兽医师猫传染病专题等多个文件015esavs猫病ii7c case indira

MaineCoon缅因6years6maleneutered去势environment:in-andvaccination:notdeworming:驱虫：最近驱过History病weight体重减厌physical体 y ytemperature:39.9体温39.9NormalC红细x5-Hemoglobin血红蛋5.5-Hematocrit血细胞比0.30-x200-WBC白细x5-Monocytes单核细x0-x1.5-x0-x3-0x0-Basophils嗜碱性粒细0x0-yindices红细胞指referenceRBC红细x5-Hemoglobin血红蛋5.5-PCV红细胞压0.30--MCV平均红细胞容40--MCH红细胞平均血红蛋白0.8--MCHC平均血红蛋白浓19-reti.Punctated分散的网织红胞0‰0-reti.Aggregated聚合的网细00-Remarks备 zymes酶

referenceAST谷草转氨ALT谷丙转氨 ALP碱性磷酸 GLDH谷氨酸脱氢-GTγ-谷氨酰转移酶 -amylase-淀粉

0-0-0-00-0-2300-0-0-0-0-Substrates底referenceBilirubin胆红0-NH30-SBA胆汁0-Cholesterol胆固1.8-Triglycerides甘油三0.57-totalprotein总蛋55-Albumin白蛋25-Urea尿5-Creatinine肌0-Glucose葡萄4-Fructosamine果糖0-Remarks备质Units位reference参考范P0.71-99-143-K3.9-2.4-11-0.7-Remarks备nitrit亚硝酸protein蛋白Glucose葡萄Ketones Bilirubin胆红spec.gravity尿

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reference-5-------1.001-FurtherDiagnostics进一步诊 FurtherDiagnostics进一步诊abdominalX-ray腹部X光lossofvisceraldetail内probably fluidFurtherDiagnostics进一步诊thoracicX-ray胸部X光unremarkable无明显FurtherDiagnostics进一步诊massiveascitesthickenedmesenterium肠thickenedduodenalwall(8mm),alteredFurtherDiagnsotics进一步诊Ascites腹Units单x106/lnucleatedcells有细Protein蛋白Remarks备clear,redtocytologyascites腹水细macrophages巨噬细neutrophiles嗜中性粒细FurtherDiagnostics进一步诊Rivalta‘s李凡他测FurtherDiagnostics进一步诊immunofluorescencesofFCoVantigeninmacrophagesof ownerselect主人Necropsy尸体解500mlredtoorange,stickygenerallythickendintestinalgranulomatouschangesintheintestinal肠壁有肉芽肿性改ThankMedizinischeKleintierklinikLMUClassification分 ysisfor渗漏液分类分modifiedtransudateExsudateFoto:Prof.J.Foto:Prof.J.ChyleUrineBile改性漏出<2.5-><1015-><1000->spec.nucleatedcell细胞形态

mesothelial间皮细

嗜中性粒细Pathophysiology病decreasedoncoticpressure胶体渗透压降=hypalbuminemia低白蛋白血increasedhydrostaticpressure静水压portalhypertension门静脉高pre-hepaticHepaticpost-hepatic

increasedvascular血管通透性增decreasedlymphatic淋 减

Classification分manyeffusionsseembloody(e.g.很多渗漏液看起来都是有血的（如，渗出液PCVusually5 红细胞压积通常5PCV>10%(oratleast¼ofperipheral红细胞压积10或者至少¼的外周红细胞压积distinguishingiatrogenic区分医源性污„fresh“bloodbyiatrogenicorganaspiration医源性引 流出“新鲜”血液会发生凝„oldblooddoesn‘tclot”陈旧“血液不凝

