Hello
I have yet another GB question. This is Mojo a 7 year old diabetic pug that has a GB filled with hyperechoic material but there are focal anechoic areas throughout the GB that do not move. I have done a search and never seen this pattern in the GB before. Advice on what this pattern in the GB represents and what should be done about it if anything would be greatly appreciated
Thanks. Brent.
Hello
I have yet another GB question. This is Mojo a 7 year old diabetic pug that has a GB filled with hyperechoic material but there are focal anechoic areas throughout the GB that do not move. I have done a search and never seen this pattern in the GB before. Advice on what this pattern in the GB represents and what should be done about it if anything would be greatly appreciated
Thanks. Brent.
Comments
This is what i would consider
This is what i would consider an “emerging Gb mucocele.” There is still some minor biliary movement and only mild overdistention and the tear drop state is still present. But stellate immobile bile and mild overdistention is present. Watch the SAP especially. I would use ursodiol on this personally but no consensus on this.
Thanks. I’m going to have
Thanks. I’m going to have research this but SAP was 337. Our high normal is 212.
I still have never seen a classic mucocoele. They’re always a derivative of the classic form.
Thanks for the quick comments
SAP of 337 is not that hight
SAP of 337 is not that hight considering what the gall bladder looks like.
How controlled is the dog’s diabetes?
Just diagnosed 4 weeks ago
Just diagnosed 4 weeks ago with diabetes. The case has become a little complicated.
Mojo had a FB 3 years ago. On the US we also found signs of adhesions in his abdomen(paralell bowels odd loops and pockets of fluid in the mesentery.) He had a very painful abdomen and was vomiting. We thought this was his main problem but posted the GB pics to ensure we weren’t being mislead
We performed an exploratory and broke down the adhesions. There was a section of jejunmum that was enlarged to twice its normal size with 1-2ft of food/feces sitting in it. The pancreas looked normal but with gentle touching you could feel pinpoint firm irregularities and the mesenteric fat had a mild amount of firm hard white nodules. We suspect either chronic adhesions from the previous surgery or from chronic pancreatitis leading to sharp loops of bowel and prevention of normal peristalsis or a combination of both. We resected a large portion of jejunum.
A question I have is: We explored the GB as well. It appeared completely normal grossly and palpated normal as well. Can this be consistent with a mucoceole or would there possibly be some gross abnormalities visible. We did not sample the GB.
We do have some samples of the white nodules and pancreas to submit.
Thanks. Brent
in my experience GI disease
in my experience GI disease begets Gb disease … the emerging Gb mucoclee here is likely sequelae form prior issue whcih is why its alwasy a good idea to express the GB when doing Gi sx to enhance Gi motility post op and empty any Gb garbage that may have been built up. This is an inside line technique thing deriving form a couple of seminars i had attended a logn time ago. But in my surgical circles was commonplace to do so but I dont know of any sx publications to this regard. Maybe remo knows..
i would add actigal anfor 6 weeks and run baytril metronidazole 3 weeks and rescan in 3 and 6 and see what it looks like. If still the dsame in 6 weeks do a Gb motility study (http://sonopath.com/resources/interventional-procedures). If you are able to do so please add pics to this thread so we can see what happens:)
Great. Thanks. We did gently
Great. Thanks. We did gently palate the GB and express a small amount but we did not completely empty it. (Fear or making things worse combined with 1 am surgery.) I will take your advice on meds and post follow ups if possible. Thanks For all the posts. Brent
Literature states that
Literature states that surgical intervention for the treatment of a mucocele is the therapeutic gold standard, with short- and long-term survival for biliary surgery being 66%; however, I tend to be a bit more conservative – treat any possible endocrinopathy and dyslipidemia and as Eric states Actigal for a few weeks and monitor ultrasonographically.