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HIDROMETRA PADA ANJING POMERIAN

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LAPORAN KASUS
HIDROMETRA PADA ANJING POMERIAN
Diah Pawitri, Erni Sulistiawati, Endang Y Astuti, Cucu K.Sajuthi
Praktek Dokter Hewan Bersama 24 jam, DrhCucu K. S, dkk
Jl. Sunter Permai Raya, Ruko Nirwana, Sunter Asri Tahap III Blok J-1 No. 2
Sunter, Jakarta Utara

Abstrak|

Hidrometra merupakan suatu kondisi klinis yang disebabkan oleh pembesaran uterus akibat akumulasi cairan yang berlebihan dengan konsentrasi cairan yang rendah dan steril. Kondisi ini seringkali tanpa disertai tanda klinis sistemik yang signifikan, dan umumnya terjadi pada yang hewan betina dewasa atau betina tua yang tidak di steril. Kasus ini melaporkan hidrometra pada seekor anjing pomerian betina bernama Happy, umur 6 tahun, dengan keluhan perut mengeras dan besar seperti hewan bunting. Pemeriksaan fisik dilakukan dengan palpasi dan teraba adanya undulasi masa di sebelah kiri, tepatnya di bawah lambung. Uji pendukung dilakukan hematologi lengkap dan profil kimia darah, hasil kedua uji pendukung menyatakan bahwa semua nilai peubah berada dalam rentang nilai normal. Berdasarkan uji pendukung lainnya radiografi dan ultrasonografi serta evaluasi sitologi dari efusi uterus, maka diagnosa kasus ini dapat di tegakkan sebagai hidrometra dengan deferensial diagnosa mukometra, hemametra atau kista endometrium. Operasi ovariohisterektomi (OH) merupakan solusi terapi terbaik, dari hasil OH menunjukkan pula bahwa hidrometra kasus ini terjadi secara unilateral dengan cornua uteri kiri yang membesar diameter 30 cm, terdiri dari lobus-lobus seperti kista berisi cairan sereous sebanyak lebih dari 2 liter. Prognosa hidrometra adalah fausta, sebaliknya diagnosa infausta pada kasus akumulasi darah pada uterus atau hemametra oleh karena kehilangan darah yang berlebihan dan dapat menyebabkan anemia sehingga dapat mengancam nyawa hewan yang bersangkutan. Kata kunci : Hidrometra, uterus, progesterone, anjing pomerian

PENDAHULUAN

Hidrometra adalah akumulasi cairan sereous di dalam uterus, analisis sitologi menunjukkan minimnya sel (hiposelular) atau bahkan aselular, keadaan ini normal pada uterus anjing selama estrus atau pada kondisi kista hiperplasia. Hidrometra adalah bagian dari pseudopregnancy atau lokal endometrial hyperplasia (Pretzer 2008). LAPORAN KASUS Kami melaporkan kasus seekor anjing betina Pomerian bernama Happy, umur 6 tahun yang datang ke klinik PDHB drh. Cucu K, dkk pada tanggal 7 Agustus 2011. Anamnese hewan antara lain hewan gelisah, malas bergerak tetapi nafsu makan masih cukup baik, keadaan umum lainnya tidak bermasalah. Hewan pernah di kawinkan pada bulan Juni 2010, tetapi tidak terjadi kebuntingan. Keluhan lainnya perut membesar dan mengeras terlihat seperti hewan bunting, diamati sejak bulan April 2011. Pemeriksaan fisik dengan palpasi teraba undulasi massa di sebelah kiri di bawah lambung. Pemeriksaan laboratorium meliputi, hematologi dan kimia darah telah dilakukan, hasil kedua uji pendukung ini menyatakan semua nilai analisis uji diagnostik tersebut berada dalam rentang nilai normal. Radiografi melaporkan adanya pembesaran uterus, sedangkan ultrasonografi menunjukkan pembesaran terjadi pada kornua uterus kiri, terlihat multipel vakuol yang berisi cairan serupa kista. Berdasarkan hasil pemeriksaan fisik, radiografi, Ultrasonografi maka diagnosa klinis ditegakkan sebagai hidrometra dengan deferensial diagnosa kista endometrium.

