Ultrasonographic evaluation to diagnose hepatic lipidosis in Egyptian Zaraibi goats with vitamin B12 deficiency

As little is known about the ultrasonographic features of hepatic lipidosis (white liver disease) in goats, this study was undertaken to evaluate the use of ultrasound for the diagnosis of hepatic lipidosis associated with vitamin B12 (cyanocobalamin) deficiency in Egyptian Zaraibi goats. A total of 38 goats (28 with weight loss, diarrhoea and anaemia and 10 clinically healthy) were studied. Twenty-one goats were demonstrated to have cobalt and cyanocobalamin deficiency (0.33 ± 0.12 lmol/l and 0.17 ± 0.10 lg/l, respectively). Goats were examined with a real-time ultrasound system using a 5-MHz convex transducer. Ultrasound-guided liver biopsies and blood samples were obtained from each animal at examination. Based on the histopathological findings, diseased goats were classified as having mild (n = 6), moderate (n = 6) or severe lipidosis (n = 9). Ultrasonographic-hepatic changes were recorded in 19 (90.4%) out of 21 goats. Severe lipidosis showed diffuse hyper-echogenicity of hepatic parenchyma. However, focal hyper-echoic lesions with various shapes, sizes and positions were visualized in mild and moderate lipidosis. Liver size increased significantly (P < 0.05) in severely affected goats compared with the controls. Histopathologically, macrovacuolations, congestion of hepatic sinusoids and infiltration of the portal area with inflammatory cells and connective tissues were evident in moderate and severely affected cases.

Journal of Advanced Research (2011) 2, 65–71 Cairo University Journal of Advanced Research ORIGINAL ARTICLE Ultrasonographic evaluation to diagnose hepatic lipidosis in Egyptian Zaraibi goats with vitamin B12 deficiency Sabry A El-Khodery Medhat N Nassif d a,* , Hussein S Hussein b, Mohamed E El-Boshy c, a Department of Internal Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt b Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt c Department of Clinical Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt d Department of Animal Medicine, Faculty of Veterinary Medicine, Kafr El-Sheikh University, Egypt Received 16 February 2010; revised 27 June 2010; accepted August 2010 Available online 27 October 2010 KEYWORDS Hepatic lipidosis; Goat; Ultrasonography; Cobalt; Pathology; Egypt Abstract As little is known about the ultrasonographic features of hepatic lipidosis (white liver disease) in goats, this study was undertaken to evaluate the use of ultrasound for the diagnosis of hepatic lipidosis associated with vitamin B12 (cyanocobalamin) deficiency in Egyptian Zaraibi goats A total of 38 goats (28 with weight loss, diarrhoea and anaemia and 10 clinically healthy) were studied Twenty-one goats were demonstrated to have cobalt and cyanocobalamin deficiency (0.33 ± 0.12 lmol/l and 0.17 ± 0.10 lg/l, respectively) Goats were examined with a real-time ultrasound system using a 5-MHz convex transducer Ultrasound-guided liver biopsies and blood samples were obtained from each animal at examination Based on the histopathological findings, diseased goats were classified as having mild (n = 6), moderate (n = 6) or severe lipidosis (n = 9) Ultrasonographic-hepatic changes were recorded in 19 (90.4%) out of 21 goats Severe lipidosis showed diffuse hyper-echogenicity of hepatic parenchyma However, focal hyper-echoic lesions with various shapes, sizes and positions were visualized in mild and moderate lipidosis Liver size increased significantly (P < 0.05) in severely affected goats compared with the controls Histopathologically, macrovacuolations, congestion of hepatic sinusoids and infiltration of the portal area with inflammatory cells and connective tissues were evident in moderate and severely affected cases * Corresponding author Tel.: +20 50 2216625; fax: +20 50 2247900 E-mail address: sahadary@hotmail.com (S.A El-Khodery) 2090-1232 ª 2010 Cairo University Production and hosting by Elsevier B.V All rights reserved Peer review under responsibility of Cairo University doi:10.1016/j.jare.2010.09.004 Production and hosting by Elsevier 66 S.A El-Khodery et al There were varying degrees of anaemia, hypoglycemia and hypoproteinemia with significant increases (P < 0.05) of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in diseased animals compared with the controls In conclusion, ultrasound may be a useful diagnostic tool in goats with suspected hepatic lipidosis associated with vitamin B12 deficiency ª 2010 Cairo University Production and hosting by Elsevier B.V All rights reserved Introduction Hepatic lipidosis is a major metabolic disorder in animals which develops when the hepatic availability of lipogenic and glucogenic products is imbalanced [1] Hepatic lipidosis has been found not only to cause liver insufficiency but also results in sudden death in sheep [2] Cobalt deficiency, vitamin E deficiency, pregnancy toxemia, toxicosis and negative energy balance were recorded as causes of hepatic lipidosis in sheep and goats [3–5] Goats are generally considered quite resistant to developing cobalt and cyanocobalamin deficiencies [6] However, recent studies have shown that Omani goats fed with diets containing 0.1 ppm of cobalt, the minimum daily requirement specified for sheep [7], developed low levels of serum vitamin B12, anaemia, [8], hepatic lipidosis [9], poorer growth rates and bone lengths [10] and a decrease in apparent nutrient digestibility [11] The clinical, biochemical and pathological findings of hepatic lipidosis associated with cobalt deficiency have been described in goats and sheep in different localities of the world [9,12–15] Ultrasonography has been used successfully to describe the normal hepatic criteria of white Alpine sheep [16,17] In small ruminants, ultrasonography was found to be an efficient tool for the diagnosis of hyadatidosis [18] and fascioliasis [19] and in the secondary hepatic changes in sheep with various diseases causing right-sided heart failure [20,21] and subclinical liver lesions [22] Ultrasonographic findings of focal and diffuse fatty liver changes in cattle are clearly documented [23,24] However, ultrasonographic and clinicopathological findings of hepatic lipidosis caused by cobalt deficiency in goats have not been described Therefore, the aim of this report is to describe the ultrasonographic findings of hepatic lipidosis associated with cobalt deficiency in Egyptian Zaraibi goats under field conditions and the associated histopathological and biochemical changes Material and methods Goats Twenty-eight Zaraibi goats between 12 and 24 months of age and with 18–26 (23 ± 2.12) kg body weight were studied from the time period 2003–2006 In addition, 10 clinically healthy female Zaraibi goats aged 12–19 months and weighing 26–31 (27 ± 1.88) kg were used as the control group History and selection of cases Examined goats (23 non-pregnant females and five males) were raised in small-scale flocks in rural areas of the Kafer El-Sheikh governorate The feeding system was dependent on grazing with supplementation of roughage Animals were diagnosed with suspected hepatic lipidosis via clinical histories and competent physical examinations [25] Illthrift, lacrimation, diar- rhoea and anaemia were the consistent clinical signs in all the goats and upon which the cases were preliminarily selected Ultrasonographic examination Ultrasonographic examination was carried out with a computed real-time scanner using 5-MHz convex transducers (Acuson128XP/10, USA) Goats were examined while they were in standing position following the methods described by Braun and Hausammann [16] with fixation of time-gain compensation