7 yr MN JRTx, ascites that is completely clear (like water), acellular w/ protein = 0. PUPD, pasty diarrhea. Blood work = TP 2.9, albumin 1, globulin 1.9, chol 99, WBC just above normal count, mild anemia. No UA or fecal.
7 yr MN JRTx, ascites that is completely clear (like water), acellular w/ protein = 0. PUPD, pasty diarrhea. Blood work = TP 2.9, albumin 1, globulin 1.9, chol 99, WBC just above normal count, mild anemia. No UA or fecal.
Are the mucosal hyperechoic infiltrates characteristic of lymphangectasia? Client is out of funds, so no biopsies.
Comments
Interesting… I can’t see
Interesting… I can’t see anything in your post. I just posted and my pictures were not uploaded. I wonder if it is a coincidence…
Good morning SonoPath forum
Good morning SonoPath forum posters!
Don’t forget to hit the “insert” button to add your still image to your forum post. Kromero, I added yours from our end, but please let me know if you were having trouble posting. Thx! Kelly Vazquez, CVT, SonoPath
I can clearly see mucosal
I can clearly see mucosal striations GCSM. I have had luck with pred, chlorambucil, tylosin, B12, low residue/low fat diet, therapeutic abdominal fluid drainage and spirinolactone in these patients that don’t allow biopsy. Good to also rule out concurrent PLN.
Sorry – could you clarify
Sorry – could you clarify GCSM? Thank you for your input!
I would shy away from biopsy
I would shy away from biopsy with an albumin that low. I agree with all that Pankatz is saying. With an albumin that low you will not be able to keep the fluid from returning in short order.
Hypoalbuminemia:
1. Hepatic in orgin
2. PLE
3. PLN
4. Fluid shifts
Get a free catch urine and check for protein as suggested above.
At least start steroids. Prognosis is poor if you can’t get that Albumin up.
“Mucosal fogging” (my term
“Mucosal fogging” (my term for coalescing striations see attached image) with that history and if no significant proteinuria then its lymphangectasia til proven otherwise. Not any loss of submucosal layering so not likley neoplasia (GI LSA can do PLE too fyi).
& the Curbside guide has a great quick reference chapter on this subject if you don;t have it yet…. plug plug plug:)
https://sonopath.com/products/book
Here are some similar cases:
http://sonopath.com/members/case-studies/search?text=mucosal+striations&species=All
& here is my quick tx as well… pick and choose what you will to help this guy… as amentioend pred and diet are likely the main things here and the rest may be window treatment:)
PLE Therapy
OBJECTIVE: keep albumin levels > 2 g/dl, Avoid thromboembolism and cavitary effusions, monitor concurrent PLN (Wheaton Terrier PLE/PLN) and liver disease:
Plasma 10 mL / kilogram IV over 4 hours
Or Human albumin 2 ml/kg/h over 10 hours. Total daily volume 20.l/kg/day
And Colloids/Hetastarch
10 to 20 mL per kilogram per hour and dogs
10 to 15 mL per kilogram per hour cats
(Can bolus first 1/3 of dose over 15 minutes)
& maintain on LRS maintenance otherwise.
Metronidazole (10-20 mg/kg po bid)
Famoditine 1 mg/kg Iv Im po dc Sid /bid
Sucralfate 0.5-1 g po tid dogs, 0.5 g bid cats in slurry Or Misoprostol 1-5 ug/kg po tid
Diet: Highly digestible high quality protein, low fiber, low fat diet (< 15% of dry matter). Hydrolyzed protein or novel protein. Purina HA or Royal Canine HP or similar.
Prednisone or prednisolone 2 mg/kg bid x 3-5 days then 2 mg/kg sid. Chlorambucil in refractive severe IBD/alimentary lymphoma cases (monitor cbc for rare bone marrow suppression) 4 mg/m2 Q 24-48 hours.
Cobalamine (B12) 250-1500 ug/dog weekly x 6 weeks.
Calcium supplementation if necessary.
Aspirin 0.5-1 mg/kg/day or Clopidrel (Plavix) 1-5 mg/kg/day.
Thanks for all of the great
Thanks for all of the great input, Eric! The book looks great as does the one still in editing.