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1. Diagnosing Liver Disease
(in 30 minutes!)
Craig B Webb, PhD, DVM, DACVIM
Professor & Head Small Animal Medicine Section
Colorado State University
Veterinary Teaching Hospital

2. Disclosure #1
None of the patients in this presentation are
members of my immediate family
.

3. Function
Glucose
Albumin
Cholesterol
BUN
Bile Acids
Damage
ALT
Toxin, Drugs, Cu
Inflammation
Infection
Immune
Histopathology
Reactive
ALP
Biliary
total bilirubin
PCV/TP
Imaging
Cytology & Culture

4. Liver Function
Congenital Portosystemic Shunts
“Sophie”
1 yo FS Chihuahua
Intermittent lethargy
Dull mentation
Chronic diarrhea
“Jack”
8 mo MC Domestic short hair
Urinary stones
Head tremor

5. Congenital Portosystemic Shunt
•Clinical Signs: Wide Range and Variable
•CNS (HE), Hypersalivation & seizures (cats)
•Urinary (Polyuria/Polydipsia, Stones)
•Growth (Poor doer)
•Gastrointestinal (Vomiting/Diarrhea)

6. Congenital Portosystemic Shunt
•Biochemical Profile
•KEY: The Liver is Not Working Well

7. Sig: 1.5 year old FS Yorkie
CC: “Big belly” full of fluid, acting “funny”

8. Clinical Diagnosis – It Must Be!
Congential Portosystemic Shunt

9. Congenital Portosystemic Shunt
•Biochemical Profile
•KEY: They Do Not Develop Ascites or Turn Yellow

10. Intestinal Lymphangiectasia

11. Congenital Portosystemic Shunt
•Biochemical Profile
•KEY: Liver Enzymes Do Not = Liver Function

12. Congenital Portosystemic Shunt
•CBC
•KEY: Microcytosis
Leukocytosis, nonregenerative anemia

13. Additional Diagnostics
•Bile Acids
• KEY: Pre- and Post
• KEY: Liver Function Test, NOT PSS Test
•Fasted Ammonium
• Sensitive PSS Test
• KEY: Handle Sample Correctly
•Abdominal Ultrasound
• KEY: Doppler
• NEW: Microbubbles
• KEY: The Bladder!

14. The “Quiet” PSS
•“Poofy” 1 yo MI Yorkie
•Presented for castration
•Undersized
•Post Prandial Bile Acids elevated
•Ultrasound – No Shunt
•Transcolonic Scintigraphy - Normal

15. The “Quiet” PSS
•Portal Vein Hypoplasia, also called MVD
(microvascular dysplasia)
•Looks like a Shunt, Smells like a Shunt
•Colonic Scintigraphy – Normal
•Histopathology
•NEW: [Protein C] High in MVD
•No Surgical Option
•Older Dogs
•Lesser Clinical Signs
•Different Anatomy: Porto-Azygos Shunt
•Surgical vs. Medical?

16. The Yellow Patient
Hyperbilirubinemia

17. First Things First: PCV (Hct)/TP
“Crit Tube”
PRE-HEPATIC
LOW PCV/NORMAL TP
e.g. Hemolysis (IMHA)
HEPATIC
POST-HEPATIC
IMAGING (Ultrasound)
e.g. Gall bladder mucocele
Choi et al. Vet Radiol Ultrasound 2014

18. Liver Damage (Dogs)
& Biliary Disease (Cats)
“Bella”
8 yo FS Labrador Ret
Anorexia, lethargy, vomiting
Weight-loss, jaundice
“Grumpy”
8 yo MC Domestic short hair
Anorexia, vomiting, ptyalism
Febrile, jaundice
HEPATIC

19. Feline Cholangitis
Neutrophilic (Acute or Chronic)
Lymphoplasmacytic

20. Feline Cholangitis
Neutrophilic
•Most Common
•ACUTE: Young
•CHRONIC: Older
•Fever & Anorexia
•V/D, icterus, abd pain
• total bilirubin
•Leukocytosis
•ALT, GGT > ALP
•Ultrasound
Ultrasound
sensitivity = 87%
specificity = 90%

21. Feline Cholangitis
Neutrophilic
• Cholecystocentesis
• Cytology & Culture
• Bacterial infection
• E coli
• Enterococcus
• Staph & Strep
• Clostridium
• Bacteroides
• Salmonella
• Pasteurella
22 g
US-guided: thru R-medial liver lobe

22. Feline Cholangitis
Lymphocytic
•European
•Any age
• Persians, N. Forest Cat
•Anorexia, weight loss
•Ascites, jaundice
•Hypergammaglobulinemia
•Ultrasound
•Histopathology

23. Feline Triaditis
Cholangitis, Pancreatitis, IBD

24. Canine Hepatopathy
K9 Copper-associated Hepatitis

25. K9 Copper-associated Hepatitis
Clinical Signs
•Anorexia & Lethargy
•Vomiting
•Weight-loss
•Jaundice
•Hepatic
encephalopathy
•Ascites
•PU/PD
Laboratory
Abnormalities
Non-Specific for [Cu] dz
•ALT (ALP) – Not Sensitive
•Bile Acids (IF NOT YELLOW)
•Total bilirubin
•Clotting times
•Decreased PCV
•{Fanconi’s Syndrome}

26. LIVER BIOPSY
with [Cu] quantification

27. Reactive
Reactive Hepatopathy (Dog)
Hepatic Lipidosis (Cat)
K9 [ALP] “Mr. Fatty”
6 yo MC Domestic short hair
Anorexia, weight-loss
Vomiting

28. Reactive Hepatopathy
Liver disease that is not Liver disease
K9 Reactive
Hepatopathy
• [ALP] Non-Specific
• Differentials:
• Drugs
• Gm- infection
• Endocrinopathies
• Benign Nodular
Hyperplasia
Feline Hepatic
Lipidosis
• Overweight & Anorexia
• ALP >>> GGT
• Icterus
• CONCURRENT DISEASE

29. Function
Glucose
Albumin
Cholesterol
BUN
Bile Acids
Damage
ALT
Toxin, Drugs, Cu
Inflammation
Infection
Immune
Histopathology
Reactive
ALP
Biliary
total bilirubin
PCV/TP
Imaging
Cytology & Culture

30. THANK YOU!
Serge Martinod
Directeur Scientifique,
Dr. Vétérinaire, Arcanatura SAS