and power output Briefly, hair was clipped and shaved between the 7th intercostal space and five cm behind the last rib After application of the coupling gel, the 11th and 12th intercostal spaces were scanned using the above-mentioned transducer Textures of the liver, portal and hepatic veins as well as visceral and diaphragmatic surfaces were examined Ultrasound-guided liver biopsy was carried out in all the suspected cases using a semi-automatic fine biopsy needle 14G (Stericut, TSK, Japan) Liver biopsies were obtained at the 11th intercostal space [26] The operation was performed with the animal standing, sedated with 0.1 mg/kg xylaxine (XYLA-JECT, Adwia, Cairo, Egypt) The biopsy site was clipped and disinfected A small incision was made with the tip of the scalpel The biopsy needle was introduced under ultrasound guidance The area with the greatest depth of liver parenchyma and lack of large hepatic blood vessels was chosen as the site for the biopsy Hematological and biochemical examinations Blood samples were collected from each animal under investigation; the first sample was collected in heparinized tubes and used for hematological examination The second sample was collected in plain Vacutainer tubes and stored at °C overnight and the serum was separated Serum was examined for cobalt, cyanocobalamin, vitamin E, total protein, AST activity and ALP activity Serum cobalt was estimated with graphite furnace atomic absorption spectrometer (640Z) equipped with GTA-100 graphite furnace and PSD-100 auto sampler (Varian, USA) Serum cyanocobalamin and vitamin E were determined by using a HPLC system (2150, LKB) Total protein, AST and ALP were estimated spectrophotometrically following standard methods using commercial test kits (Spinreact, Spain) Fecal examination Fecal samples were obtained from each animal under investigation and examined for presence of Fasciola spp eggs and other gastrointestinal parasites Postmortem and histopathological examinations Nine goats with severe lipidosis were slaughtered due to their poor condition Samples were obtained to estimate liver Ultrasonic evaluation of hepatic lipidosis due to Vit B12 deficiency 67 cobalt All liver specimens obtained either by biopsy or at postmortem examination were processed and stained (hematoxylin and eosin and Sudan III) According to the reported criteria and classification of lipidosis [9,27], livers were classified as having mild, moderate or severe lipidosis if fewer than 50%, between 51% and 75% or greater than 75% of the hepatocytes contained vacuoles, respectively Liver cobalt estimation For cobalt analysis in the liver, 10-g aliquots were dry-ashed at 480 °C The dry-ashed samples were then dissolved in 0.6 mol/l hydrochloric acid The cobalt concentration of the samples was then determined by absorbance at 240.7 nm with a graphite furnace atomic absorption spectrophotometer (640Z, USA) Statistical analysis Data analysis was performed using statistical software (GraphPad Prism for Windows, version 5.0, GraphPad Software, Inc., San Diego, CA, USA) The D’Agostino and Pearson omnibus test was used to assess the normality Data was not normally distributed; therefore, Kruskal–Walis with post hoc Dunns multiple comparison tests were used to assess statistical differences between the groups The means were considered significantly different when P < 0.05 Fig Ultrasound scan of liver in goat with diffuse fatty infiltration, showing increased echogenicity of the liver parenchyma (L) C = caudal vena cava, Arrows = hepatic veins, G = Gall bladder, Cr = Cranial, Cd = caudal, O = Omasum Results Five diseased goats were excluded from the study; two of them had low vitamin E levels (P < 0.01) (1.32 ± 0.31 mg/l vs 2.56 ± 0.44 mg/l), in addition to low serum cobalt and cyanocobalamin, and one case was infested by Fasciola spp