Abdominal US on a 12 YO Feline (Oriental Shorthair) with vomiting and weight loss. Current weight is 6.5#.
Radiographs reveal suspected Stones in Common Bile Duct (Choledocholiths).
Lab work:
- Hyperglobulinemia (6.1)
- Albumin low normal (2.5) A:G = 0.4
- Mild increase BUN (37)
- Normal Creat
- CBC- Leukocytosis (24,000) with a monocytosis and eosinophilia
There is no evidence of Anemia or elevated liver values noted.
US findings:
Abdominal US on a 12 YO Feline (Oriental Shorthair) with vomiting and weight loss. Current weight is 6.5#.
Radiographs reveal suspected Stones in Common Bile Duct (Choledocholiths).
Lab work:
- Hyperglobulinemia (6.1)
- Albumin low normal (2.5) A:G = 0.4
- Mild increase BUN (37)
- Normal Creat
- CBC- Leukocytosis (24,000) with a monocytosis and eosinophilia
There is no evidence of Anemia or elevated liver values noted.
US findings:
- Liver is hypoechoic with slightly coarse echotexture and hyperechoic reflections with shadowing noted.
- Kidneys: Small, Hyperechoic with increased Corticmedullary Demarcation. Left renal pyelectasis of 0.52 cm.
- Mildly Dilated Common Bile Duct with a few small stones seen; There is obstruction (tissue/swelling/mass) at the duodenal papilla.
- Pancreas looks pretty quiet, but is slightly enlarged and may be some pancreatic duct stones near the papilla
- GI: Hyperechoic mucosal layer of the Duodenum and thickened Duodenal papilla. Prominent Muscularis layer of the ileum with a roughly 1:1 Mucosa to Muscularis ratio.
- Mild jejunal lymphadenopathy
Fine needle biopsy of the left kidney, jejunal lymph node, and duodenal papilla performed with 1 1/2″ 25 gauge needle. Cyto returned with no evidence of neoplasia noted. Lymph node revealed reactive lymphoid hyperplasia.
So I am recommending treating for IBD and likely chronic pancreatitis. Just would like to know what others think obout the duodenal papilla. Should i get more agressive and recommend biopsy (duodenum and lieum to rule out Small Cell Lymphoma)? Also, recommend urine culture based on concurrent or previous pyelonephritis.