de LP foram realizadas e, posteriormente, análise física e citológica do LP, bem como as determinações bioquímicas no sangue e no LP. Empregou-se a análise de variância ao nível de 5% de probabilidade comparando os grupos e comparando o sangue e o LP. Em ambos os grupos foram evidenciados sinais de apatia, desidratação e hipomotilidade reticuloruminal, porém os animais do GI apresentaram alterações clínicas mais expressivas. À análise citológica do LP No sangue as concentrações de PT, globulina, colesterol e GGT foram superiores no GII (P<0,05), e a relação A/G foi maior no GI (P<0,05). No LP a albumina e a CK foram superiores no GI (P<0,05). Na comparação entre o sangue e LP, destacou-se o aumento significativo do lactato L no LP de ambos os grupos (P<0,05), caracterizando a gravidade das alterações presentes na cavidade abdominal. Recomendase a avaliação simultânea no sangue e no LP do lactato L como informação de auxílio diagnóstico e prognóstico das enfermidades digestivas dos bovinos.

The objective of this study was to simultaneously evaluate biomarkers in the blood and peritoneal fluid (PF) of cattle with intestinal diseases (GI n=14) and traumatic reticulitis (GII n=13). A clinical examination and blood collection and PF were performed and subsequently, physical and cytological analysis of PF, as well as biochemical determinations in blood and PF. The analysis of variance was used at a 5% probability level comparing the groups and comparing blood and PF. In both groups, signs of apathy, dehydration and reticuloruminal hypomotility were evidenced, but the GI animals presented more expressive clinical alterations. In the cytological analysis of PF, a predominance of polymorfhonuclear was observed in both groups. Blood TP, globulin, cholesterol and GGT concentrations were higher in GII (P<0.05), and the A/G ratio was higher in GI (P <0.05). In PF, albumin and CK were higher in GI (P<0.05). In the comparison between blood and PF, the significant increase of L-lactate in the PF of both groups (P<0.05) was observed, characterizing the severity of the alterations present in the abdominal cavity. It is recommended the simultaneous evaluation of L-lactate in the blood and PF, as a tool for diagnosis and prognosis of bovine digestive diseases.

Association of intraperitoneal ceftriaxone, intravenous gentamicin and oral metronidazole in the treatment of an abdominal abscess and peritonitis in a horse: case report / Associação da ceftriaxona intraperitoneal, gentamicina intravenosa e do metronidazol oral no tratamento de abscesso abdominal e peritonite em equino: relato de um caso

Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response.(AU)

O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.(AU)

Peritoneal fluid collection in healthy cattle and evaluation of changes in cell morphology during storage in refrigerated and non-refrigerated samples / Colheita do fluido peritoneal de bovinos sadios e verificação das alterações na morfologia celular quando mantido refrigerado ou à temperatura ambiente

This study aimed to evaluate the appropriate sites of abdominocentesis for peritoneal fluid collection in cattle and to investigate the time of cell viability in vitro, comparing three methods of sample conservation. Twenty-one healthy cattle (19 females and 2 males) were subjected to a laparocentesis procedure to obtain peritoneal fluid, with punctures in three defined sites: left cranial, right cranial, and right caudal. The total peritoneal fluid collected was divided into three aliquots and maintained under three preservation conditions: room temperature (26°C), refrigeration (4°C), and room temperature (26°C) with the addition of 1µL of 10% formaldehyde per 1mL of peritoneal fluid. The peritoneal fluid analysis performed immediately after collection consisted of: physical examination (color, appearance, volume, and specific gravity), biochemical measures (pH, total protein, fibrinogen, creatinine, and glucose), and cellularity (total and differential counts). The determination of proteins and the examination of cells were repeated in each separate aliquot at two, four, six, and eight hours after harvest. Data were analyzed through repeated measures ANOVA or Friedman test. The harvest was productive in 67% of cattle. The left cranial and the right cranial puncture sites were the most appropriate. Peritoneal fluid analyzed after collection, the total protein concentration ranged from 1.4 to 3.6g/dL, and number of leukocytes ranged from 54 to 1,322 cells/µL; 60 to 95% of leukocytes were lymphocytes. The protein concentration decreased, but the absolute values of leukocytes, lymphocytes, and segmented neutrophils did not change up to eight hours after collection, independent of the maintenance method. Cell lysis was delayed by cooling, and the addition of formaldehyde did not help preserve the integrity of cellular morphology. Laparocentesis is a safe and secure procedure in cattle and maybe more productive when performed in specific sites on the left or right sides of the cranial abdominal wall. Peritoneal fluid samples may be analyzed with reliable results for up to eight hours after collection when kept refrigerated and for up to six hours when kept at room temperature.(AU)

