Medicina e cirurgia de animais de companhia
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2019-07-18
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O presente relatório de estágio final, realizado no âmbito do Mestrado Integrado em Medicina Veterinária, tem por objetivo demonstrar as atividades práticas desenvolvidas durante seis meses de estágio no Hospital Veterinário de Baixo Vouga (HVBV), em Águeda e o relato e discussão de quatro casos clínicos das áreas de medicina interna e cirurgia de tecidos moles de animais de companhia. Durante os seis meses de estágio no HVBV, foi possível a realização de rotações divididas pelo serviço de consultas, cirurgia e internamento, possibilitando o acompanhamento de diversos casos clínicos. Dos casos acompanhados foram escolhidos quatro para serem apresentados neste relatório. O primeiro caso descrito é o de um ureter ectópico intramural unilateral numa cadela, em que a única queixa por parte dos proprietários era de incontinência urinária desde cachorra. A diferenciação do mesmo em intra e extramural não foi possível antes da cirurgia, devido a resultados contraditórios entre tomografia computadorizada e ecografia abdominal. Procedeu-se a uma intervenção cirúrgica onde se constatou que era intramural, corroborando o observado na ecografia. Foi realizada a técnica de neoureterostomia com disseção da porção intramural do ureter, que contribuiu para uma melhoria quase total da incontinência urinária da cadela. O segundo caso relata uma Síndrome de dilatação-torção gástrica, num cão de raça Dogue Alemão. Este animal foi referenciado para o HVBV evidenciando sinais clínicos de torção/dilatação gástrica. O diagnóstico definitivo foi feito através de radiografia. Após descompressão gástrica percutânea e estabilização hemodinâmica, como não foi possível intubação orogástrica, procedeu-se a uma laparotomia com gastrotomia para esvaziamento gástrico, esplenectomia e gastropexia para evitar recidiva de torção. O animal recuperou completamente após a intervenção. O terceiro caso trata-se de uma efusão pericárdica idiopática num cão de raça Pastor Alemão. Este animal apresentava sinais clínicos compatíveis com insuficiência cardíaca congestiva direita. Através de ecocardiografia evidenciou-se efusão pericárdica, inicialmente sem tamponamento cardíaco e depois com tamponamento, insuficiências valvulares atrioventriculares e hipertensão pulmonar. Foram efetuados exames complementares para descarte das etiologias possíveis de efusão pericárdica e hipertensão pulmonar, mas não foi possível a sua descoberta, tendo sido classificadas como idiopáticas. O tratamento consistiu em terapia médica para controlo dos sinais de insuficiência cardíaca, pericardiocentese após tamponamento cardíaco e, devido a recidiva, pericardiectomia através de toracoscopia com criação de janela pericárdica. A análise histopatológica da amostra de pericárdio recolhida revelou existência de fibrose, sugestiva de processo inflamatório crónico. A resolução cirúrgica permitiu a evolução favorável do quadro clínico do animal. Já o último caso clínico, descreve uma intussusceção simples jejuno-cólica. Após diagnóstico ecográfico, procedeu-se a uma laparotomia para resolução da intussusceção. Devido à inviabilidade da porção intestinal envolvida, foi necessário efetuar resseção do segmento afetado e anastomose. O animal teve uma boa recuperação após a cirurgia. Foram escolhidos estes quatro casos, devido à sua resolução cirúrgica, algo de especial interesse para a autora deste relatório. Assim, foi possível o estudo de várias técnicas cirúrgicas e raciocínio médico em diferentes áreas, permitindo de forma prática e objetiva alargar o conhecimento em relação aos mesmos.
