a 5 yr old Yorkie was referred to me by a local colleague with signs of panting, listlessness, hyporexia, lethargy and painful? abdomen; At my exam, the dog didn’t show any of these signs though. The referring DVM put the dog on zenequin, cerenia, and doxycycline for about two weeks prior to referral. X-Rays had also showed enlarged liver at regular vet. Blood work 2 weeks before referral (Chem & CBC) showed ALP 611, and ALT 160 & all else WNL, and the lepto titers were normal.
a 5 yr old Yorkie was referred to me by a local colleague with signs of panting, listlessness, hyporexia, lethargy and painful? abdomen; At my exam, the dog didn’t show any of these signs though. The referring DVM put the dog on zenequin, cerenia, and doxycycline for about two weeks prior to referral. X-Rays had also showed enlarged liver at regular vet. Blood work 2 weeks before referral (Chem & CBC) showed ALP 611, and ALT 160 & all else WNL, and the lepto titers were normal.
I performed an ABD US: mildly hypoechoic liver, GB – mild sludge, edematous mesenteric LNs in mid Abdomen, Adrenal glands – WNL, but in pancreatic region, there was an odd-shaped “tissue” with mild echogenicity, which I wasn’t sure what. The dog went back to the regular vet and had UCC/LDDS done to rule out any evidence of HAC. The results were negative. That was 3 months ago!
Meantime, the regular vet did another set of blood chemistry, which showed still high ALP (575) and ALT (157). the O wanted to have any priamry liver ruled out. So the dog came back to me for recheck and possibly liver biopsy. I told the O thel iver test can be inconclusive based on only mild ALT elevation. I briefly told the O the possibility of atypical form of HAC requiring a special steroid profile at Univ. of Tennesse! Among a few recommendations I presented (Laparoscopic or Surgical biopsy of liver, pancreas and mesenteric LNs), the O elected FNA of the Liver (resluts pending), which was done 2 days ago.
Long story short, I would like to have some imput from the community in regards to overall approaches to this case we (referring vet and I) have taken and US images I uploaded. My questions lie in two areas, the 1st – what it could be in pancreatic region? the 2nd – supposing that the liver is disease free and there is no bone disease, what could be the reason for persistently high ALp and ALT? I would appreciate any input! Thanks, btw, this is my first time putting up a case.
If you need more info -please let me know i tried to be as short and to the point as possible….