Hidrometra pada anjing

Gambar 1. Hasil USG. Multipel vakuol dengan ukuran bervariasi pada endometrium uteri dan berisi cairan  Gambar

Hidrometra pada anjing2

2. Laparatomi OH. Pembesaran kornua uterus kiri dengan diameter 30 cm

Pada tanggal 13 Agustus 2011 di lakukan operasi OH, hasil operasi diketahui terjadi perluasan dan pembesaran kornua uterus kiri dengan diameter 30 cm (gambar 2 dan 3), lesio berisi cairan serous lebih dari 2 liter, sementara korpus dan kornua kanan uterus terlihat tidak ada perubahan (normal). Cairan sereous uterus tersebut memiliki berat jenis cairan 1015, dan hasil sitologi melaporkan tidak di temukannya sel endometrium maupun sel tumor sehingga diagnosa morfologi adalah multipel kista endometrium. Pada ovarium kiri ditemukan juga kista ovari dan tidak terlihat adanya korpus luteum, sementara pada ovarium kanan tidak terlihat folikel, kista maupun korpus luteum (gambar 4). DISKUSI Hidrometra adalah suatu keadaan klinis akibat akumulasi cairan yang berkonsentrasi rendah (encer) dan steril pada uterus tanpa disertai tanda klinis sistemik yang signifikan. Akumulasi cairan dapat terjadi akibat sekresi cairan yang berlebihan dan terakumulasi dalam uterus olehkarena saluran keluar alaminya terhalangi oleh beberapa hal (Pretzer 2008).

Hidrometra pada anjing3

 Gambar 3. Uterus dan Vesika Urinaria A. Kornua Kiri B. Kornua Kanan C. Korpus Uteri D. Servik Uteri E. Vesika Urinaria

Hidrometra pada anjing4

Pada kasus ini diketahui bahwa Happy memiliki siklus ovulasi yang normal, pada bulan Juni 2010 terjadi estrus dan di kawinkan tetapi tidak terjadi kebuntingan. Estrus berikutnya lepas dari pengamatan pemilik dan terlihat kembali oleh pemilik pada bulan April 2011, tidak di kawinkan tetapi perut membesar hingga akhirnya pada bulan Agustus di bawa ke klinik. Menurut Pretzer (2008) hormon estrogen dan progesteron mengalami variasi perubahan tingkat kosentrasinya dalam setiap tahapan siklus estrus, mengikuti siklus ovulasi hormon plasma progesterone meningkat dan menstimulasi pertumbuhan endometrium dan kelenjar mensekresi cairan sambil menekan aktivitas myometrium. Saat estrus pada anjing betina terjadi kongesti dan edema pada endometrium dan mukosa ditutupi oleh sekresi sanguineous, sekresi ini merupakan produk dari epitelium kelenjar. Di bawah pengaruh progesterone jaringan sel dari kelenjar berproliferasi sehingga menyebabkan hiperplasia sampai level progesterone mencapai puncak. Menurut Feldman dan Richard (1996) induksi hormon progesteron ini dapat menyebabkan endometrium hiperplasia dan umumnya terjadi pada anjing betina usia 6 tahun keatas, pada kejadian patologik hiperplasia yang progresif dapat membentuk kista endometrium. Cystic endometrial hyperplasia (CEH) dapat menyebabkan hematometra, pyometra, mucometra atau hydrometra, dan banyak faktor dari penyakit uterus pada anjing betina. Penebalan endometrium pada kasus CEH, diketahui terjadi karena peningkatan ukuran, jumlah kelenjar endometrium disertai penigkatan aktivitas sekresi kelenjar. Sel epitel mukosa endometrium berliku-liku dengan sitoplasma bening dan hipertonik, serta stroma menjadi edematous. CEH dapat ditandai oleh adanya sekresi cairan transparan dan kental pada lumen uterus. Cairan ini sterile, jika uterus yang berisi cairan ini tersumbat maka dapat memiliki kecendrungan menjadi hidrometra Stimulasi progesteron yang meningkatkan sekresi kelenjar endometrium, penurunan kontraktilitas myometrium dapat menyebabkan penutupan servik. Penyumbatan servik pada fase ini dapat mengakibatkan korpus dan kornua uterus meluas dan membesar (Oh et al. 2005) Konfirmasi diagnosa CEH sulit karena diagnosa tersebut biasanya tidak berkaitan dengan tanda-tanda klinis kecuali jika isi uterus terinfeksi. Penegakkan diagnosa CEH yang tidak terinfeks memerlukan biopsi uterus (Smith 2006). Percobaan OH dengan meninggalkan sebagian dari uterus, ternyata menyebabkan uterus meluas dan membesar (menggembung) serupa kista dengan cairan bening. Hal tersebut juga merupakan bagian dari pseudopregnancy.