However, two goats had normal serum cobalt and cyanocobalamin The remaining 23 goats had significantly lower serum cobalt (P < 0.05) (0.33 ± 0.12 mmol/l vs 0.54 ± 0.84) and cyanocobalamin concentrations (P < 0.01) (0.17 ± 0.10 mg/l vs 0.33 ± 0.21 mg/l) than the 10 healthy goats Ultrasonographic-hepatic changes were recorded in 21 (90.4%) out of 23 goats with lipidosis associated with cobalt and cyanocobalamin deficiency All cases with severe hepatic lipidosis (n = 9) showed increased diffuse echogenicity of the liver parenchyma, which appeared in the form of hyperechoic dots distributed in the liver parenchyma In four cases, the liver exhibited a granular appearance in comparison with the control (Fig 1) Moderate lipidosis (n = 6) was characterized by the presence of large focal hyperechoic areas in the hepatic parenchyma in four cases (Fig 2) and small focal areas in two cases Ultrasonography yielded positive results in three out of six goats with mild lipidosis, which was characterized by the presence of focal hyperechoic area(s) distributed in the liver parenchyma Focal lesions had various shapes, dimensions (0.5–3 cm) and localization (Fig 3) Liver size significantly (P < 0.05) increased in severely affected goats compared with the control However, other ultrasonographic measurements showed no significant variation (Table 1) Ultrasound-guided biopsies provided 100% positive results for the histopathological examination Gross examination of liver samples was carried out on the nine goats with severe lipidosis that were slaughtered due to Fig Ultrasound scan of liver of a goat with hepatic lipidosis showing areas of increased echogenicity distributed in hepatic parenchyma (black arrows) R = shadow of rib, white arrows = hepatic veins, V = visceral surface of the liver, A = abdominal wall their poor condition Grossly, livers appeared pale and friable without changes to the hepatic vasculature or gall bladder In severe and moderate lipidosis, there was dominance of the macrovacuoles with congestion of hepatic sinusoids, infiltration of the portal area with inflammatory cells and fibrous connective tissues as well as hyperplasia of the epithelial lining (Figs 4–6) In mild lipidosis, there was a predominance of the microvacuoles in two cases Moreover, one case showed a combination of macro and microvacuoles Mild congestion of the hepatic sinusoids was only recorded in one case Erythrocytes decreased significantly in goats with lipidosis (P < 0.05) compared with the control Furthermore, haemoglobin and PCV% showed a significant decrease (P < 0.05) 68 S.A El-Khodery et al Fig Ultrasound scan of liver with lipidosis shows focal areas of increased echogenicity (F) A = abdominal wall, L = liver tissues, V = visceral surface of liver, L = liver parenchyma, A = abdominal wall Fig Photomicrograph of liver of goat with diffuse hepatic lipidosis showing macrovacuoles vacuoles pushing the nucleus to one side, signet ring appearance (arrows), infiltration of portal area with round cells, and congestion of hepatic sinasoides (arrow head) in diseased goats compared with the control and (P < 0.05) in mild cases compared with moderate and severe cases (Table 2) Differential leucocytic counts showed eosinophilia in 17 (932.8 vs 296.6 cell/ll) cases and hypersegmentation of neutrophils in 19 cases without significant changes in the total leucocytic count Liver cobalt was estimated only in the slaughtered cases (n = 9); the level was 0.019 lg/gDM–ppm Biochemical parameters showed significant changes not only between diseased and control cases but also among the disease cases themselves (Table 2) Discussion Hepatic lipidosis caused by cyanocobalamin deficiency in goats is usually diagnosed based on biochemical and pathological findings However, ultrasonography is not a routinely used diagnostic tool