Rocky Hays

PATIENT: Rocky Hays

HISTORY: ?severe primary hepatopathy – marked elevation in liver enzymes and bile acids 250, jaundiced, anorexia

Abdominal U/S

SUMMARY:

The findings confirm the suspicion of a severe primary hepatopathy and despite the elevation in coagulation times (PT 40 Р2.5 upper limit of reference range, APTT 152 0.5x upper limit) ultrasound guided biopsy was performed (4x upper limit is a contra-indication to guided biopsy).  There is no evidence of congenital portosystemic shunt although turbulent flow surrounding the renal vessels, elevated portal vein flow (0.5M/S), urinary sediment and splenorenomegaly Рare suggestive of acquired portosystemic shunting due to portal hypertension.

LIVER: Abnormal: significantly small, coarse hypoechoic exchotexture, regular margins

BILIARY TRACT: Abnormal: thickened gallbladder wall consistent with primary hepatopathy

SPLEEN: Normal to mildly enlarged

LEFT KIDNEY: Normal to mildly enlarged 7cm length

RIGHT KIDNEY: Normal as above

LEFT ADRENAL: Normal

RIGHT ADRENAL: Normal

URINARY BLADDER: Abnormal: moderate quantity of urinary sediment

ILIOSACRAL LYMPH NODES: Normal

VISCERAL LYMPH NODES: Normal

STOMACH: Normal

SMALL INTESTINES: Normal

LARGE INTESTINES: Normal

PANCREAS: Normal

GENITAL TRACT: Prostate small and hypoechoic

Echocardiography

Not Applicable.

U/S Guided Samples: Results

HISTOLOGY REPORT

SPECIMEN

3x biopsies from liver

HISTOPATHOLOGY

Three sections of liver are examined and there is no normal liver present. There is severe degeneration vacuolar swelling and necrosis of hepatocytes (particularly periacinar to midzonal hepatocytes) with moderate to marked expansion of portal tracts with hyperplasia and duplication of biliary epithelia/ducts and moderate to marked neutrophilic to plasmacytic portal infiltrates. Multifocally, there are aggregates of erythroid and myeloid precursors (extramedullary haematopoiesis). There is a moderate increase in macrophages/Kupffer cells that often contain large amounts of yellow-gold pigment (bile/haemosiderin). Multifocally, small arterioles and biliary ducts display endothelial/epithelial necrosis.

DIAGNOSIS

Sever acute to subacute necrotising neutrophilic hepatitis

COMMENT

This is a severe and inflammatory liver disease and in my opinion, is consistent with an infectious process. There is some chronicity in this lesion suggested by the biliary proliferation although there is also a significant active inflammatory and necrotising component. I could not entirely exclude infectious canine hepatitis although specific viral inclusion bodies are not evident. My main differential is a severe subacute bacterial cholangiohepatitis.

Michael Rozmanec
BVSc, MVSc, MACVSc, DipACVP, MRCVS

ECG
Not Applicable.

Endoscopy
Not Applicable.

Other

Not Applicable

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