To approach this as I was taught in vet school, I would begin with a problem list based on my physical exam:
1) Vomiting
2) Depression
3) Severe dehydration
4) Icterus/jaundice
5) Hair loss
6) Painful abdomen
7) Pale gums
From there, I would formulate a differential list. Now, I was taught to formulate differentials for EVERY problem...but in the real world, that is rarely practical. The differentials for vomiting alone could take up 4 pages. So, I would approach this globally - look at all of my problems and then formulate a differential list.
So, my differentials for this patient based on his problems (not on his bloodwork yet):
1) Liver disease (jaundice!) - cancer would be #1, as he is 12 years old
2) Leptospirosis - a bacterial disease that can cause liver and kidney disease would be a very close #2...maybe tied for #1
3) Acute liver failure with severe dehydration and possible renal insufficiency
4) Hemolytic anemia - based on the presence of jaundice, dehydration, pale gums, and depression
5) Bile duct obstruction/rupture
6) Ingestion of toxin
7) Hypothyroidism/myxedma coma
Those were my major differentials for this case. Then I turned to my bloodwork...(to be cont'd)
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2 comments:
I'm guessing the key in the bloodwork is the significant left shift, as that indicates infection more than neoplasia. But do enlighten me, I'm curious how one goes from differentials to diagnosis...
And the outcome... was your treatment successful? What happened in the end or is it ongoing?
A left shift can indicate infection yes, but it can also indicate overwhelming inflammation...so it doesn't rule in or out neoplasia. I've posted more about the case below this post.
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