Classification分milky,cloudyeffusion牛奶状云雾triglycerideseffusion>渗漏液中的甘油三酯Urineyelloweffusioncreatinine/potassiumeffusion>Bilecogniac-colouredbilirubineffusion>渗漏液中的胆红素 n漏出液的诊断计albumin-/totalprotein白蛋白-/总蛋白测albuminmajorcomponentofoncoticalbumin<1.5 白蛋白<1.5 渗漏albumindecreasedbut1.5gm/dl白蛋白减少，hypalbuminemiaprobablynotsolereasonforfurtherdiagnostictests n漏出液的诊断计Hypalbuminemiarenalloss肾功能丧尿液测试；比较好：尿蛋白与尿肌酐比dipstickinprecise:dilutedurine尿液测 UP/C>1consistentwithincreased尿蛋白和尿肌酐比值1与增加的损UP/Cmostly>5,ifsignificant尿蛋白和尿肌酐比值基本5如果有严 n漏出液的诊断计decreasedproductionliverenzymeactivitieswithsign.liverdiseasenotalwayselevated(livercirrhosis,neo sia,chronicpost-prandialbileacidsmoresensitivethan n漏出液的诊断计intestinalloss肠道损排除肝脏和肾脏；更好：肠道活noeasylabtestforprotein-loosingenteropathy(α1-antitrypsinonlyinUSA) 胰蛋白酶（仅运用于 endoscopicbiopsiesmostly内窥镜活检大多数情况下就足够surgicalbiopsiesrarely很少需要进行手术活 n漏出液的诊断计Hypalbuminemia血白蛋白减othercausesrarelyleadtosevereSkin Malnourishment营Modifiedtransudatecharacterizedby特点slightlyhigherproteincontent(>2.5蛋白质含量轻微升高2.5Lowcell低细胞计mostcommoncauseformod.congestiveright-sidedheartliverdisease肝脏 sia肿Modifiedtransudate变congestiveright-sidedheart•=post-hepaticportal充血性右心衰=pericardialeffusiontricuspidvalveCardiomyopathyheartwormdisease,pressioncavagood„screeningtest“forsidedheart右心衰的“筛选测试Modifiedtransudate变pericardialmuffledheart„pounding“脉搏“很重„rounded“heartonthoracic在胸部X光片上心脏呈“圆形ECG心Hypovoltage低electricalternans交流ModifiedtransudatepericardialeffusionModifiedtransudatetricuspidvalve 闭锁不systolicheartmurmur收缩性心杂loudestonrightthoraxdefinitivediagnosiswithecho用超声心动图明确诊tricuspidvalverightatriumdilatedliverModifiedtransudateCardiomyopathy心肌softheartsounds软posssystolicheartmurmur可能有收缩性心杂weakpulsesposs.enlargedheartshapeonthoracicdefinitivediagnosiswith用超声心动图明确诊enlargedventricularandatrialdiminishedModifiedtransudateliverdisease肝脏疾intra-hepaticportalhypertensioncompressionofliversinusoidspronetoeffusionformationbysaltandwaterretention(activationofrenin-angio-tensine-aldosteronesystem)Modifiedtransudateliverdisease肝脏疾ifposthepaticportalhypertension(esp.byheartfailure)excludedascauseformod.transudate&liverenzymeactivity/functionparametersModifiedtransudate变liverdisease肝脏疾 eveninpost-hepaticcongestion(e.g.right-sidedheartfailure)liverenzymeacitivitiescanbeincreasedduetofordefinitivediagnosis,therapy,andprognosisliverbiopsynecessaryModifiedtransudate变 sia肿afterexclusionofpost-hepaticportal肝后性门静脉高liver siamost最可能是隐藏的肿obstructionofsecondary Modifiedtransudate变 sia肿inmostpatientsno sticcellson大多数患者在细胞学检查不见肿瘤细reactivemesothelialcellscouldbeconfusedwithneo 有活性的间皮细胞可能会与肿瘤细 ultrasoundusefulforidentificationofabdominalneo advanceddiagnosticimaging:CT,更先进的诊断方法Modifiedtransudate变nodiagnosisafterinitialdiagnostic进行最初的诊断步骤之后没有诊 +biopsies(liver,mesentery,lymphnodes,GItract,anyabnormaltissue)+活检（肝脏，肠系膜， +measureportalvein测量门静脉血+mesentericvenoportogram肠系膜门静脉造影（血栓形成Exsudate渗classification分highproteincontent(>2.5高蛋白含量2.5highnuclearcellcount(>7000有核细胞数量大7000neutrophilseffusion>嗜中性粒细胞渗漏initialdecision最初的诊Septic脓non-septic非脓septic脓毒性渗漏mostly大部分是嗜中性粒细Degenerated变性patientsrecieving neutrophils嗜中性粒细oronlymildly没有或者仅有轻微的变基本不见细septic脓毒性渗漏perforatedGItract胃肠foreignbodyhematogenicdissemination通过ruptured