咨询描述:医生您好,我家老猫13岁公猫绝育,近一年体重从13、4斤瘦到现在不到九斤。挑食,嗜睡,吃多吃急容易呕吐。生化检查肝指标升高,谷丙转氨酶大于1500,谷草转氨酶245,B超显示肝上有多个低回声部位,不像囊肿,肿瘤嫌疑大。最大一个直径1.5厘米。脾脏也有多个高回声结节,平均3-4毫米,不确定是否是转移。想问问,依经验能否判断恶性良性哪个可能大,是否适合做ct和手术?复发的几率大吗
问题大致一样,细节不同?
于博
执业兽医师
好的,肝脏肿瘤多数是恶性肿瘤。而且切除很大,如果是左侧肝叶切除还算简单,右侧基本切不干净。脾脏结节不用考虑,一是年纪大正常钙化沉积,二是体积小应该不是肿瘤。
谢谢您的专业解答,那您觉得是恶性肿瘤的可能性大吗,有可能是囊肿之类的吗?如果是肿瘤,他这个年纪该怎么治疗,猫咪别受太大罪
于博
执业兽医师
好的,囊肿应该不是,囊肿内是黑色暗区。
这里像是里面有脓性分泌物,一般考虑是脓肿或者肿瘤。肝脏中立多数是恶性肿瘤,但是具体还是要病理切除送检。
现在是如果您不打算后续给猫评估良性或者恶性肿瘤,进行化疗等方式那就不要去手术,保守疗法。只要还能吃东西,不频繁呕吐就正常饲喂,口服保肝药物。
我目前比较纠结几点,
1是否要全麻做ct,ct能确定有没有切除的必要吗?如果ct还是不确定就要开腹,如果开腹发现不能切,白受罪。他特瘦,很怕撑不住。
2.如果保守治疗,错过了手术治疗会不会恶化很快?尤其如果手术可以康复,再活几年,而我错过了,会很后悔。
3.保守治疗中药可行吗?还有董军医生的***,都是否有效?
4.化疗他应该很难撑下来吧,瘦吃的也少,所以是不是不用考虑?
我一直在等待您的回复,也很焦虑,请再帮我解答一下,谢谢
于博
执业兽医师
好,
1.CT主要是看肿瘤在肝脏上面的位置,连接处,是否好切除,供医生研究切除方案,或者能不能切除。可以做一下。
2.如果您还是想给狗狗治疗的,经济也允许。那可以进行CT检查供医生研究治疗方式。如果是恶性肿瘤,切与不切其实意义差不多,没有太大意义。
3.目前临床上抗肿瘤药物,不会像人那种**药物,所以对于良性的或者结节有一些效果抑制生长甚至消肿。但是对于恶性无效,一般是切除肿瘤后使用抑制肿瘤生长
4.化疗还可以,主要是手术台上是否能下来。
这个年纪和目前状态,不建议再折腾它了
1.抗肿瘤药物他可以吃吗?是化疗药吗,吃了会不会便血不吃饭?
2.根据您的经验判断恶性肿瘤的可能性比较大,或者可能是您说的脓肿吗?感觉脓肿不那么可怕
3.保肝药物有哪些?适合他吃的
谢谢
于博
执业兽医师
好的,
1.抗肿瘤药物可以吃的,不是化疗药物,没有副作用,都是中药成分
2.也可以超声穿刺看一下细胞学是什么成分
3.稍后给您开个肝脏药物处方
1.超声穿刺要打麻药吧,猫咪应激反应特别大。穿刺细胞学可以看出恶性还是良性吗?
2.脓肿如果吃抗肿瘤药物可以自己消退不做手术吗,脓肿致死吗,疼吗
3.ct可以看出来脓肿还是肿瘤不
4.他现在疼吗,之后会疼吗,到最后会不会腹水,饿死疼死?
谢谢
于博
执业兽医师
好的,
1.可以稍微镇静一下,不至于麻醉,穿刺可以看是脓肿还是肿瘤细胞,但是像常见的肿瘤细胞比如肥大细胞,淋巴细胞也可以辨别
2.好的,脓肿可以先抗炎止痛,抑菌治疗,如果没有好转需手术切除
3.CT还是比较全面的,从质地还有结构方面看出来的
4.肝脏肿瘤最后都会有腹水,黄疸这些表现,肿瘤肯定是疼痛的。
谢谢,
最后问题
1.您开的药是保肝的吗,抗肿瘤药物吃什么?
2.中医是否考虑,有效吗
于博
执业兽医师
好的,是保肝治疗肝病肝癌的药物
稍后给您开个肿瘤药物
中医是可以尝试治疗的
医生建议及处方根据当前病情给出,仅适用于本次问诊
蘑菇宠医处方笺
用法用量需根据患宠的年龄、体重等信息开具,此处方暂不展示
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