B. Regmi and M.K. Shah (2017) Int. J. Appl. Sci. Biotechnol.

Vol 5(4): 555-558

DOI: 10.3126/ijasbt.v5i4.18768

Case Study

A Case Study on Ascites of Hepatic Origin and Their Proper

Management in a Male German Shepherd Dog
Bharata Regmi1*, Manoj Kumar Shah2
1Surgery and Radiology, Agriculture and Forestry University (AFU), Rampur, Chitwan, Nepal
2Department of Surgery and Pharmacology, AFU, Rampur, Chitwan, Nepal

Abstract
A male German shepherd dog of 11 months was presented to HART Clinic, Pokhara with the history of abdominal swelling,
respiratory distress, lethargy, anorexia and weakness. Physical examination revealed dyspnea, pale mucous membrane, and
undulating movement (thrills) of fluid on tapping the abdomen. Fecal sample collected for assessing the severity of
endoparasites which was found negative. The hematological study showed an increase in numbers of neutrophils, while there
were decreased erythrocytes and hemoglobin concentration. The biochemical analysis resulted in an elevated SGOT, SGPT
level but decrease in total protein level. Ascitic fluid collected from abdominal paracentesis on examination revealed transudate
fluid with serum-albumin ascetic gradient (SAAG) >1.1 gm/dl suggesting ascites due to portal hypertension (96% accuracy)
caused by Liver cirrhosis. The dog was diagnosed as ascites of hepatic origin resulting portal hypertension and
hypoproteinemia. The abdominocentesis was performed to drain the ascetic fluid followed by albumin and normal saline
administration. The dog was further treated with antibiotic, diuretic, amino acid and liver tonics along with protein rich but salt
free diet. The dog showed remarkable improvement with gradual reduced in abdominal distention and normalization of the
appetite after 7 days of treatment.

Keyword: ascites; dog; biochemical; SAAG; hepatic

Introduction underlying problem (Pradhan et al., 2008; Kumar et al.,

Ascites, referred as accumulation of serous fluid in 2016).
peritoneal cavity, has been attributed to chronic hepatic Generally, the ascetic fluid has been evaluated for diagnosis
failure, congestive heart failure, nephritic syndrome, of ascites. In particular, it involves the collection of
malnutrition, ankylostomiasis and protein losing abdominal fluid to analyze the bacterial presence, protein
enteropathy in canine. It results in abdominal swelling, makeup, and bleeding. Besides, the urine analysis to
dyspnea, lethargy, anorexia, vomiting, weakness, diagnose urinary loss of protein that may be due to the
discomfort. Ascites is always a sign of disease; therefore diseases like amyloidosis and glomerulonephritis.
investigation should be aimed at identifying the primary Proteinuria causes hypoproteinemia resulting into ascites.

Article may be cited as:

B. Regmi and M.K. Shah (2017) Int. J. Appl. Sci. Biotechnol. Vol 5(4): 555-558. DOI: 10.3126/ijasbt.v5i4.18768
1
*Corresponding author
Bharata Regmi,
Surgery and Radiology, Agriculture and Forestry University (AFU), Rampur, Chitwan, Nepal
Email: [email protected]

Peer reviewed under authority of IJASBT

© 2017 International Journal of Applied Sciences and Biotechnology

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B. Regmi and M.K. Shah (2017) Int. J. Appl. Sci. Biotechnol. Vol 5(4): 555-558
Radiography and ultrasonography could be performed to The ascetic fluid was drained aseptically for the immediate
determine the nature of abdominal fluid effusion. relief from dyspnea and discomfort (Fig. 3). The alamin
(albumin) and Normal saline (NS) was concurrently
A diagnostic evaluation of an animal presented with ascites
administered for 3 consecutive days to prevent the
may include a complete blood count (CBC), biochemical
hypervolemia and hypoalbuminemia.
evaluation, abdominal paracentesis and biochemical and
cytologic analyses of the fluid obtained, radiographs, biopsy
and organ function tests (Peden & Zenoble, 1982; Satish
Kumar & Srikala, 2014). In this case study, we used
hematological and serum biochemical report along with
clinical signs as diagnostic tools of ascites. Ascites fluid
analysis and SAAG were used to confirm the origin of
ascites.

Case History & Observation

A German shepherd dog of eleven months was brought to
Fig. 3: Draining of ascetic fluid
the HART Clinic as outdoor patient for the clinical
treatment. Its weight was 18 kg. The dog showed the Result
symptoms of swollen abdomen, discomfort, dyspnea, The fecal examination showed negative result.
anorexia since 5 days. There was a symmetrical Neutrophilia, hypohemoglobinemia, hypoglycemia and
enlargement of abdomen assuming a pear shape elevated level of liver enzymes were found on the hemato-
appearance, mucous membranes were pale in color and biochemical examination (Table 1; Table 2). Similarly, the
tachycardia was evident. On taping the abdomen there was ascetic fluid analysis (Table 3) revealed that the fluid was
undulating movements (Thrills) of the fluid (Fig. 1). The slightly reddish, watery, transudate with PMN=42cells/mm3
temperature was 102.4oF. <250 cells/mm3 and SAAG = 31.6 = 1.4>1.1gm/dl.