DAFTAR PUSTAKA

Feldman EC; Richard WN. 1996. Canine and feline Endocrinology and reproduction. WB Sounders company. Philadelphia USA Oh Ki-Seok, Chang-Ho Son, Bang-Sil Kim, Shun-Shin Hwang, You-Jung Kim, Su-Jin Park, Jae-HoJeong, CheolJeong, Sung-Hee Park, Kyoung-Oh Cho. 2005. Segmental Aplasia of Uterine Body in an Adult Mixed Breed Dog. Journal of Veterinary Diagnostic Investigation September 2005 vol. 17no. 5 490-492. Pretzer,S.D. 2008. Clinical presentation of canine pyometra and mucometra: A review. Abilene Animal Hospital, P.A., 320 NE 14th Street, Abilene, KS 67410, USA Smith,Frances O. 2006. Canine pyometra. Smith Veterinary Hospital, Inc., 1110 East Highway 13, Burnsville, MN 55337, USA
Gambar 3. Uterus dan Vesika Urinaria A. Kornua Kiri B. Kornua Kanan C. Korpus Uteri D. Servik Uteri E. Vesika Urinaria

 


Pericardiocentesis As a Treatment of Choice For Animal With Pericardial Effusion

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Pericardiocentesis As a Treatment of Choice For Animal With
Pericardial Effusion

Cucu K. Sajuthi , Maulana ArRaniri Putra, Piprim B Yanuarso*, Suswanto, Bambang Sulistyo, Endang Yuli Astuti, Herlina, and Royama Sari.

Praktek Dokter Hewan Bersama (PDHB) 24 jam drh. Cucu K. Sajuthi dkk

(24 HRS Veterinary Clinic Drh Cucu K. Sajuthi and Associate)
Jl. Sunter Permai Raya, Ruko Nirmana Sunter Asri Tahap III Blok J-1 No.2

*) Rumah Sakit Cipto Mangunkusumo, Jakarta

 

Introduction

Pericardial effusion is a condition when excess or abnormal fluid accumulation occurs in the pericardial space. This disease is the most common pericardial disorder and it occurs most often in dogs. Most pericardial effusion in dog are sanguinous or serosanguinous. The fluid usually appears dark red. Mostly red blood cells are found on cytological diagnosis but, reactive mesothelial, neoplastic, or other cells may be seen (Abbott, 2000).

The treatment of pericardial effusion is very different from other causes of right-side heart failure. Positive inotropic drugs do not ameliorate the signs of tamponade. Pericardiocentesis is the therapeutic procedure of choice and also provides diagnostic information. Administration of diuretic or vasodilatators without pericardiocentesis may cause further hypotention and cardiogenic shock (Nelson and Couto, 2003).

