a 5 yr old Yorkie was referred to me by a local colleague with signs of panting, listlessness, hyporexia, lethargy and painful? abdomen; At my exam, the dog didn’t show any of these signs though. The referring DVM put the dog on zenequin, cerenia, and doxycycline for about two weeks prior to referral. X-Rays had also showed enlarged liver at regular vet. Blood work 2 weeks before referral (Chem & CBC) showed ALP 611, and ALT 160 & all else WNL, and the lepto titers were normal.
a 5 yr old Yorkie was referred to me by a local colleague with signs of panting, listlessness, hyporexia, lethargy and painful? abdomen; At my exam, the dog didn’t show any of these signs though. The referring DVM put the dog on zenequin, cerenia, and doxycycline for about two weeks prior to referral. X-Rays had also showed enlarged liver at regular vet. Blood work 2 weeks before referral (Chem & CBC) showed ALP 611, and ALT 160 & all else WNL, and the lepto titers were normal.
I performed an ABD US: mildly hypoechoic liver, GB – mild sludge, edematous mesenteric LNs in mid Abdomen, Adrenal glands – WNL, but in pancreatic region, there was an odd-shaped “tissue” with mild echogenicity, which I wasn’t sure what. The dog went back to the regular vet and had UCC/LDDS done to rule out any evidence of HAC. The results were negative. That was 3 months ago!
Meantime, the regular vet did another set of blood chemistry, which showed still high ALP (575) and ALT (157). the O wanted to have any priamry liver ruled out. So the dog came back to me for recheck and possibly liver biopsy. I told the O thel iver test can be inconclusive based on only mild ALT elevation. I briefly told the O the possibility of atypical form of HAC requiring a special steroid profile at Univ. of Tennesse! Among a few recommendations I presented (Laparoscopic or Surgical biopsy of liver, pancreas and mesenteric LNs), the O elected FNA of the Liver (resluts pending), which was done 2 days ago.
Long story short, I would like to have some imput from the community in regards to overall approaches to this case we (referring vet and I) have taken and US images I uploaded. My questions lie in two areas, the 1st – what it could be in pancreatic region? the 2nd – supposing that the liver is disease free and there is no bone disease, what could be the reason for persistently high ALp and ALT? I would appreciate any input! Thanks, btw, this is my first time putting up a case.
If you need more info -please let me know i tried to be as short and to the point as possible….
Comments
Unfortunately your images did
Unfortunately your images did not load. Often you get this level of enzyme increase with non-specific liver disease such as vacuolar hepatopathy, reactive hepathopathy, mild hepatocellular injury, metabolic disease, regional abdominal disease. As the liver enzymes are remaining static etiologies, to look for is dental disease, medications, GI disease, low-grade gall bladder disease, chronic pancreatitis, dyslipidemias, hypothyroidism. Cushing’s disease is still on the radar and if all else is negative good idea to run the steroid panel. FNA cytology may not be diagnostic so a Tru-cut liver biopsy may be necessary.
From your case description and US findings also considering running a cPL.
Thank you very much for your
Thank you very much for your comment! I’ll upload a few images tomorrow am!
Yes looking forwrad to the
Yes looking forwrad to the images and please try to keep things to bullet point format tight and concise so we can get throughthem rapidly… here’s a conversion of your post in bullet format for example:
—a 5 yr old Yorkie panting, listlessness, hyporexia, lethargy and painful? abdomen reported not confimred by me;
—Tx zenequin, cerenia, and doxycycline for about two weeks prior to referral. X-Rays showed enlarged liver at regular vet. Blood work 2 weeks before referral (Chem & CBC) showed ALP 611, and ALT 160 & all else WNL, lepto normal.
—ABD US: mildly hypoechoic liver, GB – mild sludge, edematous mesenteric LNs in mid Abdomen, Adrenal glands – WNL, but in pancreatic region, there was an odd-shaped “tissue” with mild echogenicity?? The dog went back to the regular vet and had UCC/LDDS negative. That was 3 months ago!
—another set of blood chemistry, which showed still high ALP (575) and ALT (157). US recheck and possibly liver biopsy. I told the O thel iver test can be inconclusive based on only mild ALT elevation. I briefly told the O the possibility of atypical form of HAC requiring a special steroid profile at Univ. of Tennesse! O elected FNA of the Liver (resluts pending),
–My questions lie in two areas, the 1st – what it could be in pancreatic region? the 2nd – supposing that the liver is disease free and there is no bone disease, what could be the reason for persistently high ALp and ALT?
Thanks, btw, this is my first case.
Got it! uploaded several
Got it! uploaded several images! Thanks!
First image looks like a
First image looks like a reactive LN, The liver/stomach image is nsf structurally…. assuming the rest of the liver is similar this is likely a benign hepatiopathy… bx may be overkill here maybe an fna to define inflammatory cell type re the ALT and confirm benign hepatopathy as im not seeing much in the structural change department to consider Bx. SAP driving up gradually in dogs is opften breed predisposed, age related, endocrinopathy related, sometimes liver masses…. when driving up fast i get concerned. SAP is ALWAYS important in cats because the 1/2 life is 12 hours while its 72 hours in dogs. ALT and AST mean inflammation and cell damage so a little elevation may be fine or reactive hepatopathy but persistent elevations (I use the > 200 rule) are to be defined with sampling… heres a post I did a while back on defining liver enzymes that may be of interest:
https://sonopath.com/forum/evaluating-benign-liver-coarse-liver-lumped-liver-grandma-liver-enzyme-chase-what-do-they-have
Regarding scanning technique you may benefit from our 17 point abdomen download to ensure you are gettign the complete views and proper depth:
https://sonopath.com/products/downloadable
Thank you for your thoughts!
Thank you for your thoughts! Just got FNA results – hepatic lipidosis (mild), no inflammatory or neoplastic cells found! Also thanks for the links! Will keep you posted!