Beau, an eight-year-old neutered male standard poodle, was taken to his veterinarian for a routine dental procedure in September 2007. Pre-anesthetic blood work was performed and some liver abnormalities were discovered. The dental procedure was postponed and further diagnostics were carried out. Unfortunately, additional test results suggested Beau was suffering from acute liver damage. Beau was started on oral medications to help heal his liver and a prescription dietary change was implemented to reduce the liver workload.
The liver, an extremely important organ, has many functions in the body. If the liver is compromised for any reason, its functions (metabolism, vitamin and mineral storage, protein synthesis, detoxification of wastes) can be affected to varying degrees. For example, the liver plays a major role in protein synthesis, producing both albumin (a protein that maintains specific pressure within the blood vessels) and coagulation factors (proteins necessary for blood clotting). A patient with decreased levels of coagulation factors is at greater risk of experiencing hemorrhage during episodes of trauma or surgery. The liver also takes part in carbohydrate, protein and lipid metabolism. It is responsible for producing bile, an enzyme that aids in digestion. Bile, once produced, is excreted directly into the small intestine (where it works to break down lipids) and/or is stored in the gall bladder (between meals) for future use. If bile is not available, the body is unable to efficiently digest and absorb lipids for metabolism.
Beau was referred to the Ryan Veterinary Hospital in December 2007 due to ongoing weight loss and a worsening of his liver abnormalities. Blood tests and radiographs were repeated and confirmed progression of his liver disease. Because Beau’s blood tests and radiographs showed no sign of infection or cancer, an abdominal ultrasound was performed. The ultrasound suggested a possible obstruction of his bile duct, a tube that carries bile from the liver to the gallbladder and small intestine. This condition is of great concern due to the possible pressure build-up in the liver resulting from the obstruction, further increasing liver damage.
When suspected, a bile-duct obstruction can be life threatening and requires emergency surgery. Beau was taken immediately to surgery following his ultrasound, where a bile-duct obstruction had been confirmed. At surgery, doctors discovered that the bile stored in the gall bladder was abnormally thick, contributing to the obstruction in his bile duct. This diagnosis necessitated the removal of his gallbladder.
At the time of surgery, Beau experienced a significant amount of blood loss, requiring the administration of several units of packed red blood cells. Additionally, Beau’s clotting capability was compromised as a result of his decreased production of coagulation proteins. To aid his blood-clotting function, multiple units of fresh frozen plasma were administered to help provide the coagulation proteins his body could not produce on its own due to the compromised liver function.
Beau was admitted to the Ryan Intensive Care Unit for recovery following surgery. Additional units of packed red blood cells and fresh frozen plasma were administered post-operatively to address his anemia and help his body’s ability to clot. As Beau’s liver was still recovering from its chronic damage, he continued to experience abnormal bleeding over the next few days and required continued fresh frozen plasma transfusion support.
Within days, Beau was stabilized and discharged from the Intensive Care Unit. As a result of the combined efforts of the various services at the Ryan Veterinary Hospital and the supportive care of blood products provided through the Penn Animal Blood Bank, Beau was able to return to home to his family.