Tucker, an 11-year-old male German shepherd dog, is hospitalized for vomiting and collapse. For the past 6 months, he has received meloxicam treatment for arthritis. Physical examination reveals a painful abdomen, elevated heart rate of 195 bpm (normal, 70-120 bpm), and respiratory rate of 42 breaths/min (normal, 18-34 breaths/min), with fair pulses and injected mucous membranes, a rapid capillary refill time, and a rectal temperature of 103.2°F (39.6°C; normal, 102°F ± 1°F [38.9°C]). Systolic blood pressure is 75 mm Hg (normal systolic, 110-160 mm Hg). Serum chemistry profile results indicate moderate hypoglycemia (blood glucose, 60 mg/dL; normal, 70-143 mg/dL), and CBC results show a neutrophil count of 23 × 103/µL (normal, 5.05-16.76 × 103/µL) with 10% bands (normal, 0%-3%) and hematocrit of 26% (normal, 37.3%-61.7%). Abdominal ultrasonography confirms free abdominal fluid, which is sampled by fine-needle aspiration. The glucose concentration in the abdominal fluid is 32 mg/dL; total solids are 4.2 g/dL. Cytology of the aspirate shows marked neutrophilic inflammation; many of the neutrophils are degenerate, with occasional neutrophils containing intracellular bacilli. There is no evidence of masses or a foreign body. Based on patient history and presence of septic peritonitis, the dog is prepared for abdominal surgery to confirm a suspected perforated gastric or duodenal ulcer secondary to NSAID treatment.
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