Physical examination findings include small size, poor haircoat, and occasional renal enlargement . Ascitis is seen in canines with intrahepatic arteriovenous. ECG bpm. Gracias! AGENTE ETIOLÓGICO Dirofilaria immitis. Asintomático Paciente asintomáticos: Leve perdida de peso. Agitación. Diagnóstico de la dirofilariosis cardiopulmonar canina. Ascitis en un perro con dirofilariosis (Cortesía de J. A. Montoya-Alonso, Facultad de.
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Hepatic disease is often treatable and has a predictable prognosis when a definitive diagnosis is made. The aim of clinicopathological evaluation of hepatobiliary affections is to identify and characterize hepatic damage and dysfunction, identify possible primary causes of secondary liver disease, differentiate causes of icterus, evaluate potential anaesthetic risks, assess prognosis and response to xenobiotics, and monitor response to therapy. This paper describes the different diagnostic methods and imaging techniques employed in diagnosis of hepatobiliary affections in dogs.
Besides reviewing the significant clinical manifestations and imaging structural abnormalities in diagnostic approach to different hepatic affections, it also depicts radiographic, ultrasonographic, and wherever applicable, the laparoscopic characterization of different hepatic affections and target lesions encountered in clinical cases presented in the Teaching Veterinary Clinical Complex, COVAS, Palampur in the year Hepatic affections in the dog are associated with varied and often vague clinical signs and thus frequently present a diagnostic challenge to veterinary practitioners.
Furthermore, systemic diseases and various drugs can cause misleading increases in serum activities secondary or reactive hepatopathiesand it can be a clinical dilemma to decide whether liver enzyme elevations are significant, and whether they represent primary or secondary liver disease [ 2 ]. Despite availability of a range of diagnostic tests of both hepatic damage and dysfunction, there is rarely a single test that adequately identifies hepatic disease or its underlying cause.
The role of survey radiography in detecting the alteration in liver size has been widely emphasized. But with the advent of time, ultrasonography evolved as the paramount technique of diagnostic imaging. The desirable virtues of less time consumption and noninvasive assessment of the detailed internal architecture of the liver and the adjacent structures, including the portal vein, established ultrasonography as the choicest technology, for identifying the various forms of hepatic disease in canines [ 2 ].
Presently, laparoscopy is also emerging as a fruitful imaging modality.
It offers tremendous advantage of direct visceral visual inspection of liver and allows its descriptive or photographic documentation. It is important to interpret all results in light of the other aspects of the diagnostic investigation, in particular the history and physical examination.
However, for identification of specific hepatopathies and thus establishment of definitive diagnosis of primary liver disease, the histopathological examination sacitis the liver biopsy specimens is usually required. By using a combination of history, physical examination findings, results ascitsi screening, and hepatobiliary-specific laboratory tests, the clinician usually becomes apt to describe the disorder as active or quiescent.
So in the light of all these aspects, a complete evaluation comprising of the following tests, must be conducted. The complete blood count CBC is an integral part of the diagnostic investigation of any systemic disease process or for that matter of hepatic affections. It consists of quantitative and qualitative examination. The qualitative examination includes examination of blood smears for changes in cellular morphology. Biochemical findings often prove to be the most useful aid in the diagnosis of hepatobiliary affections.
Liver-specific serum enzyme activities are included routinely in screening serum biochemistry panels and are regarded as markers of hepatocellular and biliary injury and reactivity [ 2 ]. In addition to this, many biochemical tests are not specific indicators of liver disease, but do offer a crude assessment of liver status, or aid recognition of diseases that either mimic the clinical signs of liver disease or actually cause secondary liver disease.
Urine analysis provides rapid and valuable information about the urinary tract and other body systems including liver. A complete urine analysis including dipstick, specific gravity SGand sediment examination is often required, even if one component part shows no abnormalities [ 2 ].
Concurrent serum biochemical analysis, although, is often required to gain maximum benefit from urine analysis. There is definite change in the appearance of the faeces in hepatobiliary affections. So, ascitus faecal specimen analysis must be conducted although it rarely provides useful information in the evaluation of the dog with suspected hepatobiliary affection.
Diagnostic Imaging of Canine Hepatobiliary Affections: A Review
Analysis of abdominal effusions is an important component of diagnosis. It can either assist in timely identifying the pathological process responsible for the fluid accumulation or it asccitis help in indicating further investigative procedures which may be helpful in diagnosing the affection [ 4 ]. The abdominal effusion so obtained is analysed by subjecting it to gross examination, cytological examination, and microbiological examination.
Besides, total protein concentration and total nucleated cell count is also evaluated [ 2 ]. The effusion analysed is then classified as transudate, modified transudate, or exudates Figure 3. Six-year-old neutered male Labrador Retriever dog positioned in left lateral recumbency for ultrasound-guided abdominocentesis. The needle is directed perpendicular to the abdominal wall, with care taken to avoid the spleen.
