12 yo 106 lb Akita (ugh) presented with a two day history of vomiting numerous hours after eating. Is currently taking Trazadone daily.

PE:BAR T 101.2,mild dehydration otherwise normal exam.

Lab: ALT 507 (18-121), AST 264 (16-55), ALP 356 (5-160), GGT 18 (0-13) Bili Tot 0.9 (0.0-0.3), Bili Uncon 0.5 (0.0-0.2), Bili Conj 0.4 (0.0-0.1) Glob 4.4 (2.4-4.0) 

CBC:NSF

UA:1.038, 2+ protein, 3+ Bili

Spec cPL:109 (0-200)

Lept Elisa AB neg, Blood/Urine PCR pending.

Abdominal radiographs unremarkable

12 yo 106 lb Akita (ugh) presented with a two day history of vomiting numerous hours after eating. Is currently taking Trazadone daily.

PE:BAR T 101.2,mild dehydration otherwise normal exam.

Lab: ALT 507 (18-121), AST 264 (16-55), ALP 356 (5-160), GGT 18 (0-13) Bili Tot 0.9 (0.0-0.3), Bili Uncon 0.5 (0.0-0.2), Bili Conj 0.4 (0.0-0.1) Glob 4.4 (2.4-4.0) 

CBC:NSF

UA:1.038, 2+ protein, 3+ Bili

Spec cPL:109 (0-200)

Lept Elisa AB neg, Blood/Urine PCR pending.

Abdominal radiographs unremarkable

24 hrs iv fluids, IV ampicillin was eating well and no vomiting. Sent home on oral Doxycycline to cover for Lepto (tests were pending) O wanted to hold off on ultrasound until all test were back given that he was doing well and sedation would have been needed. Did I mention he was a 106 lb Akita!  

Returned 24 hours later for recurrance of vomiting though the owner reported that his urine was starting to become less brown. Wondering if the Doxy was to blame. 

O finally consented to Ultrasound (now 48 hours post initial presentation) and only abnormality I could ascertain was the Gallbladder. It was a struggle. 

Interestingly, all blood values were now back to normal or very close to it. And Dog is eating I/d and keeping it down. 

I’m now wondering how to proceed. DDX: Trazadone reaction? Cholangitis, Cholangiohepatitis. Could 24 hours of Ampicillin been enough time to reverse all those abnormal values if this was bacterial. Also normal CBC, never a fever. 

Trying to decide if I hit this hard with abs or wait it out a bit longer and recheck Gall Bladder in a week or so. 

Thanks. 

P.S. I’m guessing Eric will recommend aspirating the gall bladder, but given I’ve never done that before and given the size of this dog, I think I would refer if it comes down to that.