Case Study

03_00237 Sophie L Cirrhosis

A 12-year-old SF Labrador retriever cross was presented with a history of decreased appetite, distended abdomen and occasional vomiting. The only significant abnormality on physical examination was ascites. Moderately elevated liver enzyme activity was present on laboratory testing. Approximately 2 liters of fluid were drained from the abdomen, which was quantified as a transudate.

A 12-year-old SF Labrador retriever cross was presented with a history of decreased appetite, distended abdomen and occasional vomiting. The only significant abnormality on physical examination was ascites. Moderately elevated liver enzyme activity was present on laboratory testing. Approximately 2 liters of fluid were drained from the abdomen, which was quantified as a transudate.

DX

Cirrhosis

Sonographic Differential Diagnosis

Hepatic cirrhosis with probable portal hypertension. Long term prognosis is very poor in this patient. Ultrasound-guided biopsy of the liver could be performed to confirm cirrhosis as opposed to neoplasia. However, the pattern and global abdominal presentation is most consistent with hepatic cirrhosis and secondary portal hypertension with ascites and splenic congestion as a result. Portal vein velocities could be performed with spectral Doppler in order to confirm presence of portal hypertension in which the forward flow velocity of the portal vein would be less than 15 cm/sec.

Image Interpretation

The liver in this patient was significantly heterogenous with micro and macronodular changes and irregular contour. No overt masses were noted. These changes were most consistent with hepatic cirrhosis. There was a minor amount of excessive debris in the gallbladder. This is not clinically significant. The region of the common bile duct was unremarkable.

Outcome

Additional lab work ALKP 1136, ALT 384, urine specific gravity 1.017, there was a trace amount of protein, large clumps of WBC, and 2+ cocci. No biopsies were performed.