– 7 year old MN Collie scheduled for an orthopedic procedure
– pre-op bloodwork showed elevated ALP/ALT and mild elevation on pre/post bile acids
– pet is clinically normal
– liver diffusely hyperechoic, lacks portal markings (isoechoic to the spleen, hyperechoic to falciform fat)
– liver biopsy recommended ddx: steroid or vacuolar hepatopathy, CAH, neoplasia (lymphoma, mast cell), lipidosis
Agree that this liver looks abnormal?
– 7 year old MN Collie scheduled for an orthopedic procedure
– pre-op bloodwork showed elevated ALP/ALT and mild elevation on pre/post bile acids
– pet is clinically normal
– liver diffusely hyperechoic, lacks portal markings (isoechoic to the spleen, hyperechoic to falciform fat)
– liver biopsy recommended ddx: steroid or vacuolar hepatopathy, CAH, neoplasia (lymphoma, mast cell), lipidosis
Agree that this liver looks abnormal?
Comments
Agree that liver looks
Agree that liver looks hyperechoic but cannot comment if enlarged on these images. Agree with the differentials, although lipidosis is a feline disease. What is the drug history as NSAIDs can affect the liver. Would recommend a FNA cytology before biopsy as it may give you an answer.
Agree that liver looks
Agree that liver looks hyperechoic but cannot comment if enlarged on these images. Agree with the differentials, although lipidosis is a feline disease. What is the drug history as NSAIDs can affect the liver. Would recommend a FNA cytology before biopsy as it may give you an answer.
I agree with remo but I would
I agree with remo but I would also chase other causes of BA elevation too as the liver doesn’t look subjectively “lumped up” enough to be failing but sampling may help define that.
I agree with remo but I would
I agree with remo but I would also chase other causes of BA elevation too as the liver doesn’t look subjectively “lumped up” enough to be failing but sampling may help define that.
I’m a bit out of the box on
I’m a bit out of the box on interpreting the liver but after hundreds of archived bx results to support this thread it may help that i posted a few weeks ago.
http://sonopath.com/forum/evaluating-benign-liver-coarse-liver-lumped-liver-grandma-liver-enzyme-chase-what-do-they-have
I’m a bit out of the box on
I’m a bit out of the box on interpreting the liver but after hundreds of archived bx results to support this thread it may help that i posted a few weeks ago.
http://sonopath.com/forum/evaluating-benign-liver-coarse-liver-lumped-liver-grandma-liver-enzyme-chase-what-do-they-have
Thanks Eric and Remo
The
Thanks Eric and Remo
The liver if anything was subjectvely small however this was a large Collie with a very deep chest. He may have been on Metacam (will have check with the referring vet).
A couple of questions: If I get LP inflammation back on an FNA, would I not need to go ahead and core this liver anyway to get more information (ie. look for copper etc)?
So I should take fatty liver off the list in dog livers that look like this?
How are you treating copper hepatopathy? Recently diagnosed one in a liver with core-biopsy in a Great Dane that had an almost normal looking liver on ultrasound. Just subtle mottling.
Thanks Eric and Remo
The
Thanks Eric and Remo
The liver if anything was subjectvely small however this was a large Collie with a very deep chest. He may have been on Metacam (will have check with the referring vet).
A couple of questions: If I get LP inflammation back on an FNA, would I not need to go ahead and core this liver anyway to get more information (ie. look for copper etc)?
So I should take fatty liver off the list in dog livers that look like this?
How are you treating copper hepatopathy? Recently diagnosed one in a liver with core-biopsy in a Great Dane that had an almost normal looking liver on ultrasound. Just subtle mottling.
Dogs usually get vacuolar
Dogs usually get vacuolar hepatopathy coming back on this type liver…. LP or mixed neut infiltrates. nodular hyperplasia and maybe some copper and occasionally suppurative hepatitis….if you put a gun to my head and asked what the histopath would be here in this dog….I hate doing histopathological ultrasound so get a sample and tell me if I’m close:)
This hyperechoic liver is an aspecific finding in dogs while in cats its usually fat cat (if lots of falciform), lipidosis +/- something underneath like inflammatory hepoatopathy, lsa, mct mult myeloma….. hence the reason to always fna these clinical hyperechoic livers in cats (I use 25 g).
