After Hug, Severe Abdominal Pain in a 16-Year-Old Dog Owner

Elena Zafirova, MD; Milcho Panovski, MD, PhD


February 06, 2023

Physical Examination and Workup

Upon physical examination, the patient is in obvious discomfort. Her body temperature is 99.1°F (37.3°C), she has a blood pressure of 110/70 mm Hg, and her pulse is 110 beats/min. Her skin is pale and without jaundice, but she does have a diffuse urticarial rash that is most prominent on the trunk and proximal extremities. She appears well nourished and well developed.

Her chest has symmetrical movements during respiration, and clear breath sounds are noted on auscultation. Her heart sounds are normal, with a regular rhythm and no detectable murmurs. A firm mass overlying the liver edge in the right upper quadrant is noted on palpation. The entire upper abdomen is markedly tender and rigid, particularly in the right subcostal region.

Her laboratory testing is remarkable for leukocytosis, with a white blood cell (WBC) count of 18.6 × 103/µL (18.6 × 109/L; reference range, 4.5-11 × 103/µL) and 40% neutrophils (reference range, 40%-70%), 22% lymphocytes (reference range, 22%-44%), 8% monocytes (reference range, 4%-11%), and 21% eosinophils (reference range, 0%-8%). An elevated total bilirubin level of 1.98 mg/dL was also noted (reference range, 0.3-1.0 mg/dL). Her aspartate aminotransferase (AST) level is 101 U/L (reference range, 8-33 U/L) and her alanine aminotransferase (ALT) level is 104.7 U/L (reference range, 4-36 U/L). Her hematocrit and platelet counts are normal.

An upright radiograph of the abdomen shows a nonspecific bowel gas pattern and no findings of pneumoperitoneum. Ultrasonography is performed for a suspicion of possible gallbladder disease; it reveals a large hypoechogenic zone in the liver, with irregular margins and a small amount of free fluid around the liver. A CT scan of the abdomen is subsequently performed (Figures 1 and 2).

Figure 1.

Figure 2.


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