-gradual weight loss over 18 months ( from 16 # in April, 2014 to 13 # 2 oz in April, 2016)
-history of drooling, PU/PD, but now only PU
-dental disease (periodontitis + tooth resorption) – postponed dental procedure due to high ALT for now
-on most recent recheck (4/4/16), no outward evidence of sickness other than PU per O
-ABD US done on 2/23/16
-ALT progression; : 135 (1/15/16) –> 220 (2/23/16) –> 290 (4/4/16)
-told O we may need FNA of the liver to further define the disease and possibly reason why the weight loss
-gradual weight loss over 18 months ( from 16 # in April, 2014 to 13 # 2 oz in April, 2016)
-history of drooling, PU/PD, but now only PU
-dental disease (periodontitis + tooth resorption) – postponed dental procedure due to high ALT for now
-on most recent recheck (4/4/16), no outward evidence of sickness other than PU per O
-ABD US done on 2/23/16
-ALT progression; : 135 (1/15/16) –> 220 (2/23/16) –> 290 (4/4/16)
-told O we may need FNA of the liver to further define the disease and possibly reason why the weight loss
-no Total bilirubin or ALP increase and renal values are WNL, T4 level has been normal etc
Any input as to what might be happpening and what kind of US diagnoses can be made would be appreciated!
Comments
The liver is coarse
The liver is coarse consistent with chronic inflammatory hepatopathy/cholangitis. The arrows point to the cystic duct which gets tortuous in older cats and especially cholangitis cats. The cbd is < 0.4 cm so not obstructed and not surgical. I would core bx for structure or fna for predominant inflammatory cell type… these are usually LP inflammatory states given the low grade chronic LE burn but fna to confirm this. Core bx would be needed to rule out conversion to lymphoma as the lymphocyte behavior in relationship to the portal triads is important for the dx here that you wont get of course in fna alone that just gives cells.
Your first video looks like it has heptic LN enlargement with some distortion so may have some conversion there to LSA. Sx bx of liver and LN would be even better and likely a shopping spree of bx panc and GI.
maldigestion panel helpful too… bottom line need histopath to prove chronic triad disease cholangitis and secondary wt loss vs emerging LSA. LSA usually drives some level of SAP (congestion) and a little ALT (Leakage) but this is just a tendency and not an absolute.
Thank you very much for your
Thank you very much for your input! I uploaeded a few still images and an additional video but I see only one still image! I will probalby go with surgical biopsies.
Hi, Dr EL, I uploaded an
Hi, Dr EL, I uploaded an image of pancreas after realizing none of my still images were not uploaded! I just wonder if the LNs you saw in my first video could be lesions in the pancreas or separate/different disease in the region! I would appreciate your opinion!
Im pretty sure those are
Im pretty sure those are nodes hugging the hepatic vein and superimposes the right panc base. These are still egg shaped and encapsulated and hug the vein., Panc doesnt do that
Great to know! Thank you!!
Great to know! Thank you!!