Başlık: Evaiuation of subclinical liver lesions in goats by ultrasonographic and biochemical analysesYazar(lar):GÖNENCI, Ramazan;DURGUT, Ramazan;ERDOGAN, Suat Cilt: 50 Sayı: 1 Sayfa: 047-051 DOI: 10.1501/Vetfak_0000002229 Yayın Tarihi: 2003 PDF

Evaiuation of subclinical liver lesions in goats by ultrasonographic

and biochemical analyses*

Ramazan GÖNENCIL, Ramazan DURGUT

2,

Suat ERDOGAN

3

iMustafa Kemal University, Veterinary Faculty, Department of Surgery, Hatay; 2 Mustafa Kemal University, Veterinary Facu!ty. Department of Internal Mcdicinc, Hatay; 'Mustafa Kemal University, Vcterinary Faculty, Department of Biochemisıry. Hatay

Summary: This study included 75 Damascus and its crossbreed goats from different age and sexes in the Hatay province. Following the history, all the animals were subjected to clinical, ultrasonographic and biochemical examinations. Thc clinical signs were generally norınaL. Ultrasonographically, parenchymal lesions in 17, biliary system abnorınalities in 8 and both biliary and pa-renchymal abnormalities in 23 animals were detected. In these 48 goats with hepatic lesions; 26 parenchyma! hyperechogenicity,

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cysts and iO masses of parenchyma, and 25 wall thickenings, 3 foldings and 3 sediments of gallbladder were observed alone or to-gether. LDH levels in goats with and without hepatic lesions were higher than norınal refercnce range, whereas ALT. ALP. AST, 001'. B UN, TP, CB. CHO, albumine and glucose concentrations were in normal referencc ranges. In this study. it is concluded that Iesions could be observed ultrasonographically before clinical signs and biochemical abnormalities manifes\.

Key words: Biochemical analyses, goat, liver, ultrasonography

Keçilerde subklinik karaciğer lezyonlarının uıtrasonografik ve biyokimyasalolarak

değerlendirilmesi

Özet: Bu çalı~ımı Hatay'ın çe~itli yerlerinden temin edilen deği~ik ya~ ve cinsiyenen 75 Şam keçisi ve melezIeri üzerinde ya-pıldı. Oerekli anamnez alındıktan sonra, bütün hayvanlar klinik, ultrasonografik ve biyokimyasal muayenelere tabi tutuldu. Klinik bulgular genellikle normal idi. Ultrasonografik olarak, hayvanların ITsinde parenşimal, 8'inde bilier sistem ve 23'iinde de hem pa-renşimal hem de bilier sistem lezyonlarına birlikte rastlandı. Bu lezyonlu 48 keçide 26 papa-renşimal hiperekojenite. 17 kisı, iO kitle, 25 safnı kesesi duvarında kalınla~ma, 3 katlanma ve 3 sediment oluşuımı tek başına ya da diğer lezyonlarla birlikte gözlendi. ALT. ALP.

AST, 001', BUN, TP, CB, CHO, albumin ve glukoz konsantrasyonları lezyonlu ve Iezyonsuz keçilerde normal iken. sadece LDH

her ikisinde de yüksek bulundu. Bu çalı~ma ile karaciğer lezyonlarının klinik ve biyokimyasal anormallikler ortaya çıkmadan önce ultrasonografik olarak gözlenebileceği sonucuna varıldı.

Anahtar kelimeler: Biyokimyasal analizler, karaciğer, keçi, ultrasonografi

Introduction

Liver is highly suseeptible for parenehymal,

vas-cular and biliary system lesions. Baeterial, ehemieal,

vi-ral, toxic or immune-mediated insults may eause foeal or

eliffuse hepatic abnormalities or lesions (8-10,12).

Diagnostic and prognostie use of ultrasonography is

one of the most important and prominent tools for the de-tection and reeognition of many types of foeal parenehymal lesions such as eysts, hemorrhages, haematomas, abscesses,

neerosis, nodular hyperplasia, granulomas and neoplasia

(3,5), The liver is weıı suited for ultrasonographie evalua-tion beeause of its large size and a uniform parenehymal appearanee on ultrasound seans. On the other hand, due

to the faet that ultrasonography is least valuable for

re-eognition of diffuse forms of the disease, other diagnostie

The main inelieations for seanning the biliaı'y system

are to rule out extrahepatie obstruction, to eleteet biliary

calculi, anel to visualize thiekening of the gaııblaeleler

waıı, masses or inflammatory diseases assoeiateel with

gaııbladder and biliary traet. Enlargement of the hepatic

veins, obstruetion of the eaudal vena eava by clots or

masses, eongenital and acquired vaseular abnormalities

can also be imaged (6,7,13).

