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Francevet diagnosing liver disease wmv format
- 1. Diagnosing Liver Disease (in 30 minutes!) Craig B Webb, PhD, DVM, DACVIM Professor & Head Small Animal Medicine Section Colorado State University Veterinary Teaching Hospital
- 2. Disclosure #1 None of the patients in this presentation are members of my immediate family .
- 3. Function Glucose Albumin Cholesterol BUN Bile Acids Damage ALT Toxin, Drugs, Cu Inflammation Infection Immune Histopathology Reactive ALP Biliary total bilirubin PCV/TP Imaging Cytology & Culture
- 4. Liver Function Congenital Portosystemic Shunts “Sophie” 1 yo FS Chihuahua Intermittent lethargy Dull mentation Chronic diarrhea “Jack” 8 mo MC Domestic short hair Urinary stones Head tremor
- 5. Congenital Portosystemic Shunt •Clinical Signs: Wide Range and Variable •CNS (HE), Hypersalivation & seizures (cats) •Urinary (Polyuria/Polydipsia, Stones) •Growth (Poor doer) •Gastrointestinal (Vomiting/Diarrhea)
- 6. Congenital Portosystemic Shunt •Biochemical Profile •KEY: The Liver is Not Working Well
- 7. Sig: 1.5 year old FS Yorkie CC: “Big belly” full of fluid, acting “funny”
- 8. Clinical Diagnosis – It Must Be! Congential Portosystemic Shunt
- 9. Congenital Portosystemic Shunt •Biochemical Profile •KEY: They Do Not Develop Ascites or Turn Yellow
- 11. Congenital Portosystemic Shunt •Biochemical Profile •KEY: Liver Enzymes Do Not = Liver Function
- 12. Congenital Portosystemic Shunt •CBC •KEY: Microcytosis Leukocytosis, nonregenerative anemia
- 13. Additional Diagnostics •Bile Acids • KEY: Pre- and Post • KEY: Liver Function Test, NOT PSS Test •Fasted Ammonium • Sensitive PSS Test • KEY: Handle Sample Correctly •Abdominal Ultrasound • KEY: Doppler • NEW: Microbubbles • KEY: The Bladder!
- 14. The “Quiet” PSS •“Poofy” 1 yo MI Yorkie •Presented for castration •Undersized •Post Prandial Bile Acids elevated •Ultrasound – No Shunt •Transcolonic Scintigraphy - Normal
- 15. The “Quiet” PSS •Portal Vein Hypoplasia, also called MVD (microvascular dysplasia) •Looks like a Shunt, Smells like a Shunt •Colonic Scintigraphy – Normal •Histopathology •NEW: [Protein C] High in MVD •No Surgical Option •Older Dogs •Lesser Clinical Signs •Different Anatomy: Porto-Azygos Shunt •Surgical vs. Medical?
- 17. First Things First: PCV (Hct)/TP “Crit Tube” PRE-HEPATIC LOW PCV/NORMAL TP e.g. Hemolysis (IMHA) HEPATIC POST-HEPATIC IMAGING (Ultrasound) e.g. Gall bladder mucocele Choi et al. Vet Radiol Ultrasound 2014
- 18. Liver Damage (Dogs) & Biliary Disease (Cats) “Bella” 8 yo FS Labrador Ret Anorexia, lethargy, vomiting Weight-loss, jaundice “Grumpy” 8 yo MC Domestic short hair Anorexia, vomiting, ptyalism Febrile, jaundice HEPATIC
- 19. Feline Cholangitis Neutrophilic (Acute or Chronic) Lymphoplasmacytic
- 20. Feline Cholangitis Neutrophilic •Most Common •ACUTE: Young •CHRONIC: Older •Fever & Anorexia •V/D, icterus, abd pain • total bilirubin •Leukocytosis •ALT, GGT > ALP •Ultrasound Ultrasound sensitivity = 87% specificity = 90%
- 21. Feline Cholangitis Neutrophilic • Cholecystocentesis • Cytology & Culture • Bacterial infection • E coli • Enterococcus • Staph & Strep • Clostridium • Bacteroides • Salmonella • Pasteurella 22 g US-guided: thru R-medial liver lobe
- 22. Feline Cholangitis Lymphocytic •European •Any age • Persians, N. Forest Cat •Anorexia, weight loss •Ascites, jaundice •Hypergammaglobulinemia •Ultrasound •Histopathology
- 24. Canine Hepatopathy K9 Copper-associated Hepatitis
- 25. K9 Copper-associated Hepatitis Clinical Signs •Anorexia & Lethargy •Vomiting •Weight-loss •Jaundice •Hepatic encephalopathy •Ascites •PU/PD Laboratory Abnormalities Non-Specific for [Cu] dz •ALT (ALP) – Not Sensitive •Bile Acids (IF NOT YELLOW) •Total bilirubin •Clotting times •Decreased PCV •{Fanconi’s Syndrome}
- 26. LIVER BIOPSY with [Cu] quantification
- 27. Reactive Reactive Hepatopathy (Dog) Hepatic Lipidosis (Cat) K9 [ALP] “Mr. Fatty” 6 yo MC Domestic short hair Anorexia, weight-loss Vomiting
- 28. Reactive Hepatopathy Liver disease that is not Liver disease K9 Reactive Hepatopathy • [ALP] Non-Specific • Differentials: • Drugs • Gm- infection • Endocrinopathies • Benign Nodular Hyperplasia Feline Hepatic Lipidosis • Overweight & Anorexia • ALP >>> GGT • Icterus • CONCURRENT DISEASE
- 29. Function Glucose Albumin Cholesterol BUN Bile Acids Damage ALT Toxin, Drugs, Cu Inflammation Infection Immune Histopathology Reactive ALP Biliary total bilirubin PCV/TP Imaging Cytology & Culture
- 30. THANK YOU! Serge Martinod Directeur Scientifique, Dr. Vétérinaire, Arcanatura SAS