Two-dimensional ultrasonographic appearance of gauge needle as hyperechoic structure within the textured abdominal effusion in 6-year-old male Labrador Retriever affected with infectious peritonitis. Gross appearance of the abdominal effusion septic exudate obtained under ultrasound guidance from 6-year-old male Labrador Retriever affected with infectious peritonitis.
The liver plays a central role in the coagulation and fibrinolytic systems, asfitis subtle abnormalities may be detected by assay of individual factor activities. Whilst a bleeding diathesis will be expected if there is a history of gastrointestinal bleeding, an occult tendency should always be suspected, and a clotting profile is mandatory before a liver biopsy is performed [ 3 ].
The coagulation profile should comprise evaluation of buccal mucosal bleeding time, whole blood clotting time, one-stage prothrombin time OSPT or PTand activated partial thromboplastin time aPTT. In conjunction to it, an assessment of fibrin degradation products FDPsD-dimers, and vitamin-K should also be made [ 2 ].
These tests can be very useful in diagnosing hepatic affections, with the exception of those patients, who are icteric. These tests rely on analysis of paired blood samples to assess the capacity of the liver to clear endogenous bile acids and ammonia or exogenous bromosulphthalein and indocyanine green substances from the circulation [ 2 ].
Therefore, additional tests, including portovenography, ultrasonography, and liver biopsy are required [ 2 ]. However, lack of abdominal contrast and insensitivity to detect subtle changes limits the precision of abdominal radiography. It is difficult to evaluate the entire liver as much of the liver is silhouetted by the diaphragm, stomach and right kidney [ 5 ].
In suspected cases of hepatic neoplasia, thoracic films to evaluate the pulmonary metastasis are also desired. Left lateral capnoperitoneograph enhancing visualization of right liver lobes and diaphragmatic border in 8-year-old male Dobermann Pinscher dog demonstrating classical signs of pulmonary metastasis with strong suspicion for hepatic neoplasia.
Right lateral capnoperitoneograph enhancing visualization of left liver lobes and diaphragmatic border in 8-year-old male Dobermann Pinscher dog demonstrating classical signs of pulmonary metastasis with strong suspicion for hepatic neoplasia. Grasping of jejunal loop under laparoscopic-guidance for performing laparoscopic guided and laparotomy assisted introperative mesenteric portography in 1-year-old male mixed breed dog with progressive weakness.
Normal-appearing hepatic angiogram, demonstrating jejunal mesenteric vein normally draining into the portal vein and the extensive portal vein branches in1-year-old male mixed-breed dog.
Ultrasound-guided percutaneous normal-appearing splenic portogram demonstrating splenic vein normally draining into portal vein with hepatic contrast opacification in 3-year-old male Labrador Retriever dog.
Ultrasonography is an excellent noninvasive way to evaluate liver parenchyma. It is particularly useful in differentiating focal from diffuse disease, cystic from solid masses and obstructive from nonobstructive icterus [ 5 ].
Indications for hepatic ultrasound usually include elevated liver enzymes and presence of free abdominal effusion. This procedure is also indicated for determining the extent of abdominal metastasis in cases of hepatic neoplasia and to image congenital or acquired portocaval or portosystemic shunts.
Doppler imaging confirms the location of the suspicious vessels and direction of the blood flow within and can also provide supportive evidence of intrahepatic portal hypertension by allowing the assessment of the speed and direction of portal flow [ 2 ].
Besides, ultrasound-guided percutaneous hepatic biopsy allows precise direction of the biopsy needle to the area of abdominal tissue while avoiding large vessels, the gall bladder, and the gastrointestinal tract [ 5 ]. Laparoscopy offers tremendous advantage of direct visceral visualization three-dimensional of the liver and adjacent structures such as the pancreas and extrahepatic biliary tract. Laparoscopy may reveal very small 0. Laparoscopy may also provide accurate, definitive and staging information that otherwise would have been obtained only through a surgical laparotomy.
It is seen that laparoscopy provides better liver biopsy tissues than any other traditional percutaneous methods especially when the liver is small [ 1 ]. It also provides the advantage of procuring biopsy from areas visually that are less vascular and to monitor the extent of bleeding after a biopsy [ 3 ].
It is preferred to percutaneous techniques when excess bleeding is expected and to laparotomy when delayed wound healing hypoalbuminaemia is anticipated. The minimal invasiveness of the procedure, rapid patient recovery, and diagnostic accuracy make laparoscopy an ideal technique compared with more invasive procedures.
Despite the advent of newer laboratory tests, imaging techniques, and ultrasound-directed fine-needle biopsy or aspiration, laparoscopy remains a valuable tool when appropriately applied in a diagnostic plan.
This technique requires heavy sedation or anaesthesia and is subject to equipment availability and clinician expertise. Scintigraphy nuclear imagingmagnetic resonance imaging MRIand computed tomography have recently been used in the diagnosis of hepatobiliary affections, but the need for radioisotopes and expensive equipment has restricted their use to the teaching institutions of developed nations.
