11 yo fn WHWT with ascites and weight loss, no GI signs but mild hypoalbuminaemia and hypoglobulinaemia
Previous moderate to severe elevation of ALP>>ALT and pu/pd, ACTH stim grey zone
1.5 L fluid drained prior to me scanning, reported to be transudate on initial aspiration but sanguinous on drainage
11 yo fn WHWT with ascites and weight loss, no GI signs but mild hypoalbuminaemia and hypoglobulinaemia
Previous moderate to severe elevation of ALP>>ALT and pu/pd, ACTH stim grey zone
1.5 L fluid drained prior to me scanning, reported to be transudate on initial aspiration but sanguinous on drainage
I think the liver has slightly increased portal markings and a fine echotexture, the intestines are diffusely abnormal with muscularis hypertrophy, very mild lymphadenopathy. the spleen has areas of hyperechoigenicity, the adrenal glands were normal in size
Protein levels not low enough to be causing ascites and heart fine.
What do you think is causing the ascites…lymphoma and lymphatic obstruction? or potentially due to lymphoma or other disease of liver?
What do you think of the spleen?
veteurope1
7 responses to “Ascites”
assuming transudate fluid :
assuming transudate fluid : If no proteinuria then PLE likely with possible emerging GI LSA. If albumin is < 1.5 then the ascites can be from poor oncotic pressure. If > 1.5 then hydrostatic issues are in play amnd no liver failure. In the latter consider lymphatic obstruction/lsa. Needs full thickness of the GI and/or cytospin on the fluid and check for lymphoma cells.
With the weight loss and
With the weight loss and hypoproteinemia GI disease would be a very important possiblity. Do not need GI signs to hav severe GI tract disease.
In your clips I didn’t see
In your clips I didn’t see the spleen. Ascites could be due to 1) decreased oncotic pressure, 2) increased hidrostatic pressure, 3)increased vascular permeability. You already discarted 1).
Regarding:
2): Heart ok, but did you check portal hypertension? Is the CVC enlarged(possible thrombus)? Some kind of lymphatic obstruction also seems plausible.
3) I think less plausible in this case
No pulmonary
No pulmonary hypertension.
This animal went for ex-lap and I was told liver looked abnormal and biopsies were taken of liver and small intestine. I suspect ascites was from portal hypertension. Albumin was only mildly decreased. I will post histo results when back.
Thanks for your help .
Also, the kidney córtex
Also, the kidney córtex seemed quite hyperechogenic to me. Any sign of renal lesion on the UA?
Histo:
Liver – Biliary
Histo:
Liver – Biliary hyperplasia and fibrosis, multifocal, marked, with hepatitis, portal, lymphocytic, plasmacytic and neutrophilic.
7 responses to “Ascites”
assuming transudate fluid :
assuming transudate fluid : If no proteinuria then PLE likely with possible emerging GI LSA. If albumin is < 1.5 then the ascites can be from poor oncotic pressure. If > 1.5 then hydrostatic issues are in play amnd no liver failure. In the latter consider lymphatic obstruction/lsa. Needs full thickness of the GI and/or cytospin on the fluid and check for lymphoma cells.
With the weight loss and
With the weight loss and hypoproteinemia GI disease would be a very important possiblity. Do not need GI signs to hav severe GI tract disease.
In your clips I didn’t see
In your clips I didn’t see the spleen. Ascites could be due to 1) decreased oncotic pressure, 2) increased hidrostatic pressure, 3)increased vascular permeability. You already discarted 1).
Regarding:
2): Heart ok, but did you check portal hypertension? Is the CVC enlarged(possible thrombus)? Some kind of lymphatic obstruction also seems plausible.
3) I think less plausible in this case
No pulmonary
No pulmonary hypertension.
This animal went for ex-lap and I was told liver looked abnormal and biopsies were taken of liver and small intestine. I suspect ascites was from portal hypertension. Albumin was only mildly decreased. I will post histo results when back.
Thanks for your help .
Also, the kidney córtex
Also, the kidney córtex seemed quite hyperechogenic to me. Any sign of renal lesion on the UA?
Histo:
Liver – Biliary
Histo:
Liver – Biliary hyperplasia and fibrosis, multifocal, marked, with hepatitis, portal, lymphocytic, plasmacytic and neutrophilic.
Jejunum – Enteritis, neutrophilic, multifocal, moderate.
Liver disease causing portal hypertension the main culprit I suspect.
Makes sense thanks for the
Makes sense thanks for the followup