 

Case Study

Brownie, a male 11-years old Golden Retriever was first presented to our clinic with fatigue, panting and the dog had a sudden collapse history. The physical exam showed that respiratory rate was increased (100 beats/ minute) but the body temp was within the normal range (38.7oC). The diagnostic approach was X-ray, with the result that the heart was very big, almost fully filled the chest cavity. We suggested to the owner to bring the dog in the next day to meet our vet with special interests in cardiology, for an ECG and Ultrasound. The ECG showed shortened  complex of QRS waves. The Ultrasounding showed the presence of water in the pericardium space in a large amount. The definitve diagnosis of Brownie was pericardial effusion. The prognosis was dubius to infausta. The therapy given were Lasix® , Omega 3 plus®  and TF advance® . We planned to perform pericardiocentesis as soon as possible and the owner agreed. Two days later, the dog came to our clinic for pericardiocentesis.

 

Pericardiocentesis

Pericardiocentesis is the treatment of choice for initial stabilization of animals with cardiac tamponade. Pericardiocentesis is a relatively safe procedure when carefully performed. Removal of even small amounst of pericardial fluid can markedly decrease intrapericardial pressure in animals with tamponade (Nelson and Couto, 2003).

Brownie was sedated with intravenous administration of penthotal and the maintenance was inhalation of isoflurans. The position was Right-Lateral recumbency and the tap was performed from underneath. Pericardiocentesis from the right side minimizes the risk of trauma to the lung (because of the cardiac notch) and major coronary vessels (which are located mostly on the left) (Nelson and Couto, 2003). The skin was shaved over a wide area especially between costae three to eight, then the area was cleaned with alcohol 70% and iodine tincture 20%. We put markers in the 1/3 ventral part of intercostae three to four. The incision site was in the marked regio. The incision was about five cm dorso-ventral length. After intercostal muscles were visible, a #16 and 5″ intravenous catheter was poked through intercostal muscles to reach the pericard, with the guidance of ultrasound. After that the needle from the IV catheter was pulled out. The next step was to aspirate to make sure of the proper position of the IV catheter. Then a 0.18 short wire was inserted to the IV catheter and the IV catheter was pulled out but the short wire stayed inside. The function of the short wire was as a direction to the pericardial space. After that 4s radial sheath was inserted to the wire until it reached pericardial space. Then the wire was pulled out and the sheath left inside. After that a 150 cm guide wide terumo® was inserted to the 4s pig tail catheter, then put onto radial sheath in the chest cavity. The wire was pulled out, 4s radial sheath and pig tail catheter were fixated to the skin with thread. Pericardiosintesis was then performed. We collected 385 ml hemoserous liquid from Brownie, and we sent it to the lab for further diagnosis. After 385 ml of liquid was withdrawn by pericardiocentesis, the ECG showed that the amplitude of the complexes were now increased. On day two we collected another 95 ml hemoserous liquid. The volume of the liquid decreased everyday until day five. On day five there was no moreliquid that we could aspirate. After the absence of liquid was confirmed, we took the catheter out. To prevent infection we gave the dog cefadroxil and also omega 3® and TF advance® as a supplement.

The morphological diagnosis from cytological insection of the liquid that we had collect on pericardial space were hemorrhagic effusion with atypical cells. The atypical cells could be tumor cells or reactive mesothelial cells that correlated with hemorrhagic effusion. The differential diagnosis for this case were heart based tumor or hemangiosarcoma. Both of the diseases can cause hemorrhagic effusion. We had to take a new radiographic for the chest, and the result showed that the heart’s size was smaller than the previous radiographic.

 

Conclusions

Pericardiocentesis is the most successful method to treat pericardial effusion. Careful procedures will minimize the risks.

 

Reference

Abbott JA. 2000. Small Animal Cardiology Secrets. Hanley&Belfus. .

