DSH, 11 years old with no clinical signs presented for dental. Preanesthetic bloodwork showed an increase in ALKP(2x) and ALT (2X). Repeat liver pannel in 30 days demonstrate an increase in previous liver enzymes ( ALKP 280, ALT 450 and TBil 18umol/L). She is not icteric yet. The only abnormalities on US was a distended GB with mild thickening of the GB wall.
DSH, 11 years old with no clinical signs presented for dental. Preanesthetic bloodwork showed an increase in ALKP(2x) and ALT (2X). Repeat liver pannel in 30 days demonstrate an increase in previous liver enzymes ( ALKP 280, ALT 450 and TBil 18umol/L). She is not icteric yet. The only abnormalities on US was a distended GB with mild thickening of the GB wall.
A presumptive dg of Cholangiohepatitis was made and she was put on AB: Metronidazole and Amoxyl+ Clavulanic acid for 10 days. Again she is completelly asymptomatic, eating, drinking, acting normal. After the AB trial herliver enzymes are even higher then before.
I’m strongly suspected Cholangiohepatitis autoimmune versus Lymphoma small cell.
My question: Would you consider FNA first ( 25 g) or would you go directly for a core biopsy of the liver?
Thank you
Comments
FNA is less invasive but may
FNA is less invasive but may not give the diagnosis especially with small cell lymphoma vs lymphocytic hepatitis; however, always worth it. If non-diagnostic then Tru-Cut is needed. I assume that hyperthryroidism has been ruled out. Another reason for the progressive elevation in liver enzyme activity is that clavulanic acid may be hepato-toxic – reported in people.
Hyperthiroidism has benn
Hyperthiroidism has benn ruled out. The liver enzymes were elevated before the antibiotic trial. We end up doing an FNA. Will see. Thank you
FNA is less invasive but may
FNA is less invasive but may not give the diagnosis especially with small cell lymphoma vs lymphocytic hepatitis; however, always worth it. If non-diagnostic then Tru-Cut is needed. I assume that hyperthryroidism has been ruled out. Another reason for the progressive elevation in liver enzyme activity is that clavulanic acid may be hepato-toxic – reported in people.
Hyperthiroidism has benn
Hyperthiroidism has benn ruled out. The liver enzymes were elevated before the antibiotic trial. We end up doing an FNA. Will see. Thank you
How does the common bile duct
How does the common bile duct look? Biliary adenoca can do this.
CBD is normal but I did see a
CBD is normal but I did see a small cystic lesion that might be cystadenoma. It is focal and small so Iwas thinking that might be a different issue and not the reason for this marked elevation in liver enzymes….?
How does the common bile duct
How does the common bile duct look? Biliary adenoca can do this.
CBD is normal but I did see a
CBD is normal but I did see a small cystic lesion that might be cystadenoma. It is focal and small so Iwas thinking that might be a different issue and not the reason for this marked elevation in liver enzymes….?
I just did an advanced search
I just did an advanced search on the parameters for this patient and this is what came up:
http://sonopath.com/members/case-studies/advanced-search?si=&sono_diff=&sampling=&dx=&outcome=&species%5B%5D=feline&cs%5B%5D=12&bc%5B%5D=103&bc%5B%5D=105&bc%5B%5D=101
I think this was intended for
I think this was intended for the other post (Bilateral Hydronephrosis)
I just did an advanced search
I just did an advanced search on the parameters for this patient and this is what came up:
http://sonopath.com/members/case-studies/advanced-search?si=&sono_diff=&sampling=&dx=&outcome=&species%5B%5D=feline&cs%5B%5D=12&bc%5B%5D=103&bc%5B%5D=105&bc%5B%5D=101
I think this was intended for
I think this was intended for the other post (Bilateral Hydronephrosis)