Dr. Paul Hodges
Minimally Invasive Procedures
"Banana" the Cat
"Banana" presented to her veterinarian with an approximately 2 month history of intermittent vomiting, waxing and waning appetite, occasional lethargy, and "just not herself"
During the course of her examination, her veterinarian noted that she appeared moderately dehydrated and jaundice (yellow appearance to skin, whites of eyes and other areas)
Banana's diet had not been changed, she is strictly an indoor cat with no other cats in the household, and is up to date on her vaccinations. Banana is mildly overweight.
Banana was admitted to the hospital for further testing as well as IV fluids to help with her dehydration.
Banana's bloodwork showed significant changes to her liver enzymes (indicating liver inflammation and damage), her urine was consistent with liver disease, and her liver looked subjectively small on x-rays.
Banana's veterinarian recommended a liver biopsy to try to determine the underlying cause of her liver problem.
Bananas veterinarian recommended having the liver biopsy done laparoscopically.
A laparoscopic approach was taken to obtain a liver biopsy.
On visualization, the liver appeared quite small and pale in comparison to a normal liver (see 2 images)
Biopsy samples were taken and sent to the lab
A diagnosis of chronic fibrosing cholangiohepatitis (cirrhosis) was made based on histopathology and appropriate supportive measures were started.
Liver disease can occur for a large number of reasons in dogs and cats and will typically present with signs like this. While it is sometimes possible to determine the cause through bloodwork alone, additional testing is most often required (eg: urine tests, x-ray, ultrasound, etc). Unfortunately, many diseases can look the same and liver biopsy is often helpful in determining the underlying cause. Ideally, liver biopsies should be quick with minimal discomfort to the patient. Ultrasound guided biopsies can often be helpful, but do not allow direct visualization of the liver or potential for hemostasis if any bleeding occurs. This case serves to illustrate how a minimally invasive approach can benefit the patient and their treatment.