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Large liver and spleen.

Species: Cat
Breed: Domestic shorthair
Age: 8-11 years
Male cat 10 yo & neutered has enlarged pancreas and spleen, slightly enlarged liver. (see ultrasound results below) Abdomen is distended. No pain when pressed. Had a fever starting Mon Jan 23 for approx 4 days- temp was around 105 then gradually came down to 102 then to normal by Saturday Jan 28. He was hospitalized and on IV fluids intermittently. Anti inflammatories did not bring fever down so IV was started. He was almost back to normal but vomitted on Sun Jan 29 orange/brown liquid, his appetite was ok on Sunday and Monday but more of the same vomit today and no appetite for last 12 hours. Drinking and urinating more than usual. There was no bacteria found in the spleen but some lymphocytes were found in the spleen from a fine needle biopsy. Here are some abnormal bloodwork results if they make sense:
ALP results are 7 Ref Btwn 10-85 IU/L
Reticulocytes 0.2 %
Neutrophils 87.7%
All other blood work and Serum Spec fPL was normal
Ultrasound Details:
ABDOMEN RADS: The liver and the spleen are diffusely enlarged with rounded margins. The tail of the
spleen extends along the ventral abdomen on the right lateral radiograph. The stomach and small intestine
contain gas but are normal in size and location. The urinary bladder has a rounded shape and is
moderately enlarged but no mineral opacity content is seen and the serosal detail around the trigone is
normal. The other organs of the abdomen appear normal.
ABDOMEN US: The liver and spleen continue to appear enlarged with ultrasound, however specific
infiltrate is not seen. The gallbladder wall (0.26 cm) is thick and hyper echoic but the gallbladder is not
dilated. The pancreas is hyperechoic and enlarged with cystic areas. The peri-pancreatic fat appears
normal and no ascites is seen. There are two enlarged mesenteric lymph nodes that are located medial to
the right kidney. The right kidney has an indented area to the capsule but no acute infarcts are seen.
There is very subtle dilation of the left renal pelvis with low echogenicity fluid without dilation of the left
ureter. The right kidney (4.11 cm) and left kidney (4.48 cm) are normal in size. The urinary bladder wall is
normal. There is a large amount of hyperechoic, non-shadowing suspended and dependant debris in the
urine. The stomach contains some fluid, The duodenum , small intestines and colon appear normal.


Online vet, Dr. Marie

Dr. Marie replied:

I'm sorry to hear that Wyatt is not doing well. You didn't ask an actual question so what I will do is help to interpret what the results tell us. However, there really isn't anything specific in any of these results.

We don't worry about ALP level being lower than normal.

For the neutrophils, we don't really look at the percentage but rather the absolute number. Do you see something x10^9/L? This number will tell us more about whether there is inflammation and possibly infection present.

A normal Spec fPL tells us that pancreatitis is unlikely.

On the xray we can see that the spleen and the liver are a little enlarged but we don't know why. It's normal to see gas in the stomach and small intestine, especially if the appetite has been decreased. I'm not worried about a round bladder. The trigone is just part of the bladder.

The ultrasound confirms that the liver and spleen are bigger than normal but it doesn't give us an idea as to why. The pancreas has some cysts in it. Now, it's possible that this is something serious like a cancer, but usually if that is the case then we should see an increase in the Spec fPL. Those cysts may just be nothing. "No ascites" means that there is no fluid in the abdomen and this is a good thing.

I'm a little concerned about the two enlarged mesenteric lymph nodes. When lymph nodes are enlarged it usually means that there is either infection or cancer.

I'm not sure what the indented area on the kidney means. The dilation of the pelvis of the kidney doesn't really tell us much either. It's not uncommon to have debris int he urine. It could be some inflammation, or crystals but probably isn't connected to his current problems.

Now, I can't officially interpret these results for you. Your vet will be the best resource for you as far as that is concerned. However, I can give you my thoughts. I'm concerned by these facts:

-The spleen and liver are enlarged
-There are two big lymph nodes in the abdomen
-There were lymphocytes found on the aspirate of the spleen

This makes something like lymphoma a possibility. Lymphoma is a cancer that could be affecting the spleen and the liver and the lymph nodes as well. Many cats with lymphoma can do well with chemotherapy.

There are other possibilities. An infection could possibly produce these symptoms and if this is the case then antibiotics would be very helpful.

Inflammatory bowel disease could possibly be the cause as well but is less likely.

Let me know if that helps, or if you have more questions.

