Sharma, A.K.KUMAR, PANKAJ2019-01-162019-01-162018http://krishikosh.egranth.ac.in/handle/1/5810090707EVALUATION OF LIVER AND KIDNEY DISORDERS WITH THE USE OF ULTRASOUND GUIDED BIOPSY TECHNIQUE IN DOGSThe study was conducted in 20 clinical cases of dogs of variable age (1 – 10 years) and weight (10 – 40 kg) affected with liver and kidney disorder and brought for treatment at the department of Veterinary Surgery and Radiology, Ranchi Veterinary College, Kanke, Ranchi. These cases were screened on the basis of history, physical and clinical examination. Physiological parameters (heart rate, respiration rate and rectal temperature) and haemato-biochemical parameters (Hb, PCV, TLC, DLC, Platelets, ALP, ALT, AST, BUN, Creatinine, total protein and albumin) were determined for evaluation of disease condition. Ten clinical cases each from liver and kidney disorder were randomly divided in to two groups containing 5 animals each. In group I, fine needle aspiration biopsy was performed with the use of 10 ml hypodermic syringe of 20 G, 1.5 inch length. Whereas, the animal of group were subjected to core biopsy with the used of biopsy gun of 18 G , 20 cm length, 22 mm throw and 17 mm sample notch. Following observation was recorded before and after the biopsy procedure. In Kidney biopsy, the value of heart rate recorded at different intervals following biopsy with fine needle (group I) and automated biopsy gun (group II) were none significantly variables within the groups. The value respiration rate recorded in group I at the intervals of 1, 24 hrs were significantly higher (P<0.05) as compared to the base value. However, the values returned towards normalcy by the end of observation (144 hrs). The values recorded following biopsy with automated biopsy gun (group II) at 1 & 24 hrs were also significantly higher as compared to base line value. Rectal temperature: A sub normal temperature has been recorded in dogs in both the groups affected with kidney disorders. The value recorded at 24 and 48 hrs following biopsy in both groups were significantly high (p<0.05) as compared to base line value. Haemato – biochemical changes in liver and kidney biopsy were non – significantly variables within the groups. Ultrasonographically the cases from liver affections were diagnosed to Cirrhosis which characterized by irregular margin of liver lobes and hyperechoc nodules in the liver parenchyma whereas another scanning showed that accumulation of fluid around the liver lobes and liver tissue appeared hyperechoic also suggestive of liver cirrohosis , Presence of multiple anechoic area with degeneration of liver parenchyma cavitation indicative of liver carcinoma. Ultrasonographic scanning of kidney revealed anechoic pocket within the kidney with hyperechoic outline of medulla indicative of hydronephrosis , whereas in other scanning showed hyperechoic renal cortex which suggestive of infiltrative renal disease or acute tubular necrosis. Six animals of liver disorder showed multifocal distribution of lesion, whereas 4 animals exhibited diffuse distribution of lesion. In dogs affected with kidney disorders, multifocal distribution of lesion was maximum (60%) followed by focal 20% and diffused (20%) . Maximum animal affected with liver disorder showed the heterochoic nature of tissue echogenicity during ultrasonography followed by hypoechoic and isoechoic tissue echogenicity. Where as in the ultrasonographic examination of kidney revealed hyperechoic kidney in maximum patients followed by equal distribution of other classified tissue echogenicity viz. hypoechoic, Isoechoic and heteroechoic. Changes in the volume of liver and kidney were recorded during ultrasonographic examination. It was abnormal contour in 4 , Increased size in 4 and reduced in 2 animals of liver disorders. Whereas animal affected with kidney disorder exhibited reduced size in 4, calcified in 2 , increased in 3 and abnormal countour in 1 animals. In three renal biopsies hematuria, noted immediately following biopsy which resolved in 2–3 days. haematuric condition has not been encountered with liver biopsy procedure. Biopsy sample has been collected by fine needle using disposable syringe of 10 ml of 20 G needle was subjected to preparation of smear on slide and after proper fixation it was stained with wright/Giemsa stain for cytological examination. Cytological examination from liver tissue revealed hepatic carcinoma in 2 cases, inflammatory hepatitis in one case and appearance of blood picture in 1 cases whereas in one case it could not be sampled even after 3 attempts. Cytological examination from kidney tissue revealed nephritis in 2 cases and tubular degeneration in one cases. Whereas in two cases no abnormality. The detail of cytological findings are tabulated below: Hepatic carcinoma : The aspirate showed clusters of widely differentiated cells with markedly a typical features of increased cytoplasmic basofilia with marked variation in cell size, nuclear size and nuclear – cytoplasmic ratio indicative of malignancy. However on the basis of