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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
âSophieâ
1 yo FS Chihuahua
Intermittent lethargy
Dull mentation
Chronic diarrhea
âJackâ
8 mo MC Domestic short hair
Urinary stones
Head tremor
13. Additional Diagnostics
â˘Bile Acids
⢠KEY: Pre- and Post
⢠KEY: Liver Function Test, NOT PSS Test
â˘Fasted Ammonium
⢠Sensitive PSS Test
⢠KEY: Handle Sample Correctly
â˘Abdominal Ultrasound
⢠KEY: Doppler
⢠NEW: Microbubbles
⢠KEY: The Bladder!
14. The âQuietâ PSS
â˘âPoofyâ 1 yo MI Yorkie
â˘Presented for castration
â˘Undersized
â˘Post Prandial Bile Acids elevated
â˘Ultrasound â No Shunt
â˘Transcolonic Scintigraphy - Normal
15. The âQuietâ PSS
â˘Portal Vein Hypoplasia, also called MVD
(microvascular dysplasia)
â˘Looks like a Shunt, Smells like a Shunt
â˘Colonic Scintigraphy â Normal
â˘Histopathology
â˘NEW: [Protein C] High in MVD
â˘No Surgical Option
â˘Older Dogs
â˘Lesser Clinical Signs
â˘Different Anatomy: Porto-Azygos Shunt
â˘Surgical vs. Medical?
17. First Things First: PCV (Hct)/TP
âCrit Tubeâ
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)
âBellaâ
8 yo FS Labrador Ret
Anorexia, lethargy, vomiting
Weight-loss, jaundice
âGrumpyâ
8 yo MC Domestic short hair
Anorexia, vomiting, ptyalism
Febrile, jaundice
HEPATIC