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Yvonne McGrotty BVMS, CertSAM, DipECVIM-CA, MRCVS.
Haematology mostly unremarkable. Some mild and non-specific biochemical changes were noted. A bile acid stimulation test was performed and suggested adequate liver function in this cat (Bile acids >30 considered to be clinically significant). Clotting times were unremarkable (see below).
| BIOCHEMISTRY | ||||
| Dynamic Bile Acids | ||||
| Bile Acids | 2.5 | umol/l | 0.0 - 15.0 | |
| Total Bilirubin | 5.0 | umol/l | 0.0 - 10.0 | |
| Bile Acids post feed | H 29.7 | umol/l | 0.0 - 15.0 | |
| Full Blood Count | ||||
| WBC | 6.7 | x10^9/l | 4.0 - 15.0 | |
| RBC | 7.41 | x10^12/l | 5.50 - 10.00 | |
| Haemoglobin | 8.5 | g/dl | 8.0 - 15.0 | |
| PCV | 28.0 | % | 27.0 - 50.0 | |
| MCV | L 37.8 | fl | 40.0 - 55.0 | |
| MCH | L 11.5 | pg | 13.0 - 17.0 | |
| MCHC | L 30.4 | g/dl | 31.0 - 34.0 | |
| Platelets | 449 | x10^9/l | 200 - 600 | |
| % | Range | x10^9/l | Range | |
| Neutrophils | 45 | 45 -75 | 3.0 | 2.5 - 12.5 |
| Lymphocytes | H 52 | 25 -33 | 3.5 | 1.5 - 7.0 |
| Monocytes | 1 | 0 - 4 | 0.1 | 0.0 - 0.8 |
| Eosinophils | L 2 | 4 -12 | 0.1 | 0.0 - 1.5 |
| Basophils | 0 | 0 -1 | 0.0 | |
| Film | Film confirms platelet count | |||
| Burr cells + | ||||
| Schistocytes + | ||||
| Acanthocytes + | ||||
| Occasional microcyte seen |
| Total Protein | 64.3 | g/l | 54.0 - 78.0 | |
| Albumin | 30.3 | g/l | 21.0 - 39.0 | |
| Urea | 7.5 | mmol/l | 6.0 - 10.0 | |
| Creatinine | 172 | umol/l | 80 - 180 | |
| Total Bilirubin | 5.0 | umol/l | 0.0 - 10.0 | |
| ALP | 29 | u/l@37C | 0 - 40 | |
| ALT | H 48 | u/l@37C | 0 - 20 | |
| AST | 31 | u/l@37C | 0 - 69 | |
| Gamma GT | 2.0 | u/l@37C | 0.0 - 27.0 | |
| Calcium | 2.43 | mmol/l& | 1.60 - 3.00 | |
| Phosphate | 1.72 | mmol/l | 1.40 - 2.60 | |
| Sodium | H 157 | mmol/l | 120 - 155 | |
| Potassium | 4.40 | mmol/l | 3.60 - 5.60 | |
| Chloride | 122 | mmol/l | 112 - 129 | |
| Glucose - Random | No oxf sample receive | |||
| Triglycerides | 0.46 | mmol/l | 0.22 - 1.24 | |
| Cholesterol | 2.5 | mmol/l | 1.9 - 3.9 | |
| HAEMATOLOGY | ||||
| PT and APTT | ||||
| PT | 10 | secs | ||
| APTT | 17 | secs | ||
| PKD | Positive | |||
| CYTOLOGY | ||||
| Fluid Analysis- from free abdominal fluid | ||||
| Fluid Protein | 39.3 | g/l | ||
| Fluid Albumin | 18.8 | g/l | ||
| Fluid Globulin | 20.5 | g/l | ||
| Fluid Albumin:Globulin | 0.9 | |||
| Fluid Specific Gravity | 1.030 | |||
| WBC | 0.91 | |||
| RBC | 0.01 | |||
| Abdominocentesis was performed and a straw-coloured fluid collected for
analysis. The free abdominal fluid was a modified transudate containing non-degenerate neutrophils and occasional reactive mesothelial cells (see below). | ||||
| Surgical Exploration The abdomen was surgically explored under general anaesthesia. The abdomen contained a significant quantity of straw-coloured free fluid. The liver was massively enlarged and cystic. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 Figure 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Figure 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The left medial and proximal left lateral, quadrate, right medial lobes
and papillary process of the caudate lobe were diffusely affected. The right
lateral lobe, and distal extremity of left lateral lobe had a more normal
appearance, although the liver tissue was firm and had a nodular appearance. Both kidneys were identified at surgery and both had cystic changes. The rest of the abdomen was unremarkable. The stomach was unaffected but was being compressed by the mass. Two liver biopsies were obtained were sent for histology. Surgical resection of the mass was not possible, but numerous cysts were drained resulting in a 30-40% reduction in the size of the liver. The cat recovered uneventfully from anaesthesia and was discharged 24 hours later with an S-Adenosyl methionine supplement. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| One of the liver cysts was aspirated and fluid results are as follows: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Cytological examination was consistent with a cystic fluid with evidence of both previous and iatrogenic haemorrhage. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Histopathology was consistent with multiple biliary cysts with some areas of nodular hyperplasia with vacuolar change. There was no evidence of neoplasia or inflammation in any of the sections. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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