Bella – 9 yr FS Chihuahua, diarrhea for 6+ weeks, often dark, occasionally w/ frank blood.  Ocult blood test not performed.  No parasites.  Blood work 1 mo ago WNL.  Weight loss, hypo to anorexia.  Effusion analyzed – pink, cloudy, protein 3.9, nucleated cells 4470, cytology = 85% neutrophils, 10% lymphs, 5% macros.  Diffuse purple proteinaceous background, no neoplastic cells, no infectious cells. UA – no proteniuria.  

Bella – 9 yr FS Chihuahua, diarrhea for 6+ weeks, often dark, occasionally w/ frank blood.  Ocult blood test not performed.  No parasites.  Blood work 1 mo ago WNL.  Weight loss, hypo to anorexia.  Effusion analyzed – pink, cloudy, protein 3.9, nucleated cells 4470, cytology = 85% neutrophils, 10% lymphs, 5% macros.  Diffuse purple proteinaceous background, no neoplastic cells, no infectious cells. UA – no proteniuria.  

Ultrasound – liver hyperechoic, did not appreciate any shunts or portal hypertension; anechoic effusion all 4 quadrants not closely associated  w/ pancreas; pancreas  – both limbs thickened w/ hyperechoic mesentary; small bowel – some corrugation intermittently and some loops of jejunum thickened muscularis; stomach – poor detail to layering; mesenteric lymph nodes enlarged.

Owner is to have blood work repeated.  If albumin normal, inclined to tell her to have explore performed w/ bxs instead of trying further ultrasound aspirates.  I was trying to R/O lymphoma.  Now wondering about non-exfoliating tumors.  Effusion seems to severe for IBD and if albumin still normal, would not make sense.  Possible acute on chronic pancreatitis? But patient was not that uncomfortable for ultrasound and, again, the effusion was more widespread than I would expect.  Thoughts?