Case Studies | Internal Medicine

Asymptomatic and the hepatic enzymes elevation detected.

THE SITUATION
Bailey, a 9-year-old spayed female Labrador retriever, was presented to the ACCESS internal medicine service for further evaluation of increased hepatic enzymes. The owner reported that Bailey was very happy at home. She was completely asymptomatic and the hepatic enzymes elevation was detected at a routine examination before a dental procedure.

THE DIAGNOSIS
Bailey’s abdominal ultrasound revealed a diffusely nodular hepatic parenchyma with very irregular margins and a small amount of peritoneal effusion. She was diagnosed with copper-associated chronic hepatitis based on laparoscopy-assisted hepatic biopsy (picture 1 and 2) for histopathology, rhodanine staining, and copper quantification. The procedure was performed without any complications.

THE TREATMENT
Bailey recovered uneventfully from general anesthesia and was discharged from the hospital the same day. Based on the submitted test results, Bailey was treated with chelating therapy using D-penicillamine. A low-copper hepatic diet was also slowly introduced over a few weeks. She accepted the new food and tolerated the oral medication with no adverse reactions.

RESULTS
After several months of treatment, Bailey’s hepatic enzymes normalized and the peritoneal effusion resolved. Bailey continued to be very happy at home and her prognosis appears to be favorable at this time.

Picture 1.

IM-Case-Study-Bailey-Picture-1

Picture 2.

IM-Case-Study-Bailey-Picture-2

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