liver problem.

Re: liver problem.

Christopher Saul — Fri, 10 Feb 2012 18:42:12 GMT

Yeah I wouldn't fancy doing that surgery; I would agree with referral for surgery. I'm sure a surgeon would want to be sure there is no distant mets though; I'd prob recommend inflated DV and both lateral thoracic views. Did you FNA the local lymph nodes when you were in there?

I'm still sceptical that this is the only cause for the PUPD though; have you got urinialysis as I suggested?

Re: liver problem.

Alex Allen — Fri, 10 Feb 2012 17:31:12 GMT

Not an expert in surgery but from what you;ve described I would offer referral for liver lobectomy.Would suspect fancy haemoclips and lots of spare blood going to be required!

Sounds like the mass is causing the problems described. As pathologist states there is always a risk it's a hideously necrotic neoplasm especially given the age.

Any history of trauma?

Re: liver problem.

Claire Godfrey — Fri, 10 Feb 2012 17:19:16 GMT

Anyone?

Thought a liver lobe torsion would have been painful and dog never has been as far as can tell. Could it be haematoma that has necrosed?

Re: liver problem.

Claire Godfrey — Thu, 09 Feb 2012 17:52:41 GMT

Yesterday rescanned the liver, mass appearred unchanged.

Exploratory laprotomy, Liver only one lobe is affected, mass appearred encaspulated, extended afr down towards vena cava, rest of liver looked very normal. biopsied mass. Incised through a capsule, then there was a layer of yellowy, very mushy liver. Under this was haemorrhage and necrotic tissue.

Results

Diagnosis Severe hepatic necrosis with encapsulation.

comment. the hepatic tissue showed extensive necrosis that showed variable infiltration of neutrophils. The neutrophil infiltration is most likely secondary to necrosis. This was also evidence of encapsulation of tissue with evidence of previous haemorrhage in the area. Given the severity of the necrosis is likely that this represents a liver lobe that developed a compromised blood suplly, and a torsion portion is a possibility. However, I cannot exclued the possibility that the samples were taken, from a severely necrotic neoplasm in the liver.

Thoughts very much appreciated.

Dog is still very bright and only clinical sign is PU/PD.

Re: liver problem.

Mark Holmes — Tue, 31 Jan 2012 17:43:32 GMT

The mass may be an old haematoma with organising fibrin clot. Given elevated clotting times it would suggest diffuse liver disease rather than an isolated mass. A singular mass would increase alt/alkp but be unlikely to increase thromboplastin times.

Re: liver problem.

Claire Godfrey — Tue, 31 Jan 2012 17:16:36 GMT

Thanks for all the feedback. Xray report has come back clear. Plan is to cover with antibiotics for a week and then rescan and biopsy/remove as appropriate.

Had a case with a liver abscess in the practice 2-3months ago, referred for the scan and has done well. Just would feel silly biopsying liver if wasn't totally necessary and turned out to be an abscess.

Will update when have further results.

Re: liver problem.

Richard Fox — Tue, 31 Jan 2012 12:01:33 GMT

My 2p would be firstly nodular hyperplasia although seems a bit big from what you are describing or hepatocellular neoplasia. Abscesses are rare in dogs unlike herbivorous animals in my experience. If this material is necrotic then that can be pyrogenic. Apart from that I think you would have to bx to know whether the lesions was significant or a red herring?

Re: liver problem.

Christopher Saul — Sun, 29 Jan 2012 18:26:27 GMT

Firstly; I'd tend to agree with the others that you should investiagate the liver mass. I am NOT trying to say it is not significant, I'd just like to add a couple of points however before diving in.... there may be more than meets the eye, particularly with regards to the PUPD. It's hard to comment without seeing all the blood results but here goes...

The post prandial bile acid is not spectacularly high, normally you'd expect a much higher post prandial BA to be able to say with confidence that hepatic failure is the sole cause of the PUPD. That said, you may have just been unlucky and missed the time of gall bladder contraction. The reason why liver failure patients become PUPD is because of a lack of medullary hypertonicity, to which urea contributes significantly. What was the urea?

If the urea is normal, you may have a degree of chronic kidney disease going on concurrently with hepatic disease - each masking the other with respect to the urea. Also I take it calcium was normal?

Another cause of PUPD you haven't ruled out yet is a chronic pyelonephritis.

So before you do anything more I'd prob recommend doing a full urinalysis from a cysto sample for prot creat ratio, culture and sens and cytology.

Assuming you've decided to go to biopsy; in view of the coags definately give vitamin K prior to surgery , and might be worth getting a unit of packed cells in from the blood bank in case of surgical haemorrhage. Is referral for a tru-cut an option?

Just a few thoughts, hope it helps

Chris

Re: liver problem.

HMC — Sat, 28 Jan 2012 13:41:03 GMT

[quote user="Emma Middleton"][ your best option for diagnosis now is to open it up and biopsy/remove if appropriate.

[/quote]

I second that.

Re: liver problem.

Emma Middleton — Fri, 27 Jan 2012 17:47:50 GMT

[quote user="claire godfrey"]Awaiting xray report but plan would be for biopsy if not metastases in lungs, or potentially removal.[/quote] Hi Claire! I've nothing very useful to say other than I think as you've said already, your best option for diagnosis now is to open it up and biopsy/remove if appropriate. Be interested to know what you find if you do biopsy.

Re: liver problem.

Claire Godfrey — Fri, 27 Jan 2012 17:21:43 GMT

Rest of liver looked fine, nothing on spleen. Haematology was normal.

Think am hoping for an abscess, (nice dog nice owners,) but I know it is not likely.

Re: liver problem.

Martin Atkinson — Fri, 27 Jan 2012 17:02:36 GMT

What are your haematology results? If its an abscess I would expect a neutrophilia. If it is an isolated mass I wouldn't expect such dramatic liver function tests but raised T.bil may result of haemorrhage. I would be worried there is a haemangiosarcoma, What did the scan of the rest of the liver look like?