咨询描述:阿拉斯加,吃不下东西一个星期了,全身皮肤黄染,喝水也会吐,没啥尿,大便不成型,稀便,没精神
问题大致一样,细节不同?
赵一强
执业兽医师
主人你好,宝贝这个出现了严重的问题。通过您上传的化验指标来看宝贝有很高的炎症。这个炎症通过生化结果来看,一方面是宝贝肝脏有特别严重的胆固醇淤积症,一是宝贝胆囊可能有结石或胆管可能有堵塞。比如说结石堵塞,或者肝胆上面长了,肿瘤压迫胆管堵塞,导致他指标出现明显的异常,并引起了黄疸。
同时宝贝的肾脏指标肌酐尿素氮和磷离子的指标提示它有肾衰竭。我们一般会把肾衰竭按照严重程度分为1234期。一期最轻,四期最严重。宝贝现在就是一个四期肾衰竭,也就是说他已经达到尿毒症了。
所以宝贝这种情况,如果您还想再积极治疗的话。建议最好做一下腹部B超的检查准确诊断看一下。如果确实肾脏的心态也很差,肝脏上面可能也有我上面提到的胆管堵塞的原因引起的这种胆固醇淤积症,不管是肝肿瘤还是说胆囊结石,那基本上没有什么太大治疗意义。一个是治疗费用昂贵,一个是治疗之后的效果不太理想。可以考虑临终关怀安乐。
但是如果宝贝实际上并没有胆囊胆管的堵塞。肾脏的器官形态也还行。那就得考虑一下宝贝是不是吃了什么有毒的东西,导致了这种一过性的损伤?可以根据宝贝的症状给予对症的药物治疗。包括保肝的,泻胆的。包括针对肾脏积极输液促进肾衰缓解的,口服一些保肾的和保肝的。以及磷离子结合剂。同时针对宝贝的症状对症的消炎,止吐。止泻治疗。
做了B超跟X线,胆囊没有淤积,肝脏形态也还可以,当地输了三天液,效果不是很好,白细胞已经到了五十多,腿上有个小伤口不知道是不是这个原因造成的,没有发烧,而且肌酐已经有一千多,它现在可以24小时持续输液吗?每天液体量有限制嘛,它现在是25kg,因为前天输液输了将近两千毫升,但是尿液只有120毫升左右,这边的宠物医疗中心还是建议24小时持续输液,我又怕没有尿大剂量输液引起肾脏负担
赵一强
执业兽医师
主人你好,需要持续输液的。那麻烦您把影像的报告单都发上来,包括B超报告和X光片的原图照片。帮您看一下。
因为如果说确实排除了胆囊胆管原发疾病的问题的话。这种情况只有一种可能。那就是宝贝因为严重的尿毒症。导致了严重的贫血,导致了胆红素的再循环增多引起总胆红素上升,出现短暂性的黄疸。但是宝贝的血常规红细胞血红蛋白都正常。所以我觉得这种可能性还是比较小,我还是认为他胆囊胆管是有问题的。
这个问题先放一边,你把B超的报告单和X光的图片发上来以后我看完再说。咱们先说肾的问题。宝贝的肾病需要大剂量输液,促进肾脏排出尿液,降低肾指标的。那么按照您的描述,宝贝现在的输液量总量能达到2000毫升。但是排出的尿量远远不够,出现了进出水不平衡。 提示了宝贝现在的肾脏其实是不在工作的。或者说只有一小部分在工作。所以它产生的尿量很少。那么这种情况肯定是建议住院积极治疗的。24小时静脉缓慢输液。如果你怕输液量太大。可以拿总输液量其中的1000多毫升走静脉输液,其余1000多毫升给他走皮下输液,早晨500下午500。然后给予利尿剂。促进尿液的排出。同时,建议您最好给宝贝补充化验一下血气8+,看一下宝贝有没有代谢性酸中毒?然后根据血气的结果调整一下静脉输液的内容。
然后你说宝贝外伤。如果怀疑是外伤感染导致的肝肾的损伤衰竭。那您把外伤照片发给我一下,另外您告诉我一下外伤是怎么导致的?大概多长时间了,这个外伤当时发现的时候有明显的感染吗?这两天外伤有没有做处理?
因为是在小县城,宠物医疗中心的设备有限,我现在外出进修也没时间带他去大城市看病,腿上的伤口听我爸说是跟村里的狗子打架被咬的,具体多久受伤的不太清楚,昨天看了一下伤口还是有感染的,伤口不深,但是表面有脓性物,昨天给它简单的清洗消毒包扎了一下,你说的口服药,可以开个处方嘛,我上网看看能不能买回来
为保护用户隐私不显示图片/视频
赵一强
执业兽医师
主人你好,因为你发的这个视频来看宝贝只是一个肝脏的影像,里面的胆囊倒是没有太多的胆汁淤积。但是是同样他也打的没有太好,因为视频只有这一个切面,看不到胆管的情况。另外没有B超提供肾的形态。
X光片来看的话。这个比较粗略的看是看不到宝贝的肝胆形态的。肾脏的话片子也看不了太细节。 大体的大小倒是还行。
但是我现在看着宝贝的X光片里边胃的形态态非常差,腹腔中间有可能有肿块。如果说像您说的伤口轻微有些感染的话,我觉得不至于引起这么严重的肝肾损伤。炎症有感染,这个是肯定有的治疗也要大力消炎,这个都是必须的。还是想和您再确认一下,确定宝贝在发病之前没有吃过什么乱七八糟可能导致中毒的东西吗?因为宝贝的X光片上都能感觉得到,宝贝的胃壁有增厚。 腹腔中间应该是有一个肿块的。但是不好说是肿瘤还是说吃的异物。
那么我这边先把常规的保肝护生的药物给您开出来,您可以参考先看看。
吃的其他什么不太清楚,但是我妈说之前看它不吃东西,喂了一块生肉,到现在差不多也有一个星期了,期间就再没有吃过东西了,怎么也消化了吧。而且现在它想喝水也能喝进去,但是过一会就会吐出来,到现在也没有吃过东西,一个是没食欲,另一个也不敢喂它吃什么,怕它吐,又怕加重它肾脏负担,但是我又感觉它还是想吃点东西的,可以喂它吃点什么吗
赵一强
执业兽医师
现在别的东西我也不敢说,能给宝贝喂,建议就是吃肾脏处方粮。
如果那块生肉有变质的地方,或者已经产生了一些肉毒素的话,有可能也会导致宝贝出现一些肝肾中毒损伤这方面的问题。
医生建议及处方根据当前病情给出,仅适用于本次问诊
蘑菇宠医处方笺
用法用量需根据患宠的年龄、体重等信息开具,此处方暂不展示
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