Copper is a possibility given the relatively young age but its all over the map what is primary and what is secondary copper and yes you need a core bx for that. 500 ppm is the cutoff in dalmations higher in other breeds, 400 in bedlingtons) but it changes. I usually discuss wiht the pathologist on his/her gut feeling primary/secondary copper.
Sharon Center in Liverpool this year (ECVIM) spoke about potentially using a rhodanine stain on an fna looking for copper if you have a cytologist that will do this but its a bit “Ghetto” right now but may enhance the gut feeling in money cases that only allow fna.
This is the latest we have come up with for primary copper storage along wiht all the other kitchen sink abs and neutraceuticals: excerpt fromt he Curbside guide coming out from sonopath in a couple of months. Its such a high maintenance disease.
Copper storage disease
Verified on biopsy and quantitative/qualitative copper stain (frequent in terriers dalmations, dobermans, 40-70% in bedlingtons,)This pathology will resemble chronic active hepatitis. Peaks at 5-6 yrs of age. Dx = copper level > 400ng/dl.
13) Suprine (222-tetramine) at 15-30mg/kg bid increases copper excretion in the urine. Long-term indefinite treatment. Assess in 6 months with biopsy.
14) Penecillamine (alternate to suprine): frequent vomiting side effects
15) Zinc gluconate: 1.5-2.5mg/kg tid. May be used solely in mild cases or in combination with suprine in moderate/severe cases. Goal to reach serum levels of 200-600ug/dl measured every 4-6 months. Give on empty stomach or with tuna fish to avoid vomiting. Binds with intestinal copper to avoid absorption.
Dogs usually get vacuolar
Dogs usually get vacuolar hepatopathy coming back on this type liver…. LP or mixed neut infiltrates. nodular hyperplasia and maybe some copper and occasionally suppurative hepatitis….if you put a gun to my head and asked what the histopath would be here in this dog….I hate doing histopathological ultrasound so get a sample and tell me if I’m close:)
This hyperechoic liver is an aspecific finding in dogs while in cats its usually fat cat (if lots of falciform), lipidosis +/- something underneath like inflammatory hepoatopathy, lsa, mct mult myeloma….. hence the reason to always fna these clinical hyperechoic livers in cats (I use 25 g).
Copper is a possibility given the relatively young age but its all over the map what is primary and what is secondary copper and yes you need a core bx for that. 500 ppm is the cutoff in dalmations higher in other breeds, 400 in bedlingtons) but it changes. I usually discuss wiht the pathologist on his/her gut feeling primary/secondary copper.
Sharon Center in Liverpool this year (ECVIM) spoke about potentially using a rhodanine stain on an fna looking for copper if you have a cytologist that will do this but its a bit “Ghetto” right now but may enhance the gut feeling in money cases that only allow fna.
This is the latest we have come up with for primary copper storage along wiht all the other kitchen sink abs and neutraceuticals: excerpt fromt he Curbside guide coming out from sonopath in a couple of months. Its such a high maintenance disease.
Copper storage disease
Verified on biopsy and quantitative/qualitative copper stain (frequent in terriers dalmations, dobermans, 40-70% in bedlingtons,)This pathology will resemble chronic active hepatitis. Peaks at 5-6 yrs of age. Dx = copper level > 400ng/dl.
13) Suprine (222-tetramine) at 15-30mg/kg bid increases copper excretion in the urine. Long-term indefinite treatment. Assess in 6 months with biopsy.
14) Penecillamine (alternate to suprine): frequent vomiting side effects
15) Zinc gluconate: 1.5-2.5mg/kg tid. May be used solely in mild cases or in combination with suprine in moderate/severe cases. Goal to reach serum levels of 200-600ug/dl measured every 4-6 months. Give on empty stomach or with tuna fish to avoid vomiting. Binds with intestinal copper to avoid absorption.
Thanks!
Thanks!
Thanks!
Thanks!