Nelson RW, Couto CG. 2003. Small Animal Internal Medicine 3rd ed. Mosby inc.

 

 

Pericardiocentesis2 Pericardiocentesis3

Picture 1. The dorso-ventral position of the thorax region before (A) and after (B) pericardiocentesis. (Personal documentation, 2010)

Pericardiocentesis4 Pericardiocentesis5

Picture 2. The ECG of Brownie before (left) and after (right) pericardiocentesis
(Personal documentation, 2010)

Pericardiocentesis1

Picture 3. USG of brownie’s heart before the pericardiocentesis

 


Client Education Series

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Client Education Series
by: drh. Diah Pawitri

 

We hope these notes will give you some help.  If you have questions please do not hesitate to contact us.


1. VOMITING

What  causes vomiting?

Vomiting is not a disease but a symptom of many different disease.  Many cases of vomiting are self limiting after a few days. Less commonly vomiting may result from a serious illness, such as kidney failure. Even when vomiting is caused by mild illnesses, it may lead to death of he animal if treatment is not begun early enough to prevent severe fluid and nutrient losses.

How serious is vomiting in dogs?

We attempt to determine how sick dog has become as consequence of the vomiting.  When the dog is systemically ill, some of the following may be noted:

  1. Diarrhoea
  2. Dehydration
  3. Loss of appetite
  4. Abdominal pain
  5. High fever
  6. Lethargy

What  tests are performed to find the cause?

If vomiting is associate with several of the above sign, we perform a series test to clarify the situation.  Diagnostic  test may include radiography, ultrasound, blood test, biopsies and exploratory abdominal surgery.  Once the diagnosis is know, treatment may include medications, diets, and/or surgery.

If your dog does not appear systemically ill from the vomiting, the cause may be less serious.  Some of the minor causes of vomiting include stomach or intestinal bacteria, parasites, and dietary indiscretions.  Please keep us informed of luck of expected improvement so that we may assess the situation.


2. SEIZURES

What is a seizure?

Seizures are one of the most frequently seen neurological problem in dogs. A seizure is also known as a convulsion or  fit.  It may have all or any combination of the following :

  1. Loss or derangement of conciousness
  2. Contractions of all the muscle in the body
  3. Change the mental awarensess from non responsiveness to hallucinations
  4. Involuntary urination, defecation, or salivation
  5. Behavioural changes, including non recognition of owner, viciousness, pacing, and running in circles

Is the dog in trouble during a seizure?

Despite the dramatic sign of seizure, the dog feels no pain, only bewilderment. Dogs do not swallow the tongues.  If you put your finger into its mouth you will do not benefit to your pet and will run a high risk of being bitten very badly.  The important thing is to keep the dog from failling and hurting itself.  As long as it is on the floor or ground, there is a little chance of harm occuring.  If seizures continue for longer than a few minutes, the body temperature begins to rise.

What causes seizures?

There are many of seizures.  Epilepsy is the most common and least consequence to the dog.  The other extreme includes severe disease as brain tumor , distemper, and hypoglycaemia.

 

3. TRAVEL WITH YOUR DOG

CAR TREVEL

Animals travelling in cars should be under control in vehicles and unable to distract you while you are driving.  If you want your dog to be loose in car he should be separated from you, and thus an estate vehicle or hatchback with a strong dog guard is ideal.  Alternatively a crate or cage can be used, the dimensoins of which should be comfortable for the animal.  If the dog is not so separated from you he should be tethered so that he cannot act as adistruction.  The easiest way of doing this is place him in the footwel in the back of the car, shutting the lead, attached to properly adjusted collar, in the car door.

Motion sicknesss is a condition which affects many dogs.  It is due to the effect of the motion on the organs of balance located in the inner ear.  Signs are usually excessive salivation, restlessness or excitement.  Many of the human travel sckness remedies  are effective.  Give the tablet at least half an hour before travelling is due.