Hi all,
I have seen some dogs under phenobarb medication, that present hepatomegaly with a diffuse hyperechoic liver on ultrasound scanning, Including the common differentials for this kind of change, what is everyone’s experience? Is it common to find this findings on dogs under this medication? Thanks for any help.
Veronica
Hi all,
I have seen some dogs under phenobarb medication, that present hepatomegaly with a diffuse hyperechoic liver on ultrasound scanning, Including the common differentials for this kind of change, what is everyone’s experience? Is it common to find this findings on dogs under this medication? Thanks for any help.
Veronica
Comments
These are usually vacuolar
These are usually vacuolar hepatopathy changes as long as the capsule is uniform and the nodules are like “paint on the wall”…i.e.changes in echogenicity but the linear infrastructure is in tact. I surely put a needle in it if the infrastructure is disturbed but not very concerned if the changes in echogenicity do not involve structure. vac hep livers are slow congestion livers and gradually drive an alk phos and a little alt but don’t typically cause clinical issues. Cushings, thyroid, breed, phenobarb and 80 other issues can cause it. FNA to confirm. Try doing a pathology search on “vacuolar hepatopathy” and you will see what i mean. Then search “hepatocellular carcinoma” and “hepatic lymphoma” and you will see the differences in the clinical and sonogrpahic presentation.
http://www.sonopath.com/backroom/Secure/Search/SearchMain.aspx
These are usually vacuolar
These are usually vacuolar hepatopathy changes as long as the capsule is uniform and the nodules are like “paint on the wall”…i.e.changes in echogenicity but the linear infrastructure is in tact. I surely put a needle in it if the infrastructure is disturbed but not very concerned if the changes in echogenicity do not involve structure. vac hep livers are slow congestion livers and gradually drive an alk phos and a little alt but don’t typically cause clinical issues. Cushings, thyroid, breed, phenobarb and 80 other issues can cause it. FNA to confirm. Try doing a pathology search on “vacuolar hepatopathy” and you will see what i mean. Then search “hepatocellular carcinoma” and “hepatic lymphoma” and you will see the differences in the clinical and sonogrpahic presentation.
http://www.sonopath.com/backroom/Secure/Search/SearchMain.aspx
These are usually vacuolar
These are usually vacuolar hepatopathy changes as long as the capsule is uniform and the nodules are like “paint on the wall”…i.e.changes in echogenicity but the linear infrastructure is in tact. I surely put a needle in it if the infrastructure is disturbed but not very concerned if the changes in echogenicity do not involve structure. vac hep livers are slow congestion livers and gradually drive an alk phos and a little alt but don’t typically cause clinical issues. Cushings, thyroid, breed, phenobarb and 80 other issues can cause it. FNA to confirm. Try doing a pathology search on “vacuolar hepatopathy” and you will see what i mean. Then search “hepatocellular carcinoma” and “hepatic lymphoma” and you will see the differences in the clinical and sonographic presentation.
http://www.sonopath.com/case-studies/search
These are usually vacuolar
These are usually vacuolar hepatopathy changes as long as the capsule is uniform and the nodules are like “paint on the wall”…i.e.changes in echogenicity but the linear infrastructure is in tact. I surely put a needle in it if the infrastructure is disturbed but not very concerned if the changes in echogenicity do not involve structure. vac hep livers are slow congestion livers and gradually drive an alk phos and a little alt but don’t typically cause clinical issues. Cushings, thyroid, breed, phenobarb and 80 other issues can cause it. FNA to confirm. Try doing a pathology search on “vacuolar hepatopathy” and you will see what i mean. Then search “hepatocellular carcinoma” and “hepatic lymphoma” and you will see the differences in the clinical and sonographic presentation.
http://www.sonopath.com/case-studies/search
I agree with doing a FNA to
I agree with doing a FNA to confirm the vacuolar hepatopathy. Can also look at ALT/ALP/AST activity and if ALT/ALP is elevated with normal AST then dealing with phenobarbitone induction. However, if AST is elevated then look for other causes as AST is not induced by phenobarbitone.
I agree with doing a FNA to
I agree with doing a FNA to confirm the vacuolar hepatopathy. Can also look at ALT/ALP/AST activity and if ALT/ALP is elevated with normal AST then dealing with phenobarbitone induction. However, if AST is elevated then look for other causes as AST is not induced by phenobarbitone.
Great point Remo on the
Great point Remo on the AST.
Some antidoctal comments: On these low grade ALT livers that arent showing much sonographically I have pout them on metronidazole for 10 days and changed to a hypoallergenic diet over 8 weeks and often the alt elevations just go away…. Working on the antigen surveillance phenomenon from occult oibd/triad disease uptake through the portal system.
Anyone else ever tried this?
Many won’t bx and diet change is cheap and easy.
Great point Remo on the
Great point Remo on the AST.
Some antidoctal comments: On these low grade ALT livers that arent showing much sonographically I have pout them on metronidazole for 10 days and changed to a hypoallergenic diet over 8 weeks and often the alt elevations just go away…. Working on the antigen surveillance phenomenon from occult oibd/triad disease uptake through the portal system.
Anyone else ever tried this?
Many won’t bx and diet change is cheap and easy.
Thanks all for the comments,
Thanks all for the comments, I have done FNA on this cases and they always come back as vacuolar hepatopathy, I am still have to find out what the lab said about the last one I did some days ago.
Good point in regards tothe AST!
I have no experience on the metronidazole and diet trial but I should give it a go next time!
Thanks again.
Thanks all for the comments,
Thanks all for the comments, I have done FNA on this cases and they always come back as vacuolar hepatopathy, I am still have to find out what the lab said about the last one I did some days ago.
Good point in regards tothe AST!
I have no experience on the metronidazole and diet trial but I should give it a go next time!
Thanks again.