Dr. Marie.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thank you so much for your thoughts. Yes, I do realize now that I did not actually ask a questions, sorry about that. I was wondering how to treat this? My vet says that based on all this information we have, infection is more on the less likely scale. What about treating with a steroid? He does not have a fever, but still does not have an appetite- I have tried anything and everything I can think of. His behaviour is a little off, but he is responding somewhat to stimuli but not really sleeping very much. The pathologist has ruled out large cell lymphoma, but not small cell- an actual biopsy of the spleen would be be required for this I was told. My vet initally thought pancreatitis, possibly caused by inflammatory bowel disease and from what I have read there are many ways to treat this. She initially suggested a hydrolyzed protein diet, but since he won't eat, we won't know if this will help. But if it is lymphoma, I understand steroids may help, and steroids also may increase his appetite. What would be causing no appetite? And could steroids do harm even though we do not exactly what is going on? Any more info you can provide would be terrific. Thank you so much.


Customer reply:

Sorry ...just adding to my reply above.....the Neutrophils were at 16.6 x 10 E9L
Also he was on antibiotics but then taken off because the vet suggested that possibly the antibiotics were causing the no appetite. Should he be on them, and can he be on antib and steroids? Thanks again. Tara Hird


Online vet, Dr. Marie

Dr. Marie replied:

Thanks so much for the bonus...it is greatly appreciated!
It is a tough call to decide on how to treat from here. I won't be able to tell you for certain what to do, but I'll give you my thoughts on what I would be recommending if this was a case of mine.

So most likely we are dealing with either lymphoma or some type of IBD (that is also affecting the pancreas.) If this is IBD then yes, steroids will likely help significantly. Steroids help to shrink inflammation. If they work for Wyatt then your vet will likely keep him on them long term. Eventually the goal would be to get him on the lowest effective dose which is often just given every other day.

Now, what if this is lymphoma? If it is, we may see some improvement on steroids. The steroids can shrink some of the inflammation associated with the cancer and he should feel better. However, if this is cancer then the improvement will just be temporary and he will start to get sick again. This could be in a few weeks or a few months.

If you are at all considering chemotherapy, then it could be harmful to start steroids first. Many chemotherapies don't work well if steroids have been on board to start with. Many people get frightened by the word "chemotherapy" but cats actually handle this really well. There are a few drawbacks though. First of all, we would need a diagnosis and this means taking a surgical biopsy of the spleen. Also, to get chemotherapy you may need to see a veterinary cancer specialist. Neither of these are particularly hard on Wyatt, but you will need to decide whether the extra cost is feasible for you.

If you are not willing to pursue chemotherapy, then most likely giving steroids is a good idea. (Ultimately though you need to go with the advice of your vet.)

I think it was worthwhile stopping the antibiotics to see if they were the cause of the appetite loss. However, as there is a slight increase in neutrophils it may be worthwhile to start them up again. High neutrophils can mean infection. (But they could also just be there because of inflammation from cancer.)

Cases like this are difficult because we don't know exactly what we are treating. I hope this information helps, but let me know if you have more questions.

Dr. Marie.



Customer reply:

Thank you. We did the bloodwork on Tues Jan 24, when his fever was quite high. Since we saw high neutrophils that day when the the fever was present, and now that the fever is gone, could the neutrophils still be high (hard to say I know without more bloodwork, but your best guess is appreciated) Also to let you know, antibiotics were not started until Thursday Jan 26, after the needle biopsy was done, and he was only on them for 2.5 days (he got 2 pills a day). His fever did come down, but the vet thought it was from the cooling IV fluids he had. If there was an infection right now, wouldn't there still be a fever present? His temp was 38.4 this morning, and has been very consistent since Saturday Jan 28. Would it be helpful to check his neutrophils again while his temp is normal? Then would we know for sure if we are dealing with infection? And is the only way to actually diagnose lymphoma to do a surgical biopsy of the spleen? I really want him to have more quality of life if this is the end for him. He doesn't do well at all at the vet - he is a very very stressed kitty there, so right now I am not looking for a cure per se, but more to make him comfortable if these are his last days. Thank you so much once again, you are so very helpful. Tara


Online vet, Dr. Marie

Dr. Marie replied:

I think infection is really not that likely from what you have described. Checking his neutrophils could help but it could also add more confusion. If they are still high then we don't know if they are high because of infection or ongoing inflammation. There are really two ways to go here: 1. cover him with antibiotics just in case, or 2. just do the steroids and if he is getting worse or if the fever is returning then start antibiotics.

There really is no other way to confirm lymphoma. Sometimes we can get a diagnosis on the initial aspirate, but if the pathologist is recommending a surgical biopsy then unfortunately this is the only other option if we want a diagnosis.

One other thought I had was that you could ask your vet for a referral to a veterinary oncologist (cancer doctor) if there is one in your area. These doctors have the most experience with helping differentiate between lymphoma and other conditions. However, they are likely to want the biopsy as well.



