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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
.
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
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