- 9 yr old FS lab with history of lethargy, drooling, inappetence, and chronic weigh loss.
- Dog has been tx with metronidazole and Denamarin
- Liver enzymes have been elevated for 1 year. Most recent chem shows ALT of 347 U/L, ALP of 307 U/L, GGT of 19 U/L, TBIL of 1.8mg/dl, ALB of 2.6g/dL, and TP of 6.4g/dL. CBC shows a mild thrombocytopenia of 113,000. PT was at high end of normal and PTT was slightly prolonged. Bile acid testing was not done since TBIL was elevated.
- 9 yr old FS lab with history of lethargy, drooling, inappetence, and chronic weigh loss.
- Dog has been tx with metronidazole and Denamarin
- Liver enzymes have been elevated for 1 year. Most recent chem shows ALT of 347 U/L, ALP of 307 U/L, GGT of 19 U/L, TBIL of 1.8mg/dl, ALB of 2.6g/dL, and TP of 6.4g/dL. CBC shows a mild thrombocytopenia of 113,000. PT was at high end of normal and PTT was slightly prolonged. Bile acid testing was not done since TBIL was elevated.
- Abd US showed decreased right hepatic parenchyma. The GB was markedly distended with normal anechoic bile and gravity-dependent echogenic sludge. The left liver appeared normal in size, vasculature, and parenchyma.
- Differential diagnoses for the elevated liver enzymes and right sided microhepatica include chronic hepatitis, cirrhosis, portal vein hypoplasia, and shunt.
- The dog was placed on Vit K for 3 days and the PT and PTT rechecked as a prescreen for US guided liver biopsy. Both the PT and PTT are now both significantly elevated (>25%).
- It is important to get a liver sample on this dog but not sure what to do next since the coag panel has worsened with the dog on Vit K. Would you recommend referal for liver bx via laporoscopy so as to have better control over possible bleeds? Dog is not hypoproteinemic (yet) so transfusion does not seem appropriate. More time on Vit K?
Comments
I personally would not do an
I personally would not do an ultrasound guided biopsy on this one. Laparoscopic will allow for better overal visualization of the liver and to safely access all lobes esp if the right is small with the GB in the way.
Also can watch for bleeding
Also can watch for bleeding directly and use gel foam in the biopsy site if needed
Hmm that Gb looks pathologic
Hmm that Gb looks pathologic too and may be contirbuting to the coag issue since bile flow into the GI is important for K production. Plasma transfue?? I am sort of leaning toward cholecystectomy and liver bx here even though this isnt a typical mucocele the bile is 80% immobile and very overdistended. Looks like a CAH cirrhosis case.
Would do a fresh frozen
Would do a fresh frozen plasma transfusion and then a laparotomy as safer than Tru-cut. Although laproscope is less invasion may not be able to get the same degree of vizualization, possible surgical correction, and addressing any potential bleeds.
Thank you for your input.
Thank you for your input. Unfortunately the owners have opted not to invest in more diagnostics. In addition to metronidazle, the primary vet is instituting medical tx with amoxicillin and Doxycycline. The dog is already on ursodiol. She is also on Cerenia as her appetite is diminished. Her ALB has dropped to 2.2. I hope to recheck the gallbladder next time I am at that clinic.