Hello,
This is a 6.6 years old M/N Retriever that came in for bad diarheea, lethargy. Mild elevation in liver enzymes. Albumin low normal 23 . Due to enlarged abdomen RDVM recommended AUS. Findings : large amount of free fluid. Abdcentesis: clear like water. Liver cirrhosis.
I have 2 questions regardig this case or similar cases:
– do you recommend Liver biopsy in this cases( if PT/PTT permit) If yes do you drain the abd fluid first?
-if this fluid is due to portal hypertension do I need to measure and document that?
Thnk you,
Hello,
This is a 6.6 years old M/N Retriever that came in for bad diarheea, lethargy. Mild elevation in liver enzymes. Albumin low normal 23 . Due to enlarged abdomen RDVM recommended AUS. Findings : large amount of free fluid. Abdcentesis: clear like water. Liver cirrhosis.
I have 2 questions regardig this case or similar cases:
– do you recommend Liver biopsy in this cases( if PT/PTT permit) If yes do you drain the abd fluid first?
-if this fluid is due to portal hypertension do I need to measure and document that?
Thnk you,
Comments
Liver biopsy would confirm
Liver biopsy would confirm the diagnosis but usually in late-stage disease, often does not give an etiological diagnosis, which could then direct more specific therapy. I often find that at this stage, management with ursodiol, diuretics, diet better than trying to persue an etiological diagnosis. The albumin of 23 is unlikley to give the ascites and thus portal hypertension would the cause.
Liver biopsy – would drain some of the fluid as it makes biopsy easier.
classic cirrhosis case…
classic cirrhosis case… ascites primary diffs are passive congestion (eliminated here because hepatic veins are not dilated), poor oncotic pressure (eliminated here because albumin is > 1.5), lymphatic obstruction/neoplasia (assuming no pancreatic carcinomatosis or lymphomatosis then not a player here you can spin down and slide the sediment and look for neoplastic cells), peritonitis (fluid would be exudate) or diffuse liver disease causing portal hypertension which is what is going on here. You can confirm by doing a portal doppler study in which the portal velocity will be < 18 cm/sec. I used to biopsy these but I dont any more because like remo says its end stage so support the liver and manage the ascites. No magic bullet on these cases.
Here are some similar portal hypertension cases
http://sonopath.com/members/case-studies/search?text=portal+hypertension&species=All
In some cases, wouldn’t you
In some cases, wouldn’t you need a liver aspirate or core biopsy to differentiate between cirrhosis and neoplasia, especially if you do not find any neoplastic cells on the abdominal fluid cytospin?
I would think that a tumor
I would think that a tumor would enlarge the liver or at lest a lobe which is not the case with this end stage cirrhosis, but on an ideal world I think you can biopsy if Pt/PTT good
I would think that a tumor
I would think that a tumor would enlarge the liver or at lest a lobe which is not the case with this end stage cirrhosis, but on an ideal world I think you can biopsy if Pt/PTT good
I would think that a tumor
I would think that a tumor would enlarge the liver or at lest a lobe which is not the case with this end stage cirrhosis, but on an ideal world I think you can biopsy if Pt/PTT good
Thank you all
CAH to cirrhosis goes from
CAH to cirrhosis goes from normal when first insulted >> to swollen >> to macronodular swollen >> to progressively shriveled up like your images… depends on the stage of the progression as the swollen macronodular phase can look like neoplasia but the diff is usually round cell neoplasia … lsa & HS and such so screening fna gets the dx easily on round cell but cirrhosis gives you lasckluster inflammatory mixed population typically. So in that stage I will often fna as a screen if they wont let me bx.
Portal hypertension usually starts at the last 2 stages but more frequently in the end stage like this one…. ascites will form sooner if concurrent PLE is present which can happen so it combines lower oncotic pressure along with portal hypertension thats emerging… combination of factors to create ascites.
Thanks Eric. I do not like
Thanks Eric. I do not like doing core biopsies on these cases as the patients are often quite fragile by the time they present to me. I usually recommend doing fna’s first but often the primary DVM wants the core biopsy for the more definitive diagnosis. I appreciate your and Dr. Lobetti’s comments on this case and will add them to my client communication cache.
Always a great learning
Always a great learning experience for me. Thank you for your comments.