-9 year old beagle who has been on phenobarbital for a long time
-increasing liver enzymes (ALT ~400, SAP >1200)
-in-house bile acids were >30 but are not further quantified
– dog is clinically normal.
-no skin or foot pad lesions.
I did several FNA’s but really think they will need a biopsy to diagnose. What do you think?
Suzanne
(Ignore the portal lymph node label; there was a prominent node that I took a still image of just prior to the video clip)
-9 year old beagle who has been on phenobarbital for a long time
-increasing liver enzymes (ALT ~400, SAP >1200)
-in-house bile acids were >30 but are not further quantified
– dog is clinically normal.
-no skin or foot pad lesions.
I did several FNA’s but really think they will need a biopsy to diagnose. What do you think?
Suzanne
(Ignore the portal lymph node label; there was a prominent node that I took a still image of just prior to the video clip)
Comments
yes susanne boy
yes susanne boy hepcutaneous sure fits here but nodular hyperplasia vac hepatopathy from phenobarb can do this too. Needs bx but sometimes I have seen hepcutaneous look like this and the crusting footbads and nasal lesions come later so surely one to watch. If you told me this dog had crusting skin lesions it would sure fit. Quantitative Bile acids would be nice to knowhow bad the functional deficits are. Definitely a liver support diet as if he had a shunt.
Take a look at the basic seacrh for hepcutaneous cases and the liver presentations:
http://sonopath.com/members/case-studies/search?text=hepatocutaneous&species=All
Here is my liver rsupport protocol form the latest info out of acvim/ecvim lthis year:
Royal Canin Hepatic Support diet or Hills L/D, Metronidazole (7.5 mg/kg PO bid)over the next 14 days, Lactulose (Oral: 3.1-3.7 g/5 ml lactulose in a syrup base) long term to target 2-3 soft stools/day, with a high quality protein supplement of minor amount of yogurt or cheddar cheese. Monitor bile acids, with attention paid to dropping albumin, BUN or cholesterol. SAMe and neutraceuticals as needed. Urosodiol (10-15 mg/kg p.o.q24h) can be considered as hepatoprotectant and to enhance bile flow. Zinc serum level keep between 200—500 ug/dl. If deficient then tx zinc acetate 1-3 mg/kg/day. Gi protect if anorexic
yes susanne boy
yes susanne boy hepcutaneous sure fits here but nodular hyperplasia vac hepatopathy from phenobarb can do this too. Needs bx but sometimes I have seen hepcutaneous look like this and the crusting footbads and nasal lesions come later so surely one to watch. If you told me this dog had crusting skin lesions it would sure fit. Quantitative Bile acids would be nice to knowhow bad the functional deficits are. Definitely a liver support diet as if he had a shunt.
Take a look at the basic seacrh for hepcutaneous cases and the liver presentations:
http://sonopath.com/members/case-studies/search?text=hepatocutaneous&species=All
Here is my liver rsupport protocol form the latest info out of acvim/ecvim lthis year:
Royal Canin Hepatic Support diet or Hills L/D, Metronidazole (7.5 mg/kg PO bid)over the next 14 days, Lactulose (Oral: 3.1-3.7 g/5 ml lactulose in a syrup base) long term to target 2-3 soft stools/day, with a high quality protein supplement of minor amount of yogurt or cheddar cheese. Monitor bile acids, with attention paid to dropping albumin, BUN or cholesterol. SAMe and neutraceuticals as needed. Urosodiol (10-15 mg/kg p.o.q24h) can be considered as hepatoprotectant and to enhance bile flow. Zinc serum level keep between 200—500 ug/dl. If deficient then tx zinc acetate 1-3 mg/kg/day. Gi protect if anorexic
Usually dogs with
Usually dogs with hepato-cutaneous present with skin issues and the liver lesions are picked up secondary to that. Nodular hyperplasia important consideration but also think of neoplasia, granulomas – biopsy would be indicated.
Usually dogs with
Usually dogs with hepato-cutaneous present with skin issues and the liver lesions are picked up secondary to that. Nodular hyperplasia important consideration but also think of neoplasia, granulomas – biopsy would be indicated.
Thanks for the information.
Thanks for the information. This dog is completely non-clinical for a hepatopathy. Her BUN is on the low end of normal (8) but other liver function tests were well within normal limits. I believe they tried starting Keppra but she experienced seizural activity. I’m sure they will wind up needing a biopsy but they wanted to try FNA first.
Thanks again,
Suzanne
Thanks for the information.
Thanks for the information. This dog is completely non-clinical for a hepatopathy. Her BUN is on the low end of normal (8) but other liver function tests were well within normal limits. I believe they tried starting Keppra but she experienced seizural activity. I’m sure they will wind up needing a biopsy but they wanted to try FNA first.
Thanks again,
Suzanne