Table 1: Hematological Report

Hematology Units Reports Normal Range
WBC 103/mm3 11.5 6.0-17.0
RBC 106/mm3 5.3 5.5-8.5
Hb g/dl 9.6 12.0-18.0
PCV % 36 37.0-55.0
Neutrophils % 85 60-77
Lymphocytes % 23 12-30
Eosinophils % 1 2-10
Basophils % 0 0-1
Monocytes % 1 3-10
Fig. 1: General clinical examination Abbreviations: WBC, White Blood Corpuscles; RBC- Red Blood
Corpuscles; PCV, Pack Cell Volume; Hb, Hemoglobin
Materials and Methods
Table 2: Biochemical Report
Fecal sample was collected per rectum and examined to
Biochemistry Units Report Normal Range
reveal out the severity of endoparasitic infestation. The Blood Glucose mg/dl 55 60-125
blood was taken from radial vein for the hematological and Liver Function Test:
sero-biological analyses. Abdominal paracentesis was Total Protein g/dl 4.8 5.1-7.8
performed to obtain the fluid for the biochemical and Albumin g/dl 2.2 2.6-4.3
Globulin g/dl 2.6 2.3-4.5
cytological analyses (Fig. 2). A:G ratio 0.8 0.75-1.9
Total Bilirubin mg/dl 0.8 0-0.4
Direct Bilirubin mg/dl 0.3 0.0-0.1
Indirect Bilirubin mg/dl 0.5 0-0.3
SGOT/AST IU/L 62 5-55
SGPT/ALT IU/L 128 5-60
Alkaline Phosphatase IU/L 810 10-150
Renal Function test:
BUN mg/dl 24 7-27
Creatinine mg/dl 0.7 0.4-1.8
Table: Serum Biochemical Analysis of Ascitic Dog (Reference Range:
from Hitachi Chemistry Analyzer model 747 IDEXX Veterinary services);
Abbreviations: A: G, Albumin: Globulin; SGOT/AST, Serum Glutamic
Oxaloacetic Transaminase or Aspartate Aminotransferase; SGPT/AST,
Serum Glutamic Pyruvic Transaminase or Alanine Aminotransferase;
Fig. 2: Abdominocentesis BUN, Blood Urea Nitrogen

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B. Regmi and M.K. Shah (2017) Int. J. Appl. Sci. Biotechnol. Vol 5(4): 555-558
Table 3: Ascitic Fluid Examination Report 1968). Normal concentrations of BUN and creatinine
Parameters Results indicate normal function of kidney. The hypoglycemia is
Color Watery (slightly reddish) the indicative of hepatic insufficiency (Pradhan et al., 2008;
Kumar et al., 2016). Hematological study revealed slight
Volume 1.5 ml decrease in Hb concentration and increase in neutrophills
Appearance Clear which is similar to the report of Pradhan et al. (2008).
TLC 42 cells/mm3 Similarly, analysis of the ascetic fluid showed that the fluid
was transudate and there was no bacterial infection as PMN
Neutrophils 55%
<250 cells/mm3 (Koulaouzidis et al., 2007). SAAG can be
Lymphocytes 45% used as a screening test in ascetic due to chronic liver
Sugar 79 mg/dl disease (Satish Kumar & Srikala, 2014; Bhadesiya et al.,
2015). SAAG= 3-1.6=1.4>1.1gm/dl indicates high gradient
Protein 2.1 gm/dl
ascites which is due to portal hypertension (96% accuracy)
Albumin 0.8gm/dl and the portal hypertension may be due to Liver cirrhosis
Globulin 1.3 gm/dl (Beg et al., 2001). Similarly, another research by Uddin et
Abbreviation: TLC, Total Leukocyte Count
al. (2013) found SAAG 97% accurate in identifying the
cause of ascites .
Differential Diagnosis
Spontaneous Bacterial Peritonitis (SBP): fever, abdominal Acknowledgements
pain, abdominal tenderness ,polymorphonuclear leucocyte We wish to express our sincere thanks to all the staffs of
(PMNL) count >250 cells/mm3 (Koulaouzidis et al., 2007) HART who assisted very much during the patient handling,
Liver Cirrhosis: portal hypertension, ascites, elevation of nursing and treatment.
liver enzymes, SAAG >1.1gm/dl
Portal Hypertension: ascites, portal vein thrombosis, Conflict of Interest
Schistosomiasis (Beker & Valencia-Parparcén, 1968) The authors declare that there is no conflict of interest.
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