No abnormalities seen on CBC. Chemistry: ALP 269, ALT 534, AMY 1286, TBIL 4.5, CA 12.4, CRE 2.6, TP 9.3

• 16 yr old mn DSH presented to E-clinic 10 days ago and was diagnosed with a UTI and elevated liver enzymes.
• Cat presented to primary vet 5 d later for recheck. Liver values had increased and cat had decreased appetite and mild lethargy. Urinary tract signs are significantly improving.

• No abnormalities seen on CBC. Chemistry: ALP 269, ALT 534, AMY 1286, TBIL 4.5, CA 12.4, CRE 2.6, TP 9.3

• Abdominal US performed 5 days after above labwork shows a distended GB with a thickened wall and intraluminal mass.  CBD is also dilated and thickened.  Mass does not appear to be obstructing GB.  Suspect intraluminal mass is a tumor and not sludge based upon CF Doppler although abdominal movement was present.  Fed cat and rescanned 40 min later…GB width decreased in max diameter from 2.5cm to 1.5cm but still remained moderately distended.
• Cat is tx with Zenequin, amoxicillin and Denamarrin.  Recheck labs are pending.
• R/O’s for elevated liver enzymes include cholecystitis/cholangiohepatitis, chronic hepatitia,  extra-hepatic biliary obstruction (none seen), LSA, and FIP.  
• US guided fna of liver or referral for cholecystectomy and liver bx recc next.  O feels cat is improving on meds so no addiitional diagnostics for now.
• What are your rule outs for the GB mass?  Benign polyp?  neoplasia? I could put mucocele on the list but feel that CF Doppler study shows blood flow into the mass.