In this study, diseased goats were selected based on clinical signs and serum levels of cobalt and cyanocobalamin Goats infested with Fasciola spp and those with low vitamin E levels were excluded to narrow the differential diagnosis Ultrasonography yielded high sensitivity (90.4%) in diagnosing hepatic lipidosis in goats with low serum cobalt and cyanocobalamin It is interesting that our findings are similar to those recorded in cattle for the diagnosis of diffuse liver Fig Photomicrograph of liver showing fatty changes (black arrows), interlobular fibrous connective tissues with round cell infiltration (red arrows) and hyperplasia of the epithelium (white arrow) diseases [23] Digital analysis showed higher sensitivity and specificity for the diagnosis of lipidosis in cattle than ultrasonography [28] Based on the histopathological classification [9], all severely affected animals had increased diffuse echogenicity of the liver, which indicated an advanced state These results coincided with those recorded in cattle [28] By contrast, all cows with fatty liver changes showed diffuse hyperechoic or Table Ultrasonographic measurements of liver size, diameter of portal vein and caudal vena cava (mean ± SD) in healthy Zaraibi goats and in those with hepatic lipidosis Animal groups Liver size Portal vein Caudal vena cava Healthy control (n = 10) Mild lipidosis (n = 6) Moderate lipidosis (n = 6) Severe lipidosis (n = 9) 10.8 ± 0.6a 11.2 ± 0.6a,b 11.4 ± 0.6a,b 11.9 ± 0.8b 1.3 ± 0.1 1.2 ± 0.4 1.4 ± 0.3 1.2 ± 0.2 1.5 ± 0.7 1.5 ± 0.4 1.6 ± 0.4 1.7 ± 0.3 a,b Means with different superscript letters in the same column are significantly different at P < 0.05 Ultrasonic evaluation of hepatic lipidosis due to Vit B12 deficiency Fig Photomicrograph of liver of goat with diffuse hepatic lipidosis showing fat droplets stained orange yellow (Sudan III) heterogenic hepatic lesions [27] The moderate and mild cases had hyperechoic foci distributed in the liver parenchyma Observed focal lesions had various shapes, dimensions and localization A similar finding was recorded by Mohamed et al [24] who described the focal fatty liver changes in cattle as unevenly distributed lesions, with geographic boundaries and not associated with the displacement of adjacent vessels Moreover, in humans, focal fatty liver changes were observed with various echogenic patterns, shapes, dimensions and localization [29] The present study suggests that hyperechoic features of livers with lipidosis may be attributed to changes in the nature of the liver tissues that increase the attenuation of the ultrasound beam This suggestion is supported by Szebeni et al [30] who found that in patients with bright liver due to fat deposition, the average attenuation of ultrasound was 1.21 ± 0.06 dB/ cm per MHz, compared with bright liver due to an inflammatory reaction (0.80 ± 0.03 dB/cm per MHz) and normal liver (0.68 ± 0.03 dB/cm per MHz) The dominant histopathological finding of bright liver with an inflammatory reaction was connective tissues and lipid deposition due to fatty changes A recent study of cattle suggested the feasibility of calibrated, computer-aided ultrasound for non-invasive diagnosis of liver steatosis [31] Liver size significantly increased in the severely affected cases (P < 0.05) as compared with the control but we can’t conclude or generalize this metric for diagnosis However, determination of liver size could provide significant information for the diagnosis of a subacute hepatic fascioliasis outbreak [19] Liver size in sheep may be suspected with an increase of more than 25 cm, taking body weight into consid- Table eration [16] Therefore, liver size offers limited diagnostic information concerning lipidosis except in severe cases The diameter of the portal vein and the caudal vena cava showed no significant difference