– 7 year old FS Australian Cattle dog with history of progressively increasing liver enzymes
– most recent bloods showed BUN 2.2 (2.5-9.6), ALT 526 (10-100), ALP 424 (23-212)
– no recent bilrubin or pre/post bile acids available from referring vet
– PT, PTT and platelets normal and pre-biospy PVC/TP wnl
– pet clinically well
– liver diffusely hyperechoic, slightly mottled on ultrasound and capsule slightly irregular
– no ascites or lymphadenopthy; adrenals normal shape and size
– 7 year old FS Australian Cattle dog with history of progressively increasing liver enzymes
– most recent bloods showed BUN 2.2 (2.5-9.6), ALT 526 (10-100), ALP 424 (23-212)
– no recent bilrubin or pre/post bile acids available from referring vet
– PT, PTT and platelets normal and pre-biospy PVC/TP wnl
– pet clinically well
– liver diffusely hyperechoic, slightly mottled on ultrasound and capsule slightly irregular
– no ascites or lymphadenopthy; adrenals normal shape and size
– tortuous blood vessels ventral and caudal to left kidney – acquired shunts?
– 14 and 16 gauge core biopsies taken but very little tissue acquired – could place the needle into the liver (see clip where needle is moving to confirm liver placement) but the entire needle would pop upward when the needle fired to obtain the core as if the liver was too dense – Could this indicate fibrosis?
– also, strangley enough, the gall bladder did not appear in its normal positon – much more central and to the left; An anomoly?
Still on the right is tranverse liver with gall bladder toward the left (stomach shadowing it). The GB was best seen through the left intercostal space in this patient.
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Comments
JP I cant see your video yet
JP I cant see your video yet waiting on IT
JP I cant see your video yet
JP I cant see your video yet waiting on IT
No problem – let me know if I
No problem – let me know if I should resend
No problem – let me know if I
No problem – let me know if I should resend
Ok they are up. i dont know
Ok they are up. i dont know what type of needle you are using but the springloaded monopties I use I havent had any issue with in this type of liver. maybe the needle is dull? Your placement is fine. There are increased portal markings which would suggest chronicity but a sharp needle should cut through this readily.
The vessels are acquired shunt and likely the left gonadal vein which indicates portal hypertension. PV velocity would help confirm.
Nice case
Thanks Eric – glad they
Thanks Eric – glad they loaded.
I thought I remembered Tony Pease say something about looiking behind the left kidney in chronic liver cases. Nice to finally see one.
JP
Ok they are up. i dont know
Ok they are up. i dont know what type of needle you are using but the springloaded monopties I use I havent had any issue with in this type of liver. maybe the needle is dull? Your placement is fine. There are increased portal markings which would suggest chronicity but a sharp needle should cut through this readily.
The vessels are acquired shunt and likely the left gonadal vein which indicates portal hypertension. PV velocity would help confirm.
Nice case
Thanks Eric – glad they
Thanks Eric – glad they loaded.
I thought I remembered Tony Pease say something about looiking behind the left kidney in chronic liver cases. Nice to finally see one.
JP
Just an update: the u/s
Just an update: the u/s guided core biopsy did not yield any liver tissue as I suspected would happen. We took Lucy to surgery yesterday to find an atrophied, firm lumpy, bumpy liver. Now I can see why getting a window for biopsy was difficult. There was also some fluid in the abdomen at surgery that was not present, at least on ultrasound, 2 weeks ago.
This is actually an entire lobe that I removed on the left side by just easily ligating the vessels to it. Waiting on histopath but I don’t think this will be good news. Clinically she is showing no signs of illness what-so-ever.
Just an update: the u/s
Just an update: the u/s guided core biopsy did not yield any liver tissue as I suspected would happen. We took Lucy to surgery yesterday to find an atrophied, firm lumpy, bumpy liver. Now I can see why getting a window for biopsy was difficult. There was also some fluid in the abdomen at surgery that was not present, at least on ultrasound, 2 weeks ago.
This is actually an entire lobe that I removed on the left side by just easily ligating the vessels to it. Waiting on histopath but I don’t think this will be good news. Clinically she is showing no signs of illness what-so-ever.
Histopath Result:
Histopath Result: Micronodular cirrhosis with strong positive copper staining
Histopath Result:
Histopath Result: Micronodular cirrhosis with strong positive copper staining
Makes sense, thanks for the
Makes sense, thanks for the great follow-up and great management. The fluid at sx means portal hypertension. Technically the pv velocity would have been around 15 cm/sec or less and pancreatic edema is often present too before third spacing of the transudate and of course th esecondary shunts.
Cool case…. in my experience they usually just start to go off their food when the ascites starts to bloat the abdomen.
Makes sense, thanks for the
Makes sense, thanks for the great follow-up and great management. The fluid at sx means portal hypertension. Technically the pv velocity would have been around 15 cm/sec or less and pancreatic edema is often present too before third spacing of the transudate and of course th esecondary shunts.
Cool case…. in my experience they usually just start to go off their food when the ascites starts to bloat the abdomen.