O estudo teve como objetivo avaliar os locais adequados de laparocentese para a colheita de fluido peritoneal de bovinos e estabelecer o tempo de viabilidade celular in vitro, comparando três métodos de conservação. Vinte e um bovinos hígidos (19 fêmeas e 2 machos) foram submetidos ao procedimento de laparocentese para obtenção de fluido peritoneal, com punção em três pontos definidos: cranial esquerdo, cranial direito e caudal direito. O volume total do líquido peritoneal foi dividido em três alíquotas mantidas sob três métodos de conservação: temperatura ambiente (26°C); refrigeração (4°C); e temperatura ambiente (26°C) com adição de 1µL de formol 10% para cada 1mL de líquido peritonial. A análise do líquido peritoneal realizada imediatamente após sua obtenção consistiu em: exames físico (cor, aspecto, volume e densidade); bioquímicos (pH, proteína total, fibrinogênio, creatinina e glicose); e da celularidade (contagens total e diferencial). A determinação de proteínas e o exame da celularidade foram repetidos, em cada alíquota separada, as duas, quatro, seis e oito horas após a colheita. Análise de variâncias de medidas repetidas ou teste de Friedman foram empregados para avaliação ao longo do tempo. A colheita foi produtiva em 67% dos bovinos e os locais de punção craniais esquerdo e direito foram os mais adequados. A concentração de proteína total variou de 1,4 a 3,6g/dL e o número de leucócitos de 54 a 1.322 células/µL, com predomínio de linfócitos (60 a 95% das células) no fluido peritoneal analisado logo após a colheita. A concentração de proteínas diminuiu, mas os valores absolutos de leucócitos, de linfócitos e de neutrófilos segmentados não se modificaram até oito horas após a colheita, independente do método de manutenção das amostras. A lise celular foi retardada pela refrigeração e a adição de formol não contribuiu para preservar a integridade da morfologia celular. A laparocentese é um procedimento seguro e de execução fácil em bovinos sendo mais produtiva quando realizada em locais específicos à esquerda ou à direita craniais da parede abdominal. Amostras de fluido peritoneal podem ser analisadas com resultados confiáveis quando mantidas refrigeradas por até oito horas após a colheita e quando mantidas à temperatura ambiente por até seis horas.(AU)

Association of intraperitoneal ceftriaxone, intravenous gentamicin and oral metronidazole in the treatment of an abdominal abscess and peritonitis in a horse: case report / Associação da ceftriaxona intraperitoneal, gentamicina intravenosa e do metronidazol oral no tratamento de abscesso abdominal e peritonite em equino: relato de um caso

Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response.(AU)

O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.(AU)

Peritoneal fluid collection in healthy cattle and evaluation of changes in cell morphology during storage in refrigerated and non-refrigerated samples / Colheita do fluido peritoneal de bovinos sadios e verificação das alterações na morfologia celular quando mantido refrigerado ou à temperatura ambiente

This study aimed to evaluate the appropriate sites of abdominocentesis for peritoneal fluid collection in cattle and to investigate the time of cell viability in vitro, comparing three methods of sample conservation. Twenty-one healthy cattle (19 females and 2 males) were subjected to a laparocentesis procedure to obtain peritoneal fluid, with punctures in three defined sites: left cranial, right cranial, and right caudal. The total peritoneal fluid collected was divided into three aliquots and maintained under three preservation conditions: room temperature (26°C), refrigeration (4°C), and room temperature (26°C) with the addition of 1µL of 10% formaldehyde per 1mL of peritoneal fluid. The peritoneal fluid analysis performed immediately after collection consisted of: physical examination (color, appearance, volume, and specific gravity), biochemical measures (pH, total protein, fibrinogen, creatinine, and glucose), and cellularity (total and differential counts). The determination of proteins and the examination of cells were repeated in each separate aliquot at two, four, six, and eight hours after harvest. Data were analyzed through repeated measures ANOVA or Friedman test. The harvest was productive in 67% of cattle. The left cranial and the right cranial puncture sites were the most appropriate. Peritoneal fluid analyzed after collection, the total protein concentration ranged from 1.4 to 3.6g/dL, and number of leukocytes ranged from 54 to 1,322 cells/µL; 60 to 95% of leukocytes were lymphocytes. The protein concentration decreased, but the absolute values of leukocytes, lymphocytes, and segmented neutrophils did not change up to eight hours after collection, independent of the maintenance method. Cell lysis was delayed by cooling, and the addition of formaldehyde did not help preserve the integrity of cellular morphology...(AU)

