12 yo F/S Italian Greyhound 17#

Asymptomatic severely elevated liver enzymes. Currently ALT 1786, was 171 last month. ALP was 461 last month. On Thyroxine.

1st u/s last month: large hyperechoic liver with multiple small hypoechoic nodules (3mm-1cm). FNA: vacuolar hepatopathy.

Gastritis.

Pancreas was thickened with a cavitated 1cm nodule or LN, dorsal to stomach. I can’t reach it.

Trt with metro/omeprazole/denamarin. O declined ursodiol.

Recheck U/s today: liver is the same, GB has organized sludge, maybe early mucocele, gastritis better, left adr 6.7mm.

Questions:

1) The pancreatic nodule or LN is the same. Is it in the pancreas? Benign hyperplasia? Mass? or cystic LN?

2) No way vacuolar hepatopathy alone could cause ALT 1800. What do you think? Hepatitis? Neoplasia?

Rec Ursodiol, metro/amoxi, denamarin. Referral for liver biopsy.

Thank you!

Julie

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