- 10 year old FS French bulldog with 3 week history of diarrhea, flatulence, and weight loss.
- Chemistry profile showed ALB=2.0, ALT>1000 and ALP in the 3-400’s
- Abdominal ultrasound shows scant amounts of free anechoic fluid throughout the abdomen, thickened small intestinal and gastric walls with retention of wall layering, echogenic speckling in the small intestinal mucosal layer, coarse hepatic parenchyma, and normal pancreas.
- 10 year old FS French bulldog with 3 week history of diarrhea, flatulence, and weight loss.
- Chemistry profile showed ALB=2.0, ALT>1000 and ALP in the 3-400’s
- Abdominal ultrasound shows scant amounts of free anechoic fluid throughout the abdomen, thickened small intestinal and gastric walls with retention of wall layering, echogenic speckling in the small intestinal mucosal layer, coarse hepatic parenchyma, and normal pancreas.
- FNA’s of the liver and spleen were nondiagnostic. FNA of the ascites shows a pink, chylous effusion that is highly cellular. Cytology is pending.
- My rule outs are lymphosarcoma, protein losing enteropathy, and possibly concurrent liver disease.
- The primary DVM is requesting a liver biopsy based upon the elevated liver enxymes but I am thinking that either endoscopy or exploratory surgery should be next as the GI wall just doesn’t look quite right to me and should be biopsied. Please see clips and stills of the small intestine and stomach.
Comments
If the albumoin at the time
If the albumoin at the time of the sonogram was 2.0 then the ascites is not from low oncotic pressure as < 1.5 is necessary for that. Paraneioplastic effusion or chyle would be my suspicion. The small intestine has mucosal striations that you show (nice images) but the third still of the stomach shows fundic thickening and loss of detail and scope should get adequate samples. Spin down the fluid as well and make slides right away of the sediment to check for fresh neoplastic exfoliation. You could add corn oil to the meal a few hour before the scope to get duodenal bx with dilated lacteals but I’m more interested in the gastric bx.
If the albumoin at the time
If the albumoin at the time of the sonogram was 2.0 then the ascites is not from low oncotic pressure as < 1.5 is necessary for that. Paraneioplastic effusion or chyle would be my suspicion. The small intestine has mucosal striations that you show (nice images) but the third still of the stomach shows fundic thickening and loss of detail and scope should get adequate samples. Spin down the fluid as well and make slides right away of the sediment to check for fresh neoplastic exfoliation. You could add corn oil to the meal a few hour before the scope to get duodenal bx with dilated lacteals but I’m more interested in the gastric bx.
Thanks Eric. Do you see
Thanks Eric. Do you see ALT’s in the 1000’s with PLE?
Thanks Eric. Do you see
Thanks Eric. Do you see ALT’s in the 1000’s with PLE?
Yes likely the liver reacting
Yes likely the liver reacting to the GI through the portal system.
Yes likely the liver reacting
Yes likely the liver reacting to the GI through the portal system.