O estudo teve como objetivo avaliar os locais adequados de laparocentese para a colheita de fluido peritoneal de bovinos e estabelecer o tempo de viabilidade celular in vitro, comparando três métodos de conservação. Vinte e um bovinos hígidos (19 fêmeas e 2 machos) foram submetidos ao procedimento de laparocentese para obtenção de fluido peritoneal, com punção em três pontos definidos: cranial esquerdo, cranial direito e caudal direito. O volume total do líquido peritoneal foi dividido em três alíquotas mantidas sob três métodos de conservação: temperatura ambiente (26°C); refrigeração (4°C); e temperatura ambiente (26°C) com adição de 1µL de formol 10% para cada 1mL de líquido peritonial. A análise do líquido peritoneal realizada imediatamente após sua obtenção consistiu em: exames físico (cor, aspecto, volume e densidade); bioquímicos (pH, proteína total, fibrinogênio, creatinina e glicose); e da celularidade (contagens total e diferencial). A determinação de proteínas e o exame da celularidade foram repetidos, em cada alíquota separada, as duas, quatro, seis e oito horas após a colheita. Análise de variâncias de medidas repetidas ou teste de Friedman foram empregados para avaliação ao longo do tempo. A colheita foi produtiva em 67% dos bovinos e os locais de punção craniais esquerdo e direito foram os mais adequados. A concentração de proteína total variou de 1,4 a 3,6g/dL e o número de leucócitos de 54 a 1.322 células/µL, com predomínio de linfócitos (60 a 95% das células) no fluido peritoneal analisado logo após a colheita. A concentração de proteínas diminuiu, mas os valores absolutos de leucócitos, de linfócitos e de neutrófilos segmentados não se modificaram até oito horas após a colheita, independente do método de manutenção das amostras. A lise celular foi retardada pela refrigeração e a adição de formol não contribuiu para preservar a integridade da morfologia celular...(AU)

Biomarcadores sanguíneos e no líquido peritoneal de bovinos acometidos com enfermidades intestinais e reticulites traumáticas / Biomarkers blood and peritoneal fluid of bovines with intestinal diseases and traumatic reticulitis

O objetivo deste estudo foi avaliar simultaneamente biomarcadores no sangue e no líquido peritoneal (LP) de bovinos com enfermidades intestinais (GI n=14) e reticulites traumáticas (GII n=13). O exame clínico e a coleta de sangue e de LP foram realizadas e, posteriormente, análise física e citológica do LP, bem como as determinações bioquímicas no sangue e no LP. Empregou-se a análise de variância ao nível de 5% de probabilidade comparando os grupos e comparando o sangue e o LP. Em ambos os grupos foram evidenciados sinais de apatia, desidratação e hipomotilidade reticuloruminal, porém os animais do GI apresentaram alterações clínicas mais expressivas. À análise citológica do LP No sangue as concentrações de PT, globulina, colesterol e GGT foram superiores no GII (P<0,05), e a relação A/G foi maior no GI (P<0,05). No LP a albumina e a CK foram superiores no GI (P<0,05). Na comparação entre o sangue e LP, destacou-se o aumento significativo do lactato L no LP de ambos os grupos (P<0,05), caracterizando a gravidade das alterações presentes na cavidade abdominal. Recomendase a avaliação simultânea no sangue e no LP do lactato L como informação de auxílio diagnóstico e prognóstico das enfermidades digestivas dos bovinos.(AU)

