Hepatobiliary 2: Cases

Question 1

Peanut is a 9yo FS DLH with weight loss, anorexia for 2 weks, depression. She is icteric and dehydrated. Susp of hepatomegaly on abdominal palpation.

Erythrogram: decreased hct, decreased RBC, decreased hgb, retics not counted
Leukogram: increased WBCs, increased segs, increased monocytes, 2+ toxic change. Explain these changes, then move on to the biochem in the next card.

Answer 1

• mild anemia, normocytic, normochromic, we dont know about regernation, could be hemorrhage or anemia of inflammation?
• very mild leukocytosis characterized by a milkd neutrophilia and monocytosis, suggestive of more of a chronic inflammatory process

the anemia could be anemia of chronic inflammatory disease

Question 2

peanut’s biochem:
increase in: bilirubin, ALP, GGT, ALT, glucose, total protein, and globulin

interpret this shiz okaayyy

Answer 2

evidence of hepatocellular injury? ALT is increased so YES, AST not on this biochem panel and we dont have GLDH, LDH, or SDH

evidence of cholestasis? bilirubin, ALP, GGT are all increased and much more sevrely than the hepatocellular markers. cholesterol fine but he hasnt been eating so…ALP is esp high so we worry about hepatic lipidosis

evidence of decreased hepatic function? no, glucose, albumin, BUN, and cholesterol are all fine and not decreased

likely stress hyperglycemia

mild hyperproteinemia/hyperglobulinemia due to inflammation

diagnosis: hepatic lipidosis

Question 3

why does a portosystemic shunt cause a microcytosis? what are some other reasons or a microcytosis?

Answer 3

the shunting of blood affects iron metabolism in some way, we dont’ really know why. could also be iron def or breed related (japenese dogs)

Question 4

what changes in the urine will you see with a portosystemic shunt?

Answer 4

ammonia biurate urinary crystals

Question 5

what is the most common reason for a hypoglycemia on biochem?

Answer 5

failure to process sample appropriately, left sample on the bench forever