- 11 yo fn WHWT with ascites and weight loss, no GI signs but mild hypoalbuminaemia and hypoglobulinaemia
- Previous moderate to severe elevation of ALP>>ALT and pu/pd, ACTH stim grey zone
- 1.5 L fluid drained prior to me scanning, reported to be transudate on initial aspiration but sanguinous on drainage
- 11 yo fn WHWT with ascites and weight loss, no GI signs but mild hypoalbuminaemia and hypoglobulinaemia
- Previous moderate to severe elevation of ALP>>ALT and pu/pd, ACTH stim grey zone
- 1.5 L fluid drained prior to me scanning, reported to be transudate on initial aspiration but sanguinous on drainage
- I think the liver has slightly increased portal markings and a fine echotexture, the intestines are diffusely abnormal with muscularis hypertrophy, very mild lymphadenopathy. the spleen has areas of hyperechoigenicity, the adrenal glands were normal in size
- Protein levels not low enough to be causing ascites and heart fine.
- What do you think is causing the ascites…lymphoma and lymphatic obstruction? or potentially due to lymphoma or other disease of liver?
- What do you think of the spleen?
Comments
assuming transudate fluid :
assuming transudate fluid : If no proteinuria then PLE likely with possible emerging GI LSA. If albumin is < 1.5 then the ascites can be from poor oncotic pressure. If > 1.5 then hydrostatic issues are in play amnd no liver failure. In the latter consider lymphatic obstruction/lsa. Needs full thickness of the GI and/or cytospin on the fluid and check for lymphoma cells.
With the weight loss and
With the weight loss and hypoproteinemia GI disease would be a very important possiblity. Do not need GI signs to hav severe GI tract disease.
In your clips I didn’t see
In your clips I didn’t see the spleen. Ascites could be due to 1) decreased oncotic pressure, 2) increased hidrostatic pressure, 3)increased vascular permeability. You already discarted 1).
Regarding:
2): Heart ok, but did you check portal hypertension? Is the CVC enlarged(possible thrombus)? Some kind of lymphatic obstruction also seems plausible.
3) I think less plausible in this case
No pulmonary
No pulmonary hypertension.
This animal went for ex-lap and I was told liver looked abnormal and biopsies were taken of liver and small intestine. I suspect ascites was from portal hypertension. Albumin was only mildly decreased. I will post histo results when back.
Thanks for your help .
Also, the kidney córtex
Also, the kidney córtex seemed quite hyperechogenic to me. Any sign of renal lesion on the UA?
Histo:
Liver – Biliary
Histo:
Liver – Biliary hyperplasia and fibrosis, multifocal, marked, with hepatitis, portal, lymphocytic, plasmacytic and neutrophilic.
Jejunum – Enteritis, neutrophilic, multifocal, moderate.
Liver disease causing portal hypertension the main culprit I suspect.
Makes sense thanks for the
Makes sense thanks for the followup