between the control and diseased goats or among the diseased goats Contrary to that recorded in cattle, diffuse fatty changes in cattle were associated with dilatation and stricture of intrahepatic vessels [27] Ultrasound-guided liver biopsy confirmed the ultrasonographic findings and provided positive results in 23 cases (100%) This result coincided with that previously reported in humans [29] It is suggested that ultrasound-guided liver biopsy is important for excluding the disease conditions causing diffuse [19] and focal hepatic lesions [32] However, in humans, ultrasonographic diagnosis of lipidosis was found sufficient and biopsy was not recommended, where no other indications for biopsy existed [30] Gross liver examination was carried out only for severe lipidosis in the nine goats that were slaughtered due to their poor condition The livers were pale and friable; their histopathological findings were similar to the remaining severely affected cases Livers of diseased goats exhibited histopathological findings similar to those from lamb with OWLD and Omani goats with lipidosis [8,9,14,33] These results support our findings of lipidosis as observed in all moderately and severely affected cases Such findings indicate an advanced state of the disease in the examined animals and its presence with the connective tissue may explain the visualization of hyperechoic lesions on ultrasonographic examination Biliary hyperplasia was a common finding in cases with moderate and severe hepatic lipidosis Similar findings have been observed in lamb with OWLD [34] and severely affected Omani goats [9] The histopathological differences among the diseased goats might reflect the progressive changes associated with lipidosis and the degree of liver tissue reaction In the present study, the results of the hematological examination were similar to those recorded in Omani goats with vitamin B12 deficiency [35] and in lamb with OWLD [3] Moreover, presence of eosinophilia in 17 goats suggests parasitic infestation rather than cyanocobalamin deficiency AlZadjali et al [35] found no relationship between eosinophilia and cyanocobalamin deficiency in Omani goats Hypersegmentation of neutrophils was recorded in 19 of the diseased goats A similar result was described by Calvo Romero et al [36] who recorded that hypersegmented neutrophils were indicative of cobalamin deficiency in humans The decrease of the serum total protein may be due to the impairment of liver function It has been suggested that a decrease of serum protein associated with lipidosis might be due to the effect of cobalt deficiency on protein metabolism Hematological and biochemical findings in Zaraibi goat with hepatic lipidosis associated with cobalt deficiency Variable Control (n = 10) RBCs (·10 /ll) Hb (g/dl) PCV (%) TP(g/dl) Albumin (g/dl) AST (IU/l) ALP (IU/l) a,b,c 69 a 8.7 ± 2.3 13.4 ± 0.5a 33.7 ± 2.1a 7.9 ± 0.6a 3.1 ± 0.4a 56.3 ± 8.2a 89.5 ± 9.1a Mild (n = 6) b 8.1 ± 0.4 11.4 ± 0.3b 28.2 ± 2.3b 6.6 ± 0.7b 2.5 ± 0.3b 99.3 ± 10.1b 389 ± 44.2b Moderate (n = 6) b 7.1 ± 0.6 10.1 ± 0.2b 25.5 ± 2.1c 5.7 ± 0.3c 2.1 ± 0.3bc 167.2 ± 2.1c 577.2 ± 3c Means with different superscript letters in the same raw are significantly different at P < 0.05 Severe (n = 9) 6.7 ± 0.3b 10.3 ± 0.2b 25.7 ± 0.6c 5.6 ± 0.4c 1.9 ± 0.2c 184.7 ± 20.5c 569.3 ± 36.1c 70 [33] Moreover, the elevated activities of AST and ALP reflect the extent of liver affection Although AST is not a liver-specific enzyme, it is reportedly elevated in Omani goats [8], sheep with OWLD [37] and cattle with hepatic lipidosis [27] Also, increased ALP activity was reported in chronic liver disease, hepatic fibrosis, cholangitis, obstruction, cholestasis and most commonly with hepatic lipidosis [4] Cobalt was found necessary for propionate metabolism and consequently its deficiency could