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Christi

• Patient:
  Christi, 8 year old spayed female Pekinese.



• Presenting complaint:
  Referred with a diagnosis of Cushing’s disease, increased liver enzymes and bile acids.



• Diagnostic studies before laparoscopy:
  Bile acids, liver enzymes, and cortisol levels were increased. The urine was dilute with a specific gravity of 1.018. Coagulation studies were normal. Abdominal radiographs were used to identify a small liver and ultrasonography that there were small multifocal nodules in the liver. Liver biopsies were wanted in order to determine type of disease and whether it might be reversible.



• Endoscopic procedure:
  Laparoscopic biopsy. There was disease throughout the liver, but the most obvious change was multifocal nodular hyperplasia. This was a response by the liver attempting to heal itself.



• Benefits of using endoscopy:
  A large biopsy is required for high diagnostic accuracies. Needle biopsies using ultrasound guidance have been found to have very low accuracy, particularly for many liver diseases. (Reference: Cole TL, et al: Diagnostic comparison of needle and wedge biopsy specimens of the liver in dogs and cats. JAVMA 2002; 220: 1483-1490). When liver disease has produced bleeding tendencies, we feel that laparoscopy produces fewer insults likely to produce hemorrhage as compared to traditional open laparotomy. Examples of the sizes of biopsies obtained from open surgery, laparoscopic surgery, and needle biopsy devices are presented.

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