Differential diagnoses in 83 dogs with icterus / Diagnósticos diferenciais em 83 cães com icterícia

Icterus (jaundice) is a yellowish pigmentation resulting from the depositing of bilirubin in tissues due to its high plasmatic concentration. The pathogenesis of icterus includes metabolic changes or obstructed bilirubin excretion and it is classified as pre-hepatic, hepatic and post-hepatic. This study aimed to evaluate and classify different causes of icterus in dogs during post mortem examination. These dogs were examined from 2014 to 2017, using macroscopic and histologic exams as well as ancillary tests. Eighty-three dogs were examined macroscopically and microscopically. They were separated into groups of icterus types: 24 (28.9%) dogs had pre-hepatic icterus, 45 (54.2%) had hepatic, 13 (15.7%) pre-hepatic and hepatic and one (1.2%) had post-hepatic icterus. Many factors were identified as a cause of icterus, including infectious agents (51/83), neoplasms (13/83), hepatic degeneration (11/83), chronic hepatic diseases (6/83), and obstructive causes (1/87). Among the infectious causes, leptospirosis, ehrlichiosis and disorders suggestive of septicemia were diagnosed. Neoplasms associated with icterus were cholangiocarcinoma, hemangiosarcoma and lymphoma. Other causes of icterus included degenerative diseases, such as lipidosis and glycogen degeneration. Hepatic fibrosis (cirrhosis) as a chronic disease and cholelithiasis also produced icterus. PCR was performed to confirm leptospirosis and ehrlichiosis. Samples of total DNA were used to amplify a fragment of a gene from Leptospira interrogans and Ehrlichia canis. In some dogs, co-infection of these agents was detected. The classification and identification of icterus etiologies in dogs is very important due to the number of diseases with this alteration, where ante mortem diagnosis is not always easily performed when some of these conditions are present.(AU)

Icterícia é a pigmentação amarelada decorrente da deposição de bilirrubina em tecidos devido à elevada concentração plasmática. A patogênese da icterícia inclui alterações no metabolismo ou na excreção de bilirrubina, sendo classificada em pré-hepática, hepática ou pós-hepática. O objetivo desse estudo foi identificar, avaliar e classificar as causas de icterícia em cães necropsiados de 2014 a 2017, associando as lesões macroscópicas, histológicas e exames complementares. Foram avaliados macro- e microscopicamente 83 cães com diferentes intensidades de icterícia. Os cães foram separados em grupos de acordo com o tipo de icterícia: 24 (28,9%) cães com icterícia pré-hepática, 45 (54,2%) cães com icterícia hepática, 13 (15,7%) com icterícia pré-hepática e hepática e um (1,2%) com icterícia pós-hepática. Foram identificadas várias etiologias associadas à icterícia, dentre elas pode-se destacar, agentes infecciosos (51/83), neoplasmas (13/83), processos degenerativos (11/83), crônicos (6/83) e obstrutivos (1/83). Dentre as causas infecciosas, destacam-se a leptospirose, a erliquiose e as lesões sugestivas de septicemia. Entre os neoplasmas associados com icterícia destacaram-se o colangiocarcinoma, hemangiossarcoma e linfoma. Outras causas de icterícia incluiriam os processos degenerativos como as degenerações gordurosa e glicogênica. Fibrose hepática (cirrose) e colelitíase foram também diagnosticados como causa de icterícia. A PCR foi utilizada para o diagnóstico confirmatório de leptospirose e erliquiose. Amostras de DNA total foram utilizadas para amplificar um fragmento dos genes de Leptospira interrogans e de Ehrlichia canis. Em alguns cães foi detectada co-infecção por estes agentes. A classificação e a identificação das causas de icterícia em cães são relevantes devido ao grande número de doenças que apresentam essa alteração, muitas vezes sem diagnóstico ante mortem.(AU)

Espectro morfológico de la biopsia hepática / Morphologic spectrum of liver biopsy

La biopsia hepática constituye un excelente método diagnóstico en el espectro de la patología hepática. Para algunos autores la biopsia hepática no es considerada como el "método más indicado" debido al error de muestreo y las variaciones interobservador, sin embargo, sigue considerándose por muchos el "método de elección". Se recopilaron y analizaron en forma retrospectiva, las preparaciones histológicas y las boletas de solicitud de biopsias de todos los casos de biopsias hepáticas, provenientes de la Sección de Patología Gastrointestinal y Hepática "Dr. Pedro Grases" del Instituto Anatomopatológico "Dr. José A. O’Daly" de la Universidad Central de Venezuela, en el lapso comprendido entre enero de 1996 y diciembre de 2006. Pacientes 50,8% eran mujeres y 46,8% hombres. El grupo etario más afectado (55,4%) fue entre 31 y 60 años. Los hallazgos clínicos más frecuentes fueron ictericia (7,9%) y dolor en hipocondrio derecho (5,3%). Frecuencia de los diagnósticos histopatológicos: esteatosis (15,1%), hepatitis por virus C (12,3%), tumores metastásicos (8,9%), cirrosis (8,1%), esteatohepatitis (6,6%), patologías vasculares (5,4%), tumores primarios hepáticos (4,1%). La biopsia hepática es una excelente herramienta para el diagnóstico y tratamiento, si se realiza una buena correlación clínico patológica