affect glucose levels A similar finding was recorded by Ulvund [33] Contrary to the observation of Al-Habsi [8], Omani goats with experimental lipidosis did not exhibit hypoglycemia In the present study, clinicopathological and histopathological findings supported the ultrasonographic results and confirmed that the diagnosis of hepatic lipidosis was due to cyanocobalamin deficiency In conclusion, ultrasound may be a useful diagnostic tool in goats suspected of having hepatic lipidosis due to cyanocobalamin deficiency More experimental investigation is needed on the developmental stages of hepatic lipidosis and the associated ultrasonographic changes to determine the appropriate time for intervention Conflict of interest statement None of the authors of this paper has a financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper References [1] Goff JP, Horst RL Physiological changes at parturition and their relationship to metabolic disorders J Dairy Sci 1997;80(7): 1260–8 [2] Malone F, McParland PJ, O’Hagan J, McMurray CH Sudden deaths in wethers associated with fatty livers Vet Rec 1984;115(20):516 [3] Ulvund MJ Ovine White-Liver Disease (OWLD) Changes in blood chemistry Acta Vet Scand 1990;31(3):277–86 [4] Radostits OM, Gay CC, Blood DC, Hinchcliff KW, Constable PD Veterinary medicine 10th ed London, UK: WB Saunders; 2007 [5] Menzies P, Langs L, Boermans H, Martin J, McNally J Myopathy and hepatic lipidosis in weaned lambs due to vitamin E deficiency Can Vet J 2004;45(3):244–7 [6] Mburu JN, Kamau JM, Badamana MS Changes in serum levels of vitamin B12, feed intake, liveweight and hematological parameters in cobalt deficient small East African goats Int J Vit Nutr Res 1993;63(2):135–9 [7] Lee HJ, Marston HR The requirement of sheep grazed on cobalt-deficient pastures Aust J Agric Res 1969;20(5):905–18 [8] Al Habsi K, Johnson EH, Kadim IT, Srikandakumar A, Annamalai K, Al Busaidy R, et al Effects of low concentrations of dietary cobalt on liveweight gains, haematology, serum vitamin B12 and biochemistry of Omani goats Vet J 2007;173(1):133–9 [9] Johnson EH, Al Habsi K, Kaplan E, Srikandakumar A, Kadim IT, Annamalai K, et al Caprine hepatic lipidosis induced through the intake of low levels of dietary cobalt Vet J 2004; 168(2):174–9 [10] Kadim IT, Mahgoub O, Al Ajmi D, Al Habsi KR, Johnson EH Comparative effects of low levels of dietary cobalt and parenteral injections of Vitamin B12 on body dimensions in different breeds of Omani goats Small Rumin Res 2006;66(1–3): 244–52 S.A El-Khodery et al [11] Kadim IT, Johnson EH, Mahgoub O, Srikandakumar A, Al Ajmi D, Ritchie A, et al Effect of low levels of dietary cobalt on apparent nutrient digestibility in Omani goats Anim Feed Sci Technol 2003;109(1–4):209–16 [12] Pearson AB White liver disease and pestivirus infection in goat kids Surveillance 1987;14(3):21 [13] Black H, Hutton JB, Sutherland RJ, James MP White liver disease in goats N Z Vet J 1988;36(1):15–7 [14] Johnson EH, Muirhead DE, Annamalai K, King GJ, Al Busaidy R, Shahul Hameed M Hepatic lipidosis associated with cobalt deficiency in Omani goats Vet Res Commun 1999;23(4):215–21 [15] Johnson EH, Al Habsi K, Al Busaidy R, Khalaf SK The effect of low levels of dietary cobalt on the chemiluminescence response of polymorphonuclear leukocytes of goats Res Vet Sci 2010;88(1):61–3 [16] Braun U, Hausammann K Ultrasonographic examination of the liver in sheep Am J Vet Res 1992;53(2):198–202 [17] Acorda JA, Acebedo MC, Maligaya RL Ultrasonographic features of the liver and associated structures in Philippine native goats Philipp J Vet Med 2006;43(1):1–7 [18] Sage AM, Wachira TM, Zeyhle EE, Weber EP, Njoroge E, Smith G Evaluation of diagnostic ultrasound as a mass screening technique for the detection of hydatid cysts in the liver and lung of sheep and goats Int J Parasitol 1998;28(2): 