Hepatoeyte damage may result in the release of

enzymes that may indicate the hepatoeyte integrity or bile

exeretions into the eireulation or failure to produee and

exerete them. The bioehemieal tests are useful in the

assessment of hepatic funetions, diagnosis and the severity

of liver disease. Theyare also valuable diagnostie

in-Ramazan Gönenci - in-Ramazan Durgut - Suat Erdoğan

Results

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Figure 2. On ultrasonography. a Igaııbladder~all ıhickening is seen, which is shown by the cur~ed arrows. T1heregion shown by the arrow heads is diffuse hyp6rechoic liverıparenchyına.

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There was no signs showing theıliver disorders such

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as, ieterus, weight lose, aseites, diarrpoea and abÇlominal

pain over the livers on clinical

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examinatio,b. Few

abscesses were identified in 20 at~imals, whiJ:h were

thought to be eaused by easeous IYI~lPhadenitis tlhaı they

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experienced previously, and the majqrity of thesq animals

had pneumonia.

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On ultrasonographie exanıination, most of thıbanimals_{, i}

(n=48) had hepatie lesions includingi parenehyım\l, biliaı'y or both, and the rest of the animaı1 (27) appea:l'ed to be normal. Only par~nchymal lesions ;.yere seen in! 17 go ats

including parenehymal hyperech6genieity, e!ysts and

masses, the frequency of whieh: were 10,

?,

and 4,

respeetively. Parenchymal tissue ~ith hyperecl;~ogenieity

had an increased eehogenieity, *hieh eitheı; foeal or

diffuse. Only biliary system abnor~ıalities werJ seen in 8

goats, inc1uding thiekening, foıding and se,bimenı of

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gallbladder wa11,the frequency of ıwhieh were

;6.

iand 1,

respeetively. The appearanee ofı the gallbla'dders was

aneehoie, having thiek wa11s With hypere(:lhogenieity

(Figure 1). On the other hand, i[he 23 goat~ had both parenehymal and biliary lesions tqgether (Figu!re 2).

The liver of 17 goats hati cysts with anechoic

architecture and a thin wall (Fi!Aıre 3). The ı.longiıudinal~i ~

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seans of goats showeel 10 mUltiliocal hypnecrOiC masses

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Anova test in SPSS programme (version 9.05) w<ls used

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for statistieal analysis. i .

Figure

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Ultrasonographic appearance of gallbladder waıı

thickening. The arrows show the gallbladder wall thickening. Note that hepatic parenchyma appears almost normaL.

Materİals and Methods

This study was carried out in 75 Damascus and its crossbreed goats from different age and sexes in Hatay

province. After taking the anamnesis, they were all

subjectcd to clinical, laboratory and ultrasound exan1İnations. The animals were kept in stand position for ultrasound seans after general examination. A smaIl area of their hair

between last two intercostal space in the right side was

elipped. In the imaging proeedure, the liver was

evaluated for typical signs of hepatic degeneration in size

and echogenicity in order to deteet focal or multifocal

liver lesions. The hepatic ultrasound parameters were

evaluated routinely including size, margin, echogenieity, vascularity, gallbladder and perihepatic abnormalities.

For biochemical evaluations, 10 ml of blood samples were taken from the jugular vein, and sera were separated

by eentrifugation. Samples were analysed for serum

alkaline phosphatase (ALP), alanine aminotransferase

(ALT), aspartate aminotransferase (AST), gamma-glutanıyl

transferase (OOT), lactate dehydrogenase (LDH), blood

urea nitrogen (BUN), albumin (Alb), total protein (TP), conjugated bilirubin (CB), triglyceride (TO), glueose and

cholesterol (CHO) in AMS Autolab analyser, using

Biomedical System and Audit Diagnostie kits. One-W ay

The aim of this study was to investigate and

evaluate the subelinieal foeal liver lesions using

ultra-sonographie examination and bioehemieal analyses in

clinically normal goats in Hatay provinee. 48

Fıglll'L' 3. Appearances of a cyst ıC) and a mass (M) with a diffııse and increased hepatic echogenicity.

Figııre 4. An egg-shaped mass shown by the arrows with increased hepatic echogenicity.

in parenchyma, which are rounded and with thin and

welI-defined or irregular walls. Hypoechoic masses were differentiated from the gallbladder by their location, the

absence of contraction and gallbladder neck (Figure 4).

Folding of the gallbladder on itself was also detected in 3

goats which was differentiated from a mirror-image

artifact because there is no diaphragm between two

galIbladders (Figure 5). Gallbladder lumen filled with

sediment was apparent and agitated with back-and forth

Figııre 5. Appcanıııce of a folciing in the galibideleler "ith \\dll thiekening shown by the arrows. Smail part of the foleling is possible dilated bile dllCL Note also that there is a eyst shown by "C" elose to the diaphragm.

Table I. Nıımbers of animals with biliary, parenehyma! or both lesions, and other ultrasonographic finelings, whieh were observed alone or together.

