- 2 and 1/2 year old mn Cocker Spaniel (chart says American, but looks English) adopted 2 months ago from a friend in Utah.
- Routine exam showed a distended abdomen. The dog is asymptomatic except for a very docile disposition.
- Abdominal radiographs showed hepatomegaly. CBC was wnl except for thrombocytopenia. Chem prof showed slightly elevated liver enzymes, hypoalbuminemia (1.8) and Tbil=0.6. U/A is negative for proteinuria. 4DXt is all neg. Lept titers are pending.
- 2 and 1/2 year old mn Cocker Spaniel (chart says American, but looks English) adopted 2 months ago from a friend in Utah.
- Routine exam showed a distended abdomen. The dog is asymptomatic except for a very docile disposition.
- Abdominal radiographs showed hepatomegaly. CBC was wnl except for thrombocytopenia. Chem prof showed slightly elevated liver enzymes, hypoalbuminemia (1.8) and Tbil=0.6. U/A is negative for proteinuria. 4DXt is all neg. Lept titers are pending.
- Abdominal ultrasound showed a moderate amount of ascites, hepatomegaly, a thickened, double wall gallbladder. Fluid analysis showed a transudate. Culture of the abdominal fluid was negative. The GI tract appeared normal.
- Echocardiogram is normal. Chest radiographs are pending.
- My primary differential diagnoses are idiopathic chronic hepatitis, infectious hepatitis (Lepto, Bartonella), less likely PLE (no lesions seen).
- Clotting times are normal but platelet count is decreased at 80,000.
- Am I still ok to biopsy the liver if pretreating with Vit K?
- Would you do a palliative abdominocentesis before or after biopsying the liver?
Comments
With platelets at 80,000,
With platelets at 80,000, normal clotting times, and Vit K should not have a problem. Would recommend a mucosal bleeding time to get a handle on platelet function and a pre-biopsy plasma transfusion as there is hypoalbuminemia. Are you looking at doing a Tru-cut biopsy or a FNA?
I was planning on doing a
I was planning on doing a true cut because an FNA doesn’t seem like it would help me much with my differential list. Unfortunately the owner has limited funds and may not be up for a plasma transfusion. If the mucosal bleeding time is normal what are your thoughts on doing a true cut biopsy without doing a plasma transfusion ahead of time?
With platelets at 80,000,
With platelets at 80,000, normal clotting times, and Vit K should not have a problem. Would recommend a mucosal bleeding time to get a handle on platelet function and a pre-biopsy plasma transfusion as there is hypoalbuminemia. Are you looking at doing a Tru-cut biopsy or a FNA?
I was planning on doing a
I was planning on doing a true cut because an FNA doesn’t seem like it would help me much with my differential list. Unfortunately the owner has limited funds and may not be up for a plasma transfusion. If the mucosal bleeding time is normal what are your thoughts on doing a true cut biopsy without doing a plasma transfusion ahead of time?
This liver looks remodeled
This liver looks remodeled but not severely. If low BUN and cholesterol are present then yes maybe liver is th eculprit for low albumin but check intestinal mucosal striations first and proteinruia… Bx wiht ascites is a bit problematic.. I still do it but has inherent risks as no compression to seal the cut and you can’t tell if you have a bleed.. I still do it but there is more risk and I would want to weight that risk. Ebnsure the 80k platelet count is recent though and not a few days ago and is actually 40k now which is a problem owing to IMT or something.. its a cocker:)
This liver looks remodeled
This liver looks remodeled but not severely. If low BUN and cholesterol are present then yes maybe liver is th eculprit for low albumin but check intestinal mucosal striations first and proteinruia… Bx wiht ascites is a bit problematic.. I still do it but has inherent risks as no compression to seal the cut and you can’t tell if you have a bleed.. I still do it but there is more risk and I would want to weight that risk. Ebnsure the 80k platelet count is recent though and not a few days ago and is actually 40k now which is a problem owing to IMT or something.. its a cocker:)
If mucosal bleeding time
If mucosal bleeding time normal and platelet count is recent then can get away without plasma. Important to monitor for post-biopsy bleeding.
If mucosal bleeding time
If mucosal bleeding time normal and platelet count is recent then can get away without plasma. Important to monitor for post-biopsy bleeding.
Thank you for all of your
Thank you for all of your help! MBT was normal at 1 min 36 sec.
Thank you for all of your
Thank you for all of your help! MBT was normal at 1 min 36 sec.