The objective of this study was to simultaneously evaluate biomarkers in the blood and peritoneal fluid (PF) of cattle with intestinal diseases (GI n=14) and traumatic reticulitis (GII n=13). A clinical examination and blood collection and PF were performed and subsequently, physical and cytological analysis of PF, as well as biochemical determinations in blood and PF. The analysis of variance was used at a 5% probability level comparing the groups and comparing blood and PF. In both groups, signs of apathy, dehydration and reticuloruminal hypomotility were evidenced, but the GI animals presented more expressive clinical alterations. In the cytological analysis of PF, a predominance of polymorfhonuclear was observed in both groups. Blood TP, globulin, cholesterol and GGT concentrations were higher in GII (P<0.05), and the A/G ratio was higher in GI (P <0.05). In PF, albumin and CK were higher in GI (P<0.05). In the comparison between blood and PF, the significant increase of L-lactate in the PF of both groups (P<0.05) was observed, characterizing the severity of the alterations present in the abdominal cavity. It is recommended the simultaneous evaluation of L-lactate in the blood and PF, as a tool for diagnosis and prognosis of bovine digestive diseases.(AU)

Clinical, laboratory, ultrasonographic, and anatomopathological aspects of 30 cases of traumatic reticulosplenitis in cattle / Aspectos clínicos, laboratoriais, ultrassonográficos e anatomopatológicos de 30 casos de reticulo-esplenite traumática em bovinos

Ingestion of metallic and/or sharp foreign bodies triggers cases of traumatic reticuloperitonitis and its sequelae in cattle. Among these sequelae, we can highlight traumatic reticulosplenitis, that has high mortality, although its frequency in the ruminant medicine is low. Therefore, based on the scarcity of information on this disease, the current study aimed to evaluate the clinical, laboratory, ultrasonographic, and pathological findings of 30 adult cattle diagnosed with traumatic reticulosplenitis. Clinical, ultrasound, and anatomopathological findings were analyzed using descriptive statistics and laboratory data were evaluated using measures of central tendency. Clinically the animals presented dehydration and alterations in behavior, appetite, and ruminal motility. Hematological findings revealed neutrophilic leukocytosis (37077.17±25004.59cell/µL) with regenerative left shift and hyperfibrinogenemia (1130±364.98mg/dL). The ultrasound examination enabled visualization of mobile and echogenic filaments that corresponded to the presence of fibrin adhesions. Displacement of the reticulum and irregularity in its contour, as well as alterations in the quantity, pattern, and amplitude of reticular contractions were also observed. Splenic alterations such as abscesses were found, characterized as circular structures of varying sizes delimited by capsules containing variable echogenicity. Splenic vein thrombosis and spleen folding were also observed. The results obtained in the current study indicated that traumatic reticulosplenitis causes nonspecific clinical signs, severe laboratory alterations and, mainly, that ultrasound is an efficient method for the diagnosis of this disease, since the anatomopathological lesions confirmed the ultrasound findings.(AU)

A ingestão de corpos estranho de origem metálica e/ou pontiagudos desencadeia em bovinos, quadros de Reticuloperitonite Traumática e suas sequelas. Dentre as quais podemos destacar a retículo esplenite traumática cuja letalidade é elevada, embora a mesma apresente uma baixa frequência na clínica de ruminantes. Portanto, baseado na escassez de informações sobre esta enfermidade, este trabalho teve por objetivo avaliar os achados clínicos, laboratoriais, ultrassonográficos e anatomopatológicos de 30 bovinos adultos diagnosticados com retículo esplenite traumática. Os achados clínicos, ultrassonográfico e anatomopatológico foram analisados por meio de estatística descritiva, e os dados laboratoriais foram avaliados utilizando-se as medidas de tendência central. Clinicamente os animais apresentaram desidratação e alterações no comportamento, apetite e na motilidade ruminal. Os achados hematológicos revelaram leucocitose (37077.17±25004.59cell/µL) por neutrofilia com desvio à esquerda regenerativo e hiperfibrinogenemia (1130±364.98mg/dL). O exame ultrassonográfico possibilitou a visualização de filamentos móveis e ecogênicos que corresponderam à presença de aderências fibrinosas, observou-se também, deslocamento do retículo e irregularidade no seu contorno além das alterações na quantidade, padrão e amplitude das contrações reticulares. Permitiu ainda, a constatação de alterações esplênicas como abscessos que foram caracterizados como estruturas circulares de variados tamanhos delimitada por capsula contendo no seu interior conteúdo de ecogenicidade variável. Trombose da veia esplênica e dobramento do baço. Os resultados obtidos nesse trabalho, indicaram que a retículo esplenite traumática causa sinais clínicos inespecíficos, severas alterações laboratoriais e principalmente que a ultrassonografia é um método eficiente para o diagnóstico dessa enfermidade uma vez que as lesões anatomopatológicas confirmaram os achados ultrassonográficos.(AU)

