- 12 yr old FS Westie X with a history of recurrent PU-PD with UTI’s that respond to antibiotic therapy.
- Chemistry profile showed an elevated lipase >5000, increased TBil=2.4, and slightly increased ALT.
- The dog is currently asymptomatic.
- 12 yr old FS Westie X with a history of recurrent PU-PD with UTI’s that respond to antibiotic therapy.
- Chemistry profile showed an elevated lipase >5000, increased TBil=2.4, and slightly increased ALT.
- The dog is currently asymptomatic.
- Abdominal US Shows a normal bladder, trigone, and proximal urethra, slightly degenerative renal changes, a left adrenal gland nodule, and a faintly echogenic polyp or mass in the gallbladder neck extending into the cystic duct. The gallbladder does not appear to be obstructed. There is NO Murphy’s sign. There is echogenic, reactive fat ventral to the common bile duct and adjacent to the proximal duodenum/right pancreas.
- The plan is to perform an ACTH stim and recheck the chemistries.
- How worried should I be about the gallbladder lesion (polyp vs. bile duct carcinoma) and echogenic fat? Does echogenic fat always indicate active inflamation or can it be scarring from a previous insult (previous bout of pancreatitis).
- The dog’s only initial clinical sign was PU-PD which resolved with antibiotic therapy for the UTI.
Comments
First I would double check
First I would double check that the bilirubin is not artifactual… should have 2+ bilirubinuria and be repeatable if not artifact. The GB is not a primary player here as its not overdistended even with a polyp sitting in the neck this is a common benign presentation. That being said not all post hepatic obstructions from pancreatitits have overdistended GB but they get a dilated and often sludgy cbd. The fatty remodeling can be bright. With that high lipase and the bili (assuming its real) and that hypoechoic region in image 2 im concerned for pancreatitis and post hepatic obstruction causing the bili elevation… maybe a sludgy cbd obscured by the pancreatic fat?? Video of the area in image 2 would tell. He did start getting tachypneic in your fist video and you were scanning with pressure on the right panc base basded on your position… are you sure he wasnt painful there? Some dogs hide their pain ewell and just start panting.
Thanks Eric. They are
Thanks Eric. They are repeating the chems and results are pending. This is a dog that does not like restraint and was not sedated for the exam. As such, it is difficult to say if the panting was related to pain. With her disposition, I don’t think she would have tolerated the exam if there was pain involved. This dog is feeling good and doing well so it is hard to believe that serious disease is present unless I am catching something early. Will keep the forum posted on results. -M