- 13 year old MN DSH presented for chronic inappropriate elimination and recurrent UTI’s.
- Bloodwork showed ALP=213, ALT=393, and Tbil=2.0.
- Abdominal US showed a normal urinary tract but an abnormal gallbladder. The gallbladder is small with a thickened, layered wall and an echogenic rim around the outside of the gallbladder.
- My differential diagnoses are choleycystitis, cholangiohepatitis, mineralization of the gallbladder wall.
- The cystic and common bile ducts are tortuous and mildly dilated with no visible obstructions.
- 13 year old MN DSH presented for chronic inappropriate elimination and recurrent UTI’s.
- Bloodwork showed ALP=213, ALT=393, and Tbil=2.0.
- Abdominal US showed a normal urinary tract but an abnormal gallbladder. The gallbladder is small with a thickened, layered wall and an echogenic rim around the outside of the gallbladder.
- My differential diagnoses are choleycystitis, cholangiohepatitis, mineralization of the gallbladder wall.
- The cystic and common bile ducts are tortuous and mildly dilated with no visible obstructions.
- Do you agree that the galllbladder is a significant finding or this just due to chronic scarring from past episodes of cholecystitis. The gallbladder lumen looks peculiar like a “kiwi” but because the galllbladder is small, I am hard pressed to add mucocele to the list.
- What do you all think?
Comments
Looks like fibrosing
Looks like fibrosing cholangitis and “too many tubes sign” from the tortuous cystic duct. Staring onto porcelain Gb as well. No post hepatic obstruction and the cbd is not a surgical one because its < 5 mm in width. I would fna the liver and could do a cholecystocentessis and culture but that gb may be tough to get a needle into but I would go right intercostal for that 25 gauge if i get anything 22 g if necessary.
Baytril, actigal, clindamycin is what i like here wiht the usual hepatic support. Consider chronic infectious like toxo who likes the panc and biliary tree for example.
Thanks Eric. Because this
Thanks Eric. Because this cat presented for inappropriate elimination and no other complaints, I did not want to overdiagnose the changes I was seeing in the gallbladder. I did fna the liver and recommended initiating antibiotic therapy and possibly referral for cholecystectomy. They will start with antibiotics first. There did not seem to be much of a lumen to aspirate, but then again, I am not the needle cowboy ;).