Of these three imaging modalities, scintigraphy has been thoroughly evaluated for diagnosis of hepatobiliary affections in canines [ 2 ]. After an intravenous injection of radiopharmaceutical, scintigraphic images are made sequentially over 3 hours to determine whether isotope has been taken up by the liver, excreted into the biliary tract, and expelled into the intestine.
In canines with extrahepatic bile duct obstruction, no evidence of radiopharmaceutical is detected in the gall bladder or intestine. Another application of scintigraphy is used in the diagnosis of PSS in canines. Liver biopsy is often required to definitely characterize the nature and severity of the hepatic disease. It can be further used to differentiate acute from chronic disorders, to stage neoplastic disease and to assess response to therapy.
Selection of the best procedure for obtaining a liver biopsy depends on numerous factors including liver size, presence of coagulopathy, any focal or diffuse lesion, presence of biliary tract obstruction, or any other intra-abdominal abnormalities. The selection of the biopsy method also depends on likelihood of surgical resection of a mass, tolerance of general anaesthesia, available equipment and expertise of the clinician [ 2 ].
The biopsy specimens so procured are subjected to standardized processing and histopathological examination for yielding definitive diagnosis of hepatic affections.
ascites en caninos pdf – PDF Files
Laparoscopic-guided percutaneous Tru-Cut needle biopsy of caniha mass in 8-year-old intact male Labrador Retriever dog. Laparoscopic procurement of liver biopsy right flank approach depicting oval biopsy forceps grasping the hepatic nodule at the edge of right medial liver lobe in 7-year-old male mixed-breed dog with hepatic nodular hyperplasia and radiographic appreciation of pulmonary metastasis.
Laparoscopic postprocurement monitoring of liver biopsy site for bleeding in 7-year-old male mixed-breed dog with hepatic nodular hyperplasia. The following canine hepatopathies have been reviewed according to their prevalence in clinical practice.
In idiopathic chronic hepatitis, it is probable that after an initial inciting hepatocyte injury, immune mechanisms are involved in perpetuating the inflammation [ 8 ]. Familial chronic hepatitis in Bedlington terriers, Dobermann pinschers, West Highland White Terriers and Skye Terriers have a hereditary autosomal recessive inability to excrete copper in the bile that is associated with progressive hepatic copper accumulation and chronic liver disease [ 9 ].
Chronic drug administration heartworm preventatives, anticonvulsants, glucocorticoids, and chemotherapeutic drugs is a frequent cause of chronic hepatitis in canines [ 8 ].
Latent hepatic viral infection with canine adenovirus type I, which is responsible for infectious canine hepatitis ICHis also suspected to cause persistent inflammation and thus chronic hepatitis [ 9 ]. Cirrhosis is the irreversible end stage of the chronic hepatic injury caused by the infection, hepatotoxins copper and anticonvulsantsimmunologic injury chronic hepatitischronic cholestasis, and hypoxia [ 9 ].
Caninw inflammation, regeneration and fibrosis result in the development of portal hypertension and the establishment of multiple extrahepatic portosystemic shunts which in turn promote the development of ascites [ 18 ], whereas perihepatic changes such as ascites, portal and splenic vein dilation and splenomegaly might occur with cirrhosis because of portal hypertension [ 10 asitis.
Dogs affected by this condition are mostly young or middle aged adults of either sex with signs of hepatitis of varying severity. The symptoms included lethargy, depression, weight loss, vomiting, and jaundice. The physical examination findings with copper-associated acute hepatitis may include depression, lethargy, dehydration, jaundice, and hepatomegaly.
Erythrocytic morphologic changes which include variable red cell shapes poikilocytes with irregularly speculated erythrocytes azcitis or spur cells and target cells are considered to be consistent with chronic hepatobiliary disease [ 9 ].
An inflammatory leucogram is also sometimes seen in severe chronic inflammatory hepatopathies [ 8 ]. Consistent serum chemistry findings include increased ALT and ALP activity reflecting ongoing hepatic injury and intrahepatic cholestasis respectively, whereas less consistent findings include hypoalbuminaemia, hyperglobulinaemia, and abnormal haemostasis [ 9 ].
Ascitic fluid, when present, typically is a transudate or modified transudate [ 1 ]. Radiographic appearance of cirrhosed liver varies with the stage and severity of the disease and a small, dense liver with an irregular nodular surface may be identified with or without pneumoperitoneograph most commonly in cirrhosis [ 7 ]. However, radiographic appreciation of reduced liver size microhepatica is more difficult than hepatomegaly [ 11 ] Figure Right lateral radiograph of a 2-year-old castrated male mixed-breed dog with microhepatica.
The stomach is distended with gas, which provides contrast with asxitis liver shadow. Notice the proximity of the stomach to the diaphragm, implying reduced hepatic mass. Sonographic features in cases of cirrhosis vary from multiple hepatic nodules from asscitis regeneration besides hyperechoic hepatic parenchyma and decreased liver lobe size [ 12 ] to diffuse hyperechoic bright but small liver with distended gall bladder and irregular contour [ 1314 ].