Clinical, laboratory, ultrasonographic, and anatomopathological aspects of 30 cases of traumatic reticulosplenitis in cattle / Aspectos clínicos, laboratoriais, ultrassonográficos e anatomopatológicos de 30 casos de reticulo-esplenite traumática em bovinos

Ingestion of metallic and/or sharp foreign bodies triggers cases of traumatic reticuloperitonitis and its sequelae in cattle. Among these sequelae, we can highlight traumatic reticulosplenitis, that has high mortality, although its frequency in the ruminant medicine is low. Therefore, based on the scarcity of information on this disease, the current study aimed to evaluate the clinical, laboratory, ultrasonographic, and pathological findings of 30 adult cattle diagnosed with traumatic reticulosplenitis. Clinical, ultrasound, and anatomopathological findings were analyzed using descriptive statistics and laboratory data were evaluated using measures of central tendency. Clinically the animals presented dehydration and alterations in behavior, appetite, and ruminal motility. Hematological findings revealed neutrophilic leukocytosis (37077.17±25004.59cell/µL) with regenerative left shift and hyperfibrinogenemia (1130±364.98mg/dL). The ultrasound examination enabled visualization of mobile and echogenic filaments that corresponded to the presence of fibrin adhesions. Displacement of the reticulum and irregularity in its contour, as well as alterations in the quantity, pattern, and amplitude of reticular contractions were also observed. Splenic alterations such as abscesses were found, characterized as circular structures of varying sizes delimited by capsules containing variable echogenicity. Splenic vein thrombosis and spleen folding were also observed. The results obtained in the current study indicated that traumatic reticulosplenitis causes nonspecific clinical signs, severe laboratory alterations and, mainly, that ultrasound is an efficient method for the diagnosis of this disease, since the anatomopathological lesions confirmed the ultrasound findings.(AU)

A ingestão de corpos estranho de origem metálica e/ou pontiagudos desencadeia em bovinos, quadros de Reticuloperitonite Traumática e suas sequelas. Dentre as quais podemos destacar a retículo esplenite traumática cuja letalidade é elevada, embora a mesma apresente uma baixa frequência na clínica de ruminantes. Portanto, baseado na escassez de informações sobre esta enfermidade, este trabalho teve por objetivo avaliar os achados clínicos, laboratoriais, ultrassonográficos e anatomopatológicos de 30 bovinos adultos diagnosticados com retículo esplenite traumática. Os achados clínicos, ultrassonográfico e anatomopatológico foram analisados por meio de estatística descritiva, e os dados laboratoriais foram avaliados utilizando-se as medidas de tendência central. Clinicamente os animais apresentaram desidratação e alterações no comportamento, apetite e na motilidade ruminal. Os achados hematológicos revelaram leucocitose (37077.17±25004.59cell/µL) por neutrofilia com desvio à esquerda regenerativo e hiperfibrinogenemia (1130±364.98mg/dL). O exame ultrassonográfico possibilitou a visualização de filamentos móveis e ecogênicos que corresponderam à presença de aderências fibrinosas, observou-se também, deslocamento do retículo e irregularidade no seu contorno além das alterações na quantidade, padrão e amplitude das contrações reticulares. Permitiu ainda, a constatação de alterações esplênicas como abscessos que foram caracterizados como estruturas circulares de variados tamanhos delimitada por capsula contendo no seu interior conteúdo de ecogenicidade variável. Trombose da veia esplênica e dobramento do baço. Os resultados obtidos nesse trabalho, indicaram que a retículo esplenite traumática causa sinais clínicos inespecíficos, severas alterações laboratoriais e principalmente que a ultrassonografia é um método eficiente para o diagnóstico dessa enfermidade uma vez que as lesões anatomopatológicas confirmaram os achados ultrassonográficos.(AU)