A foreign body and suspected crystals in Denver the Dalmatian – A case study from a veterinary nurse’s perspective.

Patient Details     

Name: Denver

Signalment: 5 years old, MN Dalmatian

Weight: 29 kg

Body Score Condition: 4/9 (ideal)

Body Fat Index: 20% 

Patient’s History:

Denver was presented to the clinic for sudden onset vomiting, which had started at 9am in the morning. No diarrhoea has been seen, although has passed small amount of soft faeces this morning.

Bright and happy this morning, ate breakfast and then started vomiting at 9am and has now become significantly flatter and is no longer interested in food.

No history of eating foreign objects and owner sure nothing was missing which he could have eaten. The owner’s partner had been at home with Denver for the past 3 days and can confirm he didn’t see him eating anything unusual.

Diet: Denver is currently been fed Hill’s Science Diet Advanced Fitness, which he has been fed for the last 2 years. There have been no recent changes in diet and no extra food been fed within the last 5 days.

Vaccination and Worming: Current

Patient’s History:

Denver was presented to the clinic for sudden onset vomiting, which had started at 9am in the morning. No diarrhoea has been seen, although has passed small amount of soft faeces this morning.

Bright and happy this morning, ate breakfast and then started vomiting at 9am has now become significantly flatter and is no longer interested in food.

No history of eating foreign objects and owner sure nothing was missing which he could have eaten. The owner’s partner had been at home with Denver for the past 3 days and can confirm he didn’t see him eating anything unusual.

Diet: Denver is currently been fed Hill’s Science Diet Advanced Fitness, which he has been fed for the last 2 years. There have been no recent changes in diet and no extra food been fed within the last 5 days.

Vaccination and Worming: Current

Attending vet’s assessment:

Anaesthesia and Surgery

Following confirmation of foreign body, the owner was advised and consented to an exploratory laparotomy to remove the foreign body and to collect a urine sample for testing and a bladder flush to remove suspected crystals while Denver was anaesthetised.

I then drew up the following medications for the surgical procedure:

  • Premedication – Acepromazine = 0.29ml (0.02mg x 29 ÷ 2 = 0.29ml) – Methadone = 1.45ml (0.5mg x29 ÷ 10 = 1.45ml)
  • Induction agent – Alfaxan (alfaxalone) = 2.9ml (1mg x 29 ÷ 10 = 2.9ml)
  • Perioperative Antibiotics – Cephazolin 3.1ml x 4 (22mg x 29 ÷ 200 = 3.1ml) Q2 hrs from first administration (x2 IV x2 Subcutaneous)

Denver was then administered the premedication intravenously and monitored until it had sufficient time to take effect, anaesthesia was then induced using 2.9ml of Alfaxan. Denver was then intubated using a 10.0mm endotracheal tube. 3.1mL of Cephazolin was administered slow IV. 

I then prepped Denver for the surgical procedure large margins where clipped and the skin was vacuumed to remove lose hair. The skin was then prepped first using chlorhexidine scrub and cotton wool working from the incision site outwards. The second skin preparation was performed using alcohol-soaked swabs to remove any residue, each swab use for a single wipe working from the incision site outwards. The final step was performed using a chlorhexidine and alcohol spray solution and the whole area was sprayed and allowed to dry.

Denver was then moved to theatre and again resprayed using a chlorhexidine and alcohol spray and was draped for the procedure. Denver was connected to an anaesthetic machine and his anaesthetic was maintained using fresh oxygen and isoflurane, he was connected to an ECG and the following monitored throughout the procedure heart rate, respiratory rate, end tidal CO2, SPO2, Blood pressure and temperature.

A large ventral midline incision was made from bottom of the ribs to past the prepuce, a gastrotomy was then was performed to remove a large foreign body within the stomach and then approximately 10cm of the small intestine was resected where it has begun to perforate and to remove the foreign body. The abdomen and skin were closed routinely and Denver moved from theatre.

Once out of theatre a urinary catheter was passed, and his bladder drained using a 50ml syringe, Once the bladder was drained a sample was placed into a sterile urine pot for analysis and 500ml of 0.9% saline was then put into his bladder and again removed to flush the bladder out and remove any sediment.

Once this was completed Denver was placed into a cage along with a Bair HuggerTM to recover. Denver was closely monitored until he was swallowing, his temperature was then monitored every 30 minutes until it reached 37.5 degrees Celsius when the Bair HuggerTM was removed.

On recovery Metoclopramide was infused into a 1 Litre bag of Hartmanns and fluid therapy recommenced at twice maintenance.

I then washed and inspected the foreign body removed from the stomach it was approximately 10cm in length with a width of approximately 2.5cm at the widest part on washing the foreign body it was discovered to be approximately 75% human hair tightly bound around small pieces of toy, a hair tie and other unknown fabric. 

Denver recovered well from the surgical procedure and was to remain hospitalised for the next 24 hours for fluids and test feeding.

Denver was started on the following medications:

  • Omperazole 20mg 1 & 1/2 tablets orally once daily 
  • Amoxyclav 500mg orally twice daily
  • Maropitant (3ml) if required for nausea – SID for 3 days following surgery.

The following morning Denver was still quite although much brighter and happier a TPR was performed and no abnormalities where noted. Denver was then offered a small amount of boiled chicken breast and canned Hill’s Prescription Diet i/d™ Canine canned which he ate and kept down.

On walking outside Denver regurgitated a small amount of fluid so was administered 3ml of maropitant intravenously to stop nausea. Fluids where continued at maintenance and Omperazole and Amoxyclav administered as above.

Denver was offered small amounts of Hill’s i/d canned every 4 hours and ate well at each time.

The following morning Denver was discharged and recovered well from the surgery.

Discharge Instructions:

Denver was sent home with Hill’s i/d, which is designed to support gastrointestinal health and is highly digestible. Hill’s i/d canned was recommended as it would provide Denver with additional water which may promote more dilute urine. To reduce cost I added i/d dry kibble after a week.

Although Denver needs to be fed Hill’s Prescription Diet u/d long term, I did not recommended transitioning to the food until he had fully recovered from his procedure as Hill’s u/d is a low protein diet and may hinder the healing process.

Denver’s Feeding Plan

Follow up

Denver recovered well from the surgical procedure and no further complications occurred. Denver was been seen for his two-week re-check following the procedure and doing well and sutures removed.  At this recheck the owners collected a bag of Hill’s Prescription Diet u/d dry to commence transitioning.

Denver’s owners were advised to feed once Hill’s u/d has been commenced the owners will come back for a recheck 8 weeks later to perform a follow up urinalysis to check for urate crystals and urine specific gravity.

At this time, it will be determined whether any further changes to his diet or water supplementation is required. It has also been recommended to perform an abdominal ultrasound in 6 months to check the bladder for uroliths, sediment and crystals.

Gemma Edwards, VN

Gemma is a qualified veterinary nurse and gained her Certificate of Veterinary Nursing in 2018 from TAFE NSW. She currently works at Northern Suburbs Veterinary Hospital, in Victoria.
Gemma is passionate about providing knowledge to clients to help them make informed choices on the best nutrition for their pet. She is a current participant in the Hill’s Nutritional Nurse Consultation Course that supports nurses to perform nutritional consultations, recommendations, claculate accurate feeding plans, educate and support owners in overcoming feeding issues while saving the veterinarian’s time.


Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.