Liver biopsy is an excellent diagnostic method in the spectrum of liver pathology. For some authors liver biopsy is considered the "best method" due to sampling error and interobserver variations, however is still considered by many the "method of choice". We collected and analyzed retrospectively, the histological preparations and request ballots biopsies of all cases of liver biopsies, from the Section of Gastrointestinal and Liver Pathology "Dr. Pedro Grases "Institute of Pathology" Dr. José A. O’Daly "Central University of Venezuela, in the period between January 1996 and December 2006. 50.8% patients were female and 46.8% male. The most affected age group (55.4%) was between 31 and 60 years. The most frequent clinical findings were jaundice (7.9%) and right upper quadrant pain (5.3 %). Frequency of histopathological diagnoses: steatosis (15.1%), hepatitis C virus (12.3%), metastatic tumors (8.9%), cirrhosis (8.1%), steatohepatitis (6.7%), vascular diseases (5.4%), primary liver tumors (4.1%). Liver biopsy is an excellent tool for diagnosis and treatment, if you do a good clinicopathologic correlation

Renohepaticopancreatic dysplasia: diagnostic dilemma

We present the case of an eighteen day old baby boy hospitalized with an abdominal mass, renal insufficiency and jaundice. Multiple radiographic, radionuclear and surgical interventions were required to diagnose renohepaticopancreatic dysplasia, also known as Ivemark II syndrome. In spite of aggressive intensive care support, the patient developed multisystemic organ failure and died. Clinical presentation and autopsy findings are presented.

"EXPATH" an expert system for pathology for the diagnosis of jaundice.

Computers are increasingly playing an important role in the field of medicine. A computer aided expert system has been developed for the differential diagnosis of jaundice. In this article the major features and application of this modular software are discussed.

Endotoxin-induced enteric hypomotility in jaundiced loops in vitro

Biliary obstruction may be accompanied by systemic endotoxemia due to increased growth of enteric microbiota and failure of hepatic clearance mechanisms. This endotoxemia is related to increased postoperative morbidity and mortality. An increased growth of the aerobic flora has been demonstrated experimentally in the presence of biliary obstruction, and in previous studies we observed intestinal hypomotility of jaundiced loops in vitro. To determine the ileal motor response in the presence of jaundice caused by biliary obstruction and in the presence of endotoxemia, an in vitro study was carried out on ileal segments from 10 female Holtzman rats, 2-3 months old, weighing 200 to 300 g, divided into two groups (N = 5): A, washed loops of jaundiced rats, and B, washed loops of jaundiced rats to which endotoxin was added. On the seventh postoperative day, we evaluated the effect of exogenous endotoxin (E. coli 0111:B4, Sigma) on the motor response to acetylcholine of distal ileal segments isolated from both animal groups. A 4-cm ileal segment, located 10 cm from the ileal papilla, was removed and studied in an organ chamber in order to assess dose-response curves to acetylcholine. There was an increase in threshold dose in jaundiced loops with intraluminally injected endotoxin when compared with the loops without intraluminal endotoxin (291 + 188 vs 8.5 + 6.7 muM, P<0.05). The maximum contraction was reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (5.3 + 1.7 vs 18.7 + 4.8 mm, P<0.05), and pD2 was also reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (2.4 + 0.6 vs 3.7 + 0.5, P<0.05). There was no statistical difference between jaundiced loops with and without intraluminal endotoxin when the maximal contraction doses were compared (86 + 66 vs 48 + 22 mM, P>0.05). These results demonstrate that intraluminal endotoxin depressed enteric motility in jaundiced rats.

Cáncer de la ampolla de Vater / Cancer of the Vater ampulla

Se presenta una serie de 18 pacientes sometidos a pancreatoduodenectomía por cáncer de ampolla de Vater, entre febrero de 1983 y marzo de 1994, 10 hombres y 8 mujeres con una edad promedio de 57 años. Los síntomas más frecuentes de presentación fueron ictericia en 17 enfermos (94.4 por ciento9 y baja de peso en 11 (61.1 por ciento). La complicación quirúrgica más frecuente fue la fístula pancreática en 4 pacientes (22 por ciento). Falleció un enfermo (5.5 por ciento), lográndose una sobrevida actuarial de 38 por ciento a 5 años, para la serie global

Gall bladder carcinoma sonographic diagnosis

Carcinoma of the gall bladder is difficult to diagnose in its early stage owing to non-specificity of its clinical symptoms which are similar to gall stone disease. Sonographic features of 23 patients verified to have gall bladder carcinoma were reviewed. The main features were large solid mass filling the gall bladder cavity in 52% of cases, tumourous growth along irregularly thickened bladder wall in 30%, polypoid mass in 9% and fungating mass on markedly thickened wall in 9%. Associated features were gallstones in 78%, cholecystitis in 65%, liver metastases in 17%, biliary radicles dilatation in 13%, empyema in 9% and ascites in 4%. Sonography is a useful method for the preoperative diagnosis of gall bladder carcinoma

Evaluation of computed tomography and ultrasound of pancreas in jaundiced and non-jaundiced patients with pancreatic cancer

A retrospective study was performed to find a single best imaging method for pancreatic cancer. In a total of 28 patients, 20 presented with obstructive jaundice and the remaining 8 presented with a mixture of symptoms such as abdominal pain, weight loss and anorexia. 10 of the jaundiced and 5 of the non jaundiced patients had both computed tomography [C.T.] and ultrasound [U.S.] examinations. This study shows that U.S. can be used as a single best modality in patients with obstructive jaundice suspected of pancreatic malignancy. It also shows that C.T. is much superior modality to U.S. in non jaundiced patients with symptoms suggestive of pancreatic malignancy

Vomiting of gall stones: a case report

A case of vomiting gall stones, which is very rarely reported, is presented here - with with a discussion of signs and symptoms and diagnosis of such a case