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Lola’s GI Hypomotility

Patient: Lola Anna; #164024 ACC#: 154960. Lola’s GI Hypomotility. Mason Savage, DVM. History. Lola - 6 year old female spayed DLH Referred in to Internal Med for: Evaluation of a 3 month history of weight loss in the face of a ravenous appetite

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Lola’s GI Hypomotility

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  1. Patient: Lola Anna; #164024 ACC#: 154960 Lola’s GI Hypomotility Mason Savage, DVM

  2. History • Lola - 6 year old female spayed DLH • Referred in to Internal Med for: • Evaluation of a 3 month history of weight loss in the face of a ravenous appetite • Evaluation of 3 episodes of acute lethargy with decreased responsiveness requiring hospitalization.

  3. Physical Examination • GI: bladder is largely distended and mildly thickened bowel loops are appreciated • Otherwise, unremarkable

  4. Diagnostics • Planned to begin with basic bloodwork • However, unable to draw blood from patient… so began with imaging

  5. Thoracic Radiographs Normal cardiopulmonary structures

  6. Thoracic Radiographs Stomach and cranial intestine moderately gas and fluid distended, otherwise unremarkable.

  7. Abdominal Ultrasound

  8. Abdominal Ultrasound • Findings very similar to feline dysautonomia

  9. Abdominal Ultrasound

  10. Feline Dysautonomia • Feline Dysautonomia • Paper from 2010 describing common imaging findings in patient’s with this disease • Disease is autonomic ganglia degeneration • Leads to failure of autonomic nervous system • Often accompanied with concurrent sypathetic nervous system dysfunctions (dilated pupils, elevated 3rd eyelids, …) • Possible sex (male) predisposition and geographic (Midwest) distribution?

  11. Feline Dysautonomia • Imaging findings

  12. Feline Dysautonomia • Imaging findings

  13. Lola Case Progress • Hospitalized overnight • Following day was laterally recumbent and non-responsive

  14. Lola Case Progress • Venous Blood Gas revealed extreme acidemia • pH of 6.8 • Patient eventually diagnosed with d-lactic acidosis secondary to severe exocrine pancreatic insufficiency

  15. Lola Case Progress

  16. D-lactic acidosis 2’ to Severe EPI • D-lactate is produced by from bacterial flora in intestine • Reports of d-lactic acidosis in people seen with short-bowel syndrome secondary to GI surgery • Can be accompanied by GI dysmotility • Single case report (2005) in cat with similar ultrasonographic findings

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