Icteric labrador

Re: Icteric labrador

Michael Woodhouse — Fri, 06 Feb 2015 01:12:51 GMT

[quote user="John Flynn"]Wouldn't be daft to screen/treat for lepto given platelet numbers a little lower than normal and hepatic disease sounds acute if I've read correct.[/quote]

Lepto was my first thought. We get a couple of cases each year. Yellow dogs are hospitalised and barrier nursed until the result is back. Had a really nice, strong 7 year old springer die end of last year from lepto. Just had puppy vaccs.

I fail to see why people want to do a bile acid stimulation when a point reading is already high......

Re: Icteric labrador

John Flynn — Thu, 05 Feb 2015 21:10:46 GMT

[quote user="Claire Fisher"]If jaundice is present I don't think a bile acid stimulation test will add much more.[/quote]

+1 I really can't see any point to repeating fasting bile acids and adding in post-prandial bile acids - it will tell you nothing additional.

If ultrasound was unremarkable, then I'd opt for 2 or 3 tru-cut biopsies after 5 days Vit-K is my usual approach; or 5 days vitK then open up for proper look around and surgical biopsy dependent on your confidence in the ultrasound exam.

Wouldn't be daft to screen/treat for lepto given platelet numbers a little lower than normal and hepatic disease sounds acute if I've read correct.

For the avoidance of doubt: this is not cushings.

DISCLAIMER - as you can undoubtedly tell, I'm also a fellow general vet, with no special knowledge relevant to your case!

Re: Icteric labrador

Claire Fisher — Thu, 05 Feb 2015 19:50:29 GMT

If jaundice is present I don't think a bile acid stimulation test will add much more.

The ALT is huge compared to the ALKP so I'd think more liver disease than anything else. Labradors are prone to copper associated hepatitis so coags and biopsy would be my next step.

Re: Icteric labrador

Virginia Campbell — Thu, 05 Feb 2015 16:56:25 GMT

***DISCLAIMER**- I'm not an internal med anything - but some thoughts.

With this level of jaundice I'd think post hepatic more than hepatic.

A strategically-placed mass doesn't have to be very big to squish the bile duct.

I've seen a big fat pancreas squash a bile duct enough to cause post hepatic jaundice, but the dog was as pukey and sore as you would expect a roaring pancreatitis dog to be.

Re: Icteric labrador

Will McMullan — Thu, 05 Feb 2015 16:48:35 GMT

Can't believe this dog isn't more ill than you describe. I would definitely be running a bile acid stim test, possibly repeat the liver ultrasound and think about biopsies? Very unlikely to be cushings, or just cushings.

Re: Icteric labrador

sigita petruskeviciene — Thu, 05 Feb 2015 15:47:38 GMT

Forgot to add that had the ultrasound done at other practice. They didn't find anything abnormal on liver/gallbladder stucture. the only thinks was found was few hypoechoic areas in the spleen which they say might be just incidental finding.

Re: Icteric labrador

Anthony Dennison — Thu, 05 Feb 2015 15:25:20 GMT

I think the cortisol is raised due to illness, and wouldn't concentrate on it currently. I think a Bile Acid Stim test and abdominal imaging (ultrasound to look at the liver architecture, especially the gall bladder) would be the next best step.

Labradors will eat until they are on death's door sometimes, and there are some significant liver changes there.