their features of clustering with tendency to angular adherence. It was diagnosed as heptic carcinoma.Inflammatory hepatitis: The aspirates showed degenerative hepatocytes along with infiltration of mononuclear cells suggestive of acute hepatitis. Nephritis: Aspirates showed tubular epithelial cells varying form cuboidal to squamous type with prominent feature of lymphocytes, monocytes with mononuclear cells. Tubular degeneration of kidney: Aspirates showed degeneration of tubular epithelial cells as evidenced by desquamation of lining epithelial cells as well as most o the lining epithelial cells were absent. Kidney and hepatic core biopsy were obstained with double spring loaded biopsy gun with a throw of 22 mm and sample notch of 17 mm under ultrasound guided free hand technique in the animals of group II. Histopathological examination of collected samples from liver through automated biopsy gun revealed hepatitis (1), coagulative hepatic necrosis (1) and fibrosis in the liver (1) . There were no results in terms of histopathological findings In two case of hepatic core biopsy. Tissue core biopsy collected from automated biopsy gun from kidney exhibited acute tubular necrosis and interstitial nephritis in 1 animals each. While in other three cases of kidney biopsy , diagnosis could not be possible might be due to insufficient samples and fragmentation of tissue during processing of hispathological examination.The detail of pathological findings were tabulated below: Hepatitis : There were infiltration of mononuclear cells in portal areas along with evidence of hepatic degeneration. Fibrosis in liver : Proliferation of fibroblast cells and collagen fibers mostly in portal as well as interlobular area Coagulative hepatic necrosis: Focal area of hepatic necrosis characterized by eosinophilic cytoplasm with nuclear features of picnosis, kariorhexia, kariolysisa and anucleosis. Interstitial nephritis: There was mononuclear cell infiltration in interstitial area along with degenerative desquamative changes in tubular epithelial cells. A cute tubular necrosis: The tubular epithelial cells were seen features of degenerative changes as characterized by cytoplastic eosinophilia, vacuolar changes as well as picnotic nuclei along with desquamative changes. On the basis of above findings following conclusion can be drawn: • Right kidney biopsy was found to be comparatively more accessible to get the tissue as compared to left kidney. Whereas the biopsy from left kidney was easier and precise due to its clear-cut demarcation between cortex and medulla under ultrasonography. • Clinical and haemato- biochemical parameters recorded before and after biopsy in both the organs did not revealed significant variation. • Ultrasonographic examination revealed more abnormality has been detected on the left side of liver • Intraoperative observation during ultrasonographic examination revealed that 60 % of case showed multifocal lesion in both kidney and liver affections. Ultrasonographic examination in terms of volume of organ exhibited highest percentage of abnormal contour, increased volume with 40% each in liver scanning whereas on kidney scanning showed maximum percentage (40%) of reduced size of kidney with no demarcation between cortex and medulla. • Cytological examination from liver tissue revealed hepatic carcinoma in 2 cases, inflammatory hepatitis in one case and appearance of blood picture in 1 cases whereas in one case it could not be sampled even after 3 attempts. Cytological examination from kidney tissue revealed nephritis in 2 cases and tubular degeneration in one cases. Whereas in two cases no abnormality has been detected. • Histopathological examination of collected samples from liver through automated biopsy gun revealed hepatitis (1), coagulative hepatic necrosis (1) and fibrosis in the liver (1). There were no results in terms of histopathological findings in two case of hepatic core biopsy. Tissue core biopsy collected from automated biopsy gun from kidney exhibited acute tubular necrosis and interstitial nephritis in 1 animal each. While in other three cases of kidney biopsy , diagnosis could not be possible. • On the basis of above findings it can be concluded that the fine needle biopsy with help of 10 ml hypodermic needle with 20 G 1.5 inch needle by aspiration was quite helpful get the sufficient cells for cytological examination in small and medium breeds of dogs in neoplastic condition but limited access and insufficient samples in the fibrotic and vacuolar lesions. However, biopsy gun with 18 G needle was quite useful to get sufficient amount of tissue for histopathological examination of liver and kidney tissue with no adverse reaction but it gives only 50 % (3 cases of liver and 2 case of Kidney) success rate in the diagnosis of disease condition. Studies on large scale are warranted to improve the collection of samples from the multiple lobes particularly for liver disorder and refined technique for processing of samples for diagnosis of disease conditions.en-USnullThesis