Hello,

Nikki is a 12 years old papillon F/S that presented for anorexia for the last 3 days  and vomiting.She was  Icteric on presentation, She has heart murmur, she is on Pimobendan and Butorphanol for collapsing tracheea. Her heart condition is compensated

BW : severly increased all liver enzymes with ALT and ALKP at 5000. 

AUS : large distended GB, no muccocele, DPAP and CBD appear not to be obstructed . Liver is enlarged, there are 2 small hypoechoic nodules in the left liver lobe. 

Cytology of FNA liver is pending

Hello,

Nikki is a 12 years old papillon F/S that presented for anorexia for the last 3 days  and vomiting.She was  Icteric on presentation, She has heart murmur, she is on Pimobendan and Butorphanol for collapsing tracheea. Her heart condition is compensated

BW : severly increased all liver enzymes with ALT and ALKP at 5000. 

AUS : large distended GB, no muccocele, DPAP and CBD appear not to be obstructed . Liver is enlarged, there are 2 small hypoechoic nodules in the left liver lobe. 

Cytology of FNA liver is pending

Presumtive dg is Cholangiohepatitis/ Toxin. 

After 4 days of supportive treatment, Plasmalyte with Complex Vit b, Cerenia, hepatoprotectants, metronidazole 10 mg/kg, enrofloxacin 10 mg/kg , cefazolin 22 mg/kg, Zantac 1 mg/kg she appear to improve clinically, all her liver enzymes are decreasing except the ALKP and GGT which are going up. ALKP is 10000 !

My questions are :

1.if this is cholestasis, should I see distension of the CBD, and obvious intrahepatic biliary ducts distension? If this is cholsetasis due to recovery from hepatic insult when should I see resolution of ALKP/ GGT. All  the other enzymes are going down and clinically this dog is improving…?

2.what else would you do? 

Thank you,

Calin