This final report, carried out in the scope of the Integrated Masters in Veterinary Medicine, aims to demonstrate the practical activities developed during six months of training at the Hospital Veterinário do Baixo Vouga (HVBV), in Águeda, and the report and discussion of four clinic cases in the areas of internal medicine and soft tissue surgery of small animals. During the six months, it was possible to perform rotations divided by the services of consultation, surgery and hospitalization, which allowed the follow-up of several clinical cases. Of the cases followed, four were chosen to be presented in this report. The first case described is a unilateral intramural ectopic ureter in a female dog, in which the only complaint was of urinary incontinence since puppyhood. The differentiation between intra- and extramural was not possible before the surgery, due to the opposite results between computed tomography and abdominal ultrasound. A surgical procedure was performed where it was found that it was intramural, corroborating the ultrasound examination. The technique of neoureterostomy with dissection of intramural portion of the ureter was performed, which contributed to an almost complete resolution of the urinary incontinence of the bitch. The second case, reports a Gastric dilatation-volvulus syndrome in a Grand Danois. This animal was referred to HVBV showing clinical signs of gastric dilatation/volvulus. The definitive diagnosis of this pathology was made by radiography. After percutaneous gastric decompression and hemodynamic stabilization, as orogastric intubation was not possible, laparotomy was performed with gastrotomy for gastric emptying, splenectomy and gastropexy to avoid recurrence of torsion. The animal recovered completely after the intervention. The third case is an idiopathic pericardial effusion in a German Shepherd. This animal had signs compatible with right congestive heart failure. Echocardiography revealed pericardial effusion, initially without cardiac tamponade and then with tamponade, atrioventricular valve insufficiencies and pulmonary hypertension. Complementary exams were performed to discard the possible etiologies of pericardial effusion and pulmonary hypertension, but it was not possible to find them, and therefore they were classified as idiopathic. Treatment consisted of medical therapy to control heart failure clinical signs and pulmonary hypertension, pericardiocentesis after cardiac tamponade and due to recurrence, pericardiectomy with pericardial window through thoracoscopy. The histopathological analysis of the pericardium sample revealed fibrosis, suggestive of a chronic inflammatory process. The surgical resolution allowed the favorable evolution of the clinical condition of this animal. The last case describes a simple jejuno-colic intussusception. After the diagnosis by ultrasound, a laparotomy was performed to solve the intussusception. Due to the inviability of the intestinal portion involved, it was necessary to perform resection of the affected segment and anastomosis. The animal had a good recovery after the surgery. These four cases were chosen due to their surgical resolution, something of special interest to the author of this report. With the report and discussion of the same, it was possible to study several surgical techniques and medical reasoning in different areas, allowing to extend the knowledge in relation to them.
This final report, carried out in the scope of the Integrated Masters in Veterinary Medicine, aims to demonstrate the practical activities developed during six months of training at the Hospital Veterinário do Baixo Vouga (HVBV), in Águeda, and the report and discussion of four clinic cases in the areas of internal medicine and soft tissue surgery of small animals. During the six months, it was possible to perform rotations divided by the services of consultation, surgery and hospitalization, which allowed the follow-up of several clinical cases. Of the cases followed, four were chosen to be presented in this report. The first case described is a unilateral intramural ectopic ureter in a female dog, in which the only complaint was of urinary incontinence since puppyhood. The differentiation between intra- and extramural was not possible before the surgery, due to the opposite results between computed tomography and abdominal ultrasound. A surgical procedure was performed where it was found that it was intramural, corroborating the ultrasound examination. The technique of neoureterostomy with dissection of intramural portion of the ureter was performed, which contributed to an almost complete resolution of the urinary incontinence of the bitch. The second case, reports a Gastric dilatation-volvulus syndrome in a Grand Danois. This animal was referred to HVBV showing clinical signs of gastric dilatation/volvulus. The definitive diagnosis of this pathology was made by radiography. After percutaneous gastric decompression and hemodynamic stabilization, as orogastric intubation was not possible, laparotomy was performed with gastrotomy for gastric emptying, splenectomy and gastropexy to avoid recurrence of torsion. The animal recovered completely after the intervention. The third case is an idiopathic pericardial effusion in a German Shepherd. This animal had signs compatible with right congestive heart failure. Echocardiography revealed pericardial effusion, initially without cardiac tamponade and then with tamponade, atrioventricular valve insufficiencies and pulmonary hypertension. Complementary exams were performed to discard the possible etiologies of pericardial effusion and pulmonary hypertension, but it was not possible to find them, and therefore they were classified as idiopathic. Treatment consisted of medical therapy to control heart failure clinical signs and pulmonary hypertension, pericardiocentesis after cardiac tamponade and due to recurrence, pericardiectomy with pericardial window through thoracoscopy. The histopathological analysis of the pericardium sample revealed fibrosis, suggestive of a chronic inflammatory process. The surgical resolution allowed the favorable evolution of the clinical condition of this animal. The last case describes a simple jejuno-colic intussusception. After the diagnosis by ultrasound, a laparotomy was performed to solve the intussusception. Due to the inviability of the intestinal portion involved, it was necessary to perform resection of the affected segment and anastomosis. The animal had a good recovery after the surgery. These four cases were chosen due to their surgical resolution, something of special interest to the author of this report. With the report and discussion of the same, it was possible to study several surgical techniques and medical reasoning in different areas, allowing to extend the knowledge in relation to them.
Descrição
Relatório de Estágio Final
Mestrado Integrado em Medicina Veterinária
Palavras-chave
Neoureterostomia , Gastropexia