Customer reply:

Thank you so very much Dr. Marie, you have been very helpful. I really do appreciate your time.
Sincerely,
Tara Hird


Customer reply:

I need your advice again please....Wyatt was on prednisolone for 2 days -- had 5mg 2x per day, now is on .2ml of Dex twice per day(has had 2 injections now). We changed to Dexamethasone b/c I had some left from a treatment I was doing for my other cat. He also had an injection last night of Cerenia ( not sure on that dose, sorry) and was given a quarter of a tablet of a 15mg tab of Mirtazapine. He is also on .15ml injections of buprenorphine every 12 hours, and is also taking half a 10mg tab of famotidine every 24 hours.
He is still hardly eating anything. He goes to smell his food and seems eager, but then either walks away, or licks a little or eats a few morsels of kibble. I have offered him everything, and I have been force feeding the Hills ad over the last 48 hours. But he absolutely hates this.
I thought that with being on a steroid, having the appetite stimulant and having the antacid and anti-nausea meds, he would start eating more. I really do not know what else to do. He is not himself right now- he hasnt slept in prob 48 hours and he doesnt really sit still for more than a few minutes, and he certainly doesnt look comfortable-- could that be just the pain meds......but he is purring and rubbing and scratching. Any advice you have at this point would be very appreciated. Thank you once again. Tara Hird


Online vet, Dr. Marie

Dr. Marie replied:

Oh dear. This doesn't sound good. It is likely not the medicines that are causing him to refuse to eat. None of these really should upset his stomach. In fact all of these meds should really help his appetite.

The Mirtazapine is usually a really good appetite stimulant and I get really concerned when a cat refuses to eat even after having this.

I think we are getting to the point where we have some hard decisions to make. Your vet will likely give you some options but from what I see here you have three options:

1. Be proactive and do an exploratory surgery to determine for certain if we are dealing with cancer. There is a small chance that we might find something on surgery that could be surgically repaired. Or, it may be obvious that he has significant cancer problems and euthanasia could happen on the table. Or, we could take biopsies so we can get a diagnosis and possibly pursue chemotherapy.

2. Continue with the medicines and see if he improves.

3. Talk to your vet about inserting a feeding tube. This sometimes will help to get a cat eating again if we can get some nutrition into him.

4. Start thinking about euthanasia.

From what you have written it is not looking good. I wish I had better advice for you.



Customer reply:

Thank you for those options. Would it be inhumane to let nature take its course, and keep him comfortable with the pain meds in the meantime? I really don't think I could handle euthanasia, but I want to be as humane as possible.


Online vet, Dr. Marie

Dr. Marie replied:

This is always a tough question to answer. Unfortunately in almost every case if a cat is not doing well I recommend euthanasia rather than letting them die naturally. Cats can hang in there for a very long time without food. I have seen cats go weeks without food and by the time they were brought in for euthanasia they were in very bad shape and had suffered for weeks.

Additionally, if cats are really sick we often don't have a nice peaceful death at home. We will commonly see seizures, repeated vomiting and severe breathing issues as the end nears. It is not pleasant.

I'm so sorry to be so graphic, but I have seen it many times that someone has tried to avoid euthanasia and then comes rushing in with an animal in horrible distress.

Your vet will help you decide if it is time, but if it is, hopefully you can manage to do euthanasia. Many vets will do home euthanasia if this is something you wish. Or, if you feel that you simply cannot be present the vet will be ok with doing the euthanasia without you present. This is ok as well. Wyatt will likely be well sedated and will not know what is happening.



Customer reply:

Thank you once again for your advice...I sincerely appreciate the honestly and candor.
Tara


Customer reply:

Dr. Marie:

I have some recent bloodwork for Wyatt that I would like to ask you about- these are the abnormal values:

ALT 207
Glucose 19.6
RBC 5.3
Hematocrit .23
Reticulocytes .2
fPL 20

I assume the 20 for the fPL means for sure that it is pancreatitis? I just would like to know that based on his values here and my past notes, what would be the first thing you would do in his treatment? Obviously the ALT is a concern.
He seems to be holding his own so far. Eating is a little better; pain meds seem to be doing ok for him; and there is no vomiting or diarrhea as of yet. He is not grooming himself though.
Again, any advice is very greatly appreciated.
Thank you.
Tara Hird





Online vet, Dr. Marie

Dr. Marie replied:

The fPL is quite high. This tells us that there is *something* going on with the pancreas. However, it could be pancreatitis or it could be a pancreatic tumor.

The ALT is a little high, but it's really not that bad.

The glucose is quite high as well. We sometimes see high glucose with stress, but it could be that he is developing diabetes. I have seen some animals develop diabetes because of a severe pancreatic problem. Your vet will likely want to check a urine sample to see if there is glucose in the urine which will tell us about diabetes.

He is also quite anemic (low on red cells.) This could mean a number of things...possibly bleeding into the abdomen or that his body simply isn't making enough.

It's hard to say where to go from here. It is good that he is eating better. I would likely keep doing what we are doing and recheck some bloodwork in another week if this were my case.



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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