349–53 [19] Scott PR, Sargison ND, Macrae A, Rhind SR An outbreak of subacute fasciolosis in Soay sheep: ultrasonographic biochemical and histological studies Vet J 2005;170(3): 325–31 [20] Scott PR, Penny CD Right-sided congestive heart failure associated with an extensive pleural abscess in two sheep Vet Rec 2000;147(15):423–4 [21] Scott PR, Sargison ND Extensive ascites associated with vegetative endocarditis and Sarcocystis myositis in a shearling ram Vet Rec 2001;149(8):240–1 [22] Gonenci R, Durgut R, Erdogan S Evaluation of subclinical liver lesions in goats by ultrasonographic and biochemical analyses Ankara Univ Vet Fak Derg 2003;50(1):47–51 [23] Iwao T Ultrasonographic appearance of diffuse changes in the bovine liver Jpn J Vet Res 1987;35(2):130 [24] Mohamed T, Oikawa S, Kurosawa T, Takehana K, Hosaka Y, Okada H, et al Focal fatty liver in a heifer: Utility of ultrasonography in diagnosis J Vet Med Sci 2004;66(3): 341–4 [25] Kelly WR Veterinary clinical diagnosis 3rd ed London, UK: Bailliere Tindall Ltd.; 1984 [26] Ne´spoli PB, Gheller VA, Peixoto PV, Franc¸a TN, Carvalho AU, de Arau´jo DKG, et al Evaluation of hepatic biopsy techniques in sheep [Avaliac¸a˜o de te´cnicas de bio´psia hepa´tica em ovinos] Pesq Vet Bras 2010;30(1):29–36 [27] Cebra CK, Garry FB, Getzy DM, Fettman MJ Hepatic lipidosis in anorectic, lactating holstein cattle: a retrospective study of serum biochemical abnormalities J Vet Int Med 1997;11(4):231–7 [28] Acorda JA, Yamada H, Ghamsari SM Comparative evaluation of fatty infiltration of the liver in dairy cattle by using blood and serum analysis, ultrasonography and digital analysis Vet Q 1995;17(1):12–4 [29] Caturelli E, Squillante MM, Andriulli A, Cedrone A, Cellerino C, Pompili M, et al Hypoechoic lesions in the ‘bright liver’: a reliable indicator of fatty change A prospective study J Gastroenterol Hepatol 1992;7(5):469–72 [30] Szebeni A, Tolvaj G, Zalatnai A Correlation of ultrasound attenuation and histopathological parameters of the liver in chronic diffuse liver diseases Eur J Gastroenterol Hepatol 2006;18(1):37–42 Ultrasonic evaluation of hepatic lipidosis due to Vit B12 deficiency [31] Thijssen J, Starke A, Weijers G, Haudum A, Herzog K, Wohlsein P, et al Computer-aided B-mode ultrasound diagnosis of hepatic steatosis: a feasibility study IEEE Trans Ultrason Ferroelectr Freq Control 2008;55(6):1343–54 [32] Lofstedt J, Schelling S, Stowater J, Morris E Antemortem diagnosis of hepatic adenocarcinoma in a ewe J Am Vet Med Assoc 1988;193(12):1537–8 [33] Ulvund MJ Ovine White-Liver Disease (OWLD) Pathology Acta Vet Scand 1990;31(3):309–24 [34] McLoughlin MF, Rice DA, Taylor SM Liver lesions resembling ovine white liver disease in cobalt deficient lambs Vet Rec 1984;115(13):325 71 [35] Al Zadjali A, Johnson EH, Srikandakumar A Serum vitamin B12 levels in Omani goats Trop Anim Health Prod 2004;36(5): 473–82 [36] Calvo Romero JM, Magro Ledesma D, Arrebola Garci´a JD, Romero Requena J, Ramos Salado JL, Bureo Dacal JC Pernicious anemia and other megaloblastic anemias [Anemia perniciosa y otras anemias megalobla´sticas] An Med Int 1999; 16(12):626–9 [37] Mitchell PJ, McOrist S, Thomas KW, McCausland IP White liver disease of sheep Aust Vet J 1982;58(5):181–4  ... recorded in Omani goats with vitamin B12 deficiency [35] and in lamb with OWLD [3] Moreover, presence of eosinophilia in 17 goats suggests parasitic infestation rather than cyanocobalamin deficiency... on the nine goats with severe lipidosis that were slaughtered due to Fig Ultrasound scan of liver of a goat with hepatic lipidosis showing areas of increased echogenicity distributed in hepatic. .. controls In conclusion, ultrasound may be a useful diagnostic tool in goats with suspected hepatic lipidosis associated with vitamin B12 deficiency ª 2010 Cairo University Production and hosting by