FNA of liver guided by ultrasound

 

Clinical History

The dog has a history of poor appetite and no weight gain. The dog gave birth to puppies 5 months ago. The dog has been vomiting lately. The physical examination showed worsening unpigmented lips – because of chronic licking the nose region from existing nausea. Therapy has been none.

 

Laboratory Review

On 2/26/08, the CBC shows a mild eosinophilia. The serum chemistry profile shows an increase in total bilirubin, ALP, ALT, AST, globulins, and GGTP.

Ultrasound Examination

The liver shows a homogeneous to inhomogeneous texture in its parenchyma. No masses noted within the liver parenchyma. FNA of the liver for cytologic examination were obtained. The gall bladder is mildly distended, and its walls are not thickened or hyperechoic. The gall bladder does contain some sludge material. The spleen shows a homogeneous to inhomogeneous texture in its parenchyma -- no masses noted. The left and right kidneys are similar in size, shape, and echotexture. Each kidney shows an inhomogeneous texture in the renal cortex. No masses or calculi were noted in either kidney. The urinary bladder is distended with urine and contains some urine sediment material -- no masses or calculi noted. The left and right adrenal glands are similar in size and shape -- no adrenal gland tumor noted. Cyst-like lesions are present in both ovaries. The uterus is not seen. The stomach, small intestine, and colon are normal. The pancreas shows an inhomogeneous texture in its parenchyma.

Case Management

Based on the clinical information that you have provided me, my clinical diagnosis is existing chronic liver disease. There was no obvious evidence of cancer noted during this abdominal ultrasound study. This dog’s current liver disease is most likely a chronic lymphocytic hepatitis and/or vacuolar hepatopathy and not liver neoplasia. I generally will feed these dogs Prescription Diet L/D and daily administer Denamarin. Periodic use of prednisone at 1-2 mg/kg BID for 5-7 days and oral lactulose BID are used to improve the dog’s activity. Therapy of special diet and antioxidants is probably for a lifetime.

Johnny D. Hoskins, DVM, PhD, Diplomate ACVIM (Internal Medicine)

 

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