“These are images of a 12-year-old MN Yorkshire terrier’s gallbladder.” Please bear with me, I’m a beginner at ultrasound… 🙂
“These are images of a 12-year-old MN Yorkshire terrier’s gallbladder.” Please bear with me, I’m a beginner at ultrasound… 🙂
- History of a poor appetite.
- The history of this dog is also rather confusing – he was presented on emergency late in the evening after his owners had been away all day and found him collapsed, hypothermic with respiratory distress and multiple spots of white frothy vomitus and bloody diarrhea all over. He was very dehydrated.
- All blood work is WNL.
- His radiographs showed a single 1 cm diameter urinary bladder calculus and were normal otherwise. He recovered rapidly with fluids and oxygen, and was sent home the next day with antibiotics, cerenia and tramadol.
- Before he left I recorded the above images of his gall bladder. The patient seems painful upon ultrasound in the area of the gallbladder. (I have more images including a picture of the urinary bladder with stone) He has been doing ok since, has not had any vomiting or diarrhea and is eating with a picky appetite, which is usual for him (owners feed “people food”)
So, I am not sure whether the vomiting/diarrhea/collapse had