Iowa State University's College of Veterinary Medicine student Allison Masters presents a case of elevated liver enzymes as seen at Iowa Veterinary Specialties.

1. Laparoscopic Liver Biopsies
A Case of Elevated Liver
Enzymes
By: Allison Masters

2. Patient: Cain
• Cairn Terrier
• 11 years old
• Neutered male

3. Blood Work
• Elevated albumin
• Elevated liver enzymes
–Increased alkaline phosphatase (AlkP)
–Increased alanine transaminase (ALT)
• Elevated lipase
• Rest of blood work within normal limits

4. 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

5. 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

6. Liver biopsy sample being taken via laparoscopy

7. 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

8. 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