Lesions Biliary Parenchymal Biliary+ Total

system tissue ParenchYll1al

(n=8) (n=17) (n=23) (n=48) Hypereehogenieity LO In 2n Wall thiekening n ~L) 25 eyst 7 LO 17 Mass 4 (i 10 Folding ı 2 3 Sedimentation i 2 3 Total 8 21 55 X4

The biochemical analyses of the blood senını

resulted in that the activities of AST, ALT, ALP and

GGT, and the !evel of glucose, CB, TP, Alb, BUN anel CHO were found to be in normal ranges whereas the activity of LDH was higher than the normal reference

range although there was no significant difference

(p>O.05) between goats with and without hepatic lesions (Tabı e 2).

Dİscussİon and Condusion

Many clinical signs, such as ictenıs, weight lose,

ascites, diarrhoea and abdominal pain, which are regarded

not to be pathognomonic, may be present with liver

disease (4,10). None of these symptoms were eletecteel in

the study presented. Pathologic changes in the liver may

Ramazan Gönenci - Ramazan Durgut - Suat Erdoğan

Blood serum parameters

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Table 2. Blood senım bioehemİeal analyses of goats with and wİthout subeliniea] hepatİe 1esions dİagnosed by ul\rasound.

Hepatİe lesions (n=48) Non hepatie lesion!s (n=27) i

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X :t Sx Min-Max X :t Sx Mın-Max;

Ultrasound is an important tool in detecting focal

liver abnormaIities such as cyst, hemalThage, granuloma

and neoplasia because of the uniform background

provided by the normal parenchyma. These focal lesions

can not be differentiated from each other, because they

may Jook similar in echogenicity, size and appearance on

scans (8,9,12). However, cysts might be distinguished

from the others. There are two reports supporting this

notion that the sensitivity and specificity of uItrasound

examination to detect hydatid cysts in goats was

82.1-97.65% and hepatic cysts are usually detected

incielentally without clinical signs (5,11). They showed no clinical signs in animals with 17 hepatic cysts in the

study, anel they were differentiated from gallbladder by

its lack of contraction on ultrasound as researchers

reported (2,3,5,11). A mass may appear moderately

circumscribed, exceeding the normalliver margin with an

echogenicity, which had slightly more-mixed appearance

than normal liver. The increases in hepatic echogenicity

may be due to fibrosis, dystrophic caIcification or

cirrhosis 0,6,8,9). No clinical and biochemical

abnor-malities or ascites were observed in these animals,

implying that the echogenic architectme of the liver

parenchyma might be due to fibrosis or dystrophic

calcification.

The normal gallbladder wall is visualized, the neck of the gallbladder is usually not visible in normal animals

though. Thickening of the wall is a nonspecific finding

seen sametimes with acute and chronic hepatitis,

cholecystitis, cholangiohepatitis or hypoalbuminemia,

less frequently right heart failme, septic conditions, and

neoplasia (1,7-9). Thickening of the gallbladder imaged

1/6-484 : - i 12-66 ; 351-726 : 14-5i : 62-358 ; 37-97 ; 40-101 ! i 0.01 -03~ 18-59

!

6.00-8.6(r 1.IO-2.9(r) 12-49 ! i 244.65:t 12.31 31.34:t 1.65 498.38:t 13.66 32.95:t1.17 i86.78:t20.29 63.22:t2.17 62.56:t2.19 0.14:tO.09 30.86:t1,47 6.79:t093 2.12:t0.76 29.97:t1.54

was lost about 75% (4,10).

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in this study can be possibly resuIt,ed from chıl'onic or

mild hepatitis or cholecystitis. It sho~ıld be notedi that the liver has a large reserve capacity, al?d clinical s{gns and biochemical parameters can occm w~en the liver Ifunction

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In this study, the amount of gallbladder ı~ediment

was not found to be pathognomonid:. The sedinrent may

be seen in healthy non-fasting anin~als as wellj as those

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with illness such as icterus, chronic hepatitis, fi~rosis and

caIculi (8,10)

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It is reported that folding of gallbladder ob'ıserved in

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this study may be that gallbladddr dilated Oli partially

folded on itself (8,9). i :

In chronic hepatitis, GGT, AUP and LDH linereases, and biliary damage and hyperplasih were seenl(4,10). In

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this study, GGT and ALP wereı found nor~nal levels

indicatina that liver functional capacitiy was niot entİrely

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lost, whereas LDH levels wer9 higher than normal

reference range. This increase in ILDH may ılesult from

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an other organ damage or disease! In conclusi;on, results presented here suggest that subcliı~ical Iiver lei~ions could be detected commonly with ultra'sonographici evaIuatian

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even if they may be clinically liJormal, and: [heir

bioc-d~ il .

hemjcal parameters are alsa foun ito be nOrı11<:1ın goats.

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Received 16 April 2002 / Accepted 13Ma)' 2002

Correspondenee address:

Dr. Ramazaıı Göııenci,

Mustqfa Kemal Üııiversitesi, Veteriııer Fakültesi Cerrahi Anabilim Dalı,