Laparoscopic Liver Biopsies

A Case of Elevated Liver Enzymes

By: Allison Masters

Patient: Cain

• Cairn Terrier• 11 years old• Neutered male

Blood Work• Elevated albumin• Elevated liver enzymes– Increased alkaline phosphatase (AlkP)– Increased alanine transaminase (ALT)

• Elevated lipase• Rest of blood work within normal limits

Abdominal Ultrasound• Liver

– diffusely nodular heterogeneous hypoechoic nodules

• Gallbladder– biliary sludge present

• Spleen– rounded margins

• Kidneys– mild chronic glomerulonepthritis

• Small intestine– mild concentric mural thickening

• Rest of ultrasound findings within normal limits

Laparoscopy• Incision caudal to umbilicus was made for

camera port• Organs visualized: liver, spleen, gall

bladder, small intestine, bladder, and colon– kidneys not able to be visualized with this

method• Liver

– multiple nodules within the parenchyma– Multiple biopsies taken

• Incision sites closed• No complications encountered

Liver biopsy sample being taken via laparoscopy

Liver Biopsy• Histopathology

– Hepatocytes contain glycogen-filled vacuoles

– Few lymphocytes, plasma cells, macrophages, and neutrophils

– Hepatocyte vacuolar degeneration due to nodular hyperplasia

• Bacteriology– Campylobacter negative– No growth in BHI broth

• Toxicology– Deficient in Copper

Treatment• Hospitalization

– Intravenous fluids for hydration– Fentanyl continuous rate

infusion for pain management• Chronic Management

– Tramadol for pain management– Denamarin for liver function and

support