Timber is 1 year old Min. Schnauzer. He has had diarrhea since the owner has had him (~4-6 months)
Presented today ADR, not eating and a fever of 104.5
Labs of Note: Glucose low @ 61 BUN low @ 4 TP low @ 3.3 (glob 1.9 & alb 1.4) Cholesterol low @ <6 ALT high @ 182 WBC high @ 24,500 w/ neutrophilia Urine: SG of 1.018 and no protein on dipstick.
Timber is 1 year old Min. Schnauzer. He has had diarrhea since the owner has had him (~4-6 months)
Presented today ADR, not eating and a fever of 104.5
Labs of Note: Glucose low @ 61 BUN low @ 4 TP low @ 3.3 (glob 1.9 & alb 1.4) Cholesterol low @ <6 ALT high @ 182 WBC high @ 24,500 w/ neutrophilia Urine: SG of 1.018 and no protein on dipstick.
My U/S interpretation: Jenjunal and Duodenal walls are thickened and if I squint really hard maybe the mucosa is stipled a little bit. There is a mild-moderate ascites present. The pancreas looks enlarged and hyperechoic but I’m assuming this is secondary to edema vs actual disease. The liver subjectively seems small and appears hypoechoic.
I’m leaning towards IBD/PLE with this dog, but the liver bugs me with the microhepatica, and I suppose EPI is a possibility…Most of the lab abnormalities with the exception of the low globulin could swing with either the liver of the gut, so I’m tossing this out there for an opinion.
I’ve not talked to the owner yet regarding more testing (TLI, bile acids etc)
Comments
Here’s a couple more SI shots
Here’s a couple more SI shots
Given the complexity this is
Given the complexity this is more of a telemedicine case as opposed to the forum which is mainly for a 1-2 organ presentation so I would say this is about as complicated a case we would want on the forum wiht unlimited additional threads of conversation on a subject.
But regardless I dont like the pyloric wall or the pancreas here. Given that there is no proteinuria then the albumin has to be GI because the liver, though a touch small, in nsf. Not all PLE cases show mucosal striations readily and if you adjust your linear settings they may jump out bette here. There is ill defined fat around the pancreas and undulating contour. Passive congestion typically does uniform swelling so I would 25g fna the pancreas and look for inflammatory cell type and tx ple/pancreatitis and recheck and watch that pyloric wall so its not turning into a GI LSA which can do PLE as paraneoplastic entity.
Thanks,
I was going to talk
Thanks,
I was going to talk to the ower about a telemedicine consult today, so maybe I’ll be able to send it in
If you get a moment, could you highlight the pyloric wall changes you’re seeing…I didn’t note anything when I scanned so I’d like to learn from what I missed.
Thanks,
Sure here you go
from
Sure here you go
from the first video… may just be hypertrophy but early lsa looks like this too.
With breed, age,
With breed, age, hypoglycemia, low BUN and SG, neutrophilia, and microphepatica liver disease (shunt, fibrosis, primary portal vein hypoplasia) is highly liklely. EPI possile but not the right breed.
Consider checking for
Consider checking for atypical additions.
Could the pyloric wall be thickened secondary to edema with the albumin being so low