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Lily McIntyre PID 159285

Lily McIntyre PID 159285. James Montgomery. History. 5 month old female golden retriever Progressive abdominal effusion, lethargy, and vomiting History of dietary indiscretion Intermittently inappetent Multiple biochemistry panels revealed persistently elevated liver enzymes. Presentation.

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Lily McIntyre PID 159285

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  1. Lily McIntyrePID 159285 James Montgomery

  2. History • 5 month old female golden retriever • Progressive abdominal effusion, lethargy, and vomiting • History of dietary indiscretion • Intermittently inappetent • Multiple biochemistry panels revealed persistently elevated liver enzymes

  3. Presentation • Marked abdominal distension • Moderately increased ALP • Mildly increased ALT • Hyperbilirubinemia • Panhypoproteinemia • Elevated pre- and post-prandial bile acids • Abdominal fluid: pure transudate

  4. Diagnostic Imaging • Thoracic radiographs - Acc: 142708 • Sternal lymphomegaly • Peritoneal fluid

  5. Diagnostic Imaging • Abdominal ultrasound – Acc: 142721 • Liver generally hyperechoic and smaller on left • Several hypoechoic nodules on right • Rounded liver lobes • No aberrant vessels identified to suggest PSS • Portal vein to aorta ratio is 0.82 • Normal portal velocity – no evidence of portal hypertension • Kidneys mildly larger than expected

  6. Diagnostic Imaging • CT – Acc: 142777 • Portosystemic shunt via left gastric vein • Microhepatia • Possible portal hypertension • Ascites, gastric and pancreatic edema • Acquired shunt?

  7. Clinical picture • Evidence of portal hypertension with PSS? • Not likely congenital PSS • Suspect congenital liver disease • Owners elected euthanasia with necropsy

  8. Necropsy • Liver small and firm • Left gastric vein PSS • Multiple small acquired shunt vessels at the root of mesentery • Marked ascites • Histopath: Diffuse, severe, lobular dissecting hepatitis

  9. Lobular Dissecting Hepatitis • Rare, progressive hepatitis seen mainly in young dogs • Median age in one retrospective study was 11 months with 54% of the dogs being 7 months or younger • Comparable to neonatal hepatitis in humans with a wide variety of possible etiologies (viral, toxoplasmosis, Treponemapallidum, metabolic, toxins, idiopathic) • Present with abd distension, weight loss, anorexia, diarrhea, polydipsia, vomiting • Several cases occurred in littermates • Cause unknown • Prognosis is poor as progresses to cirrhosis Van den Ingh and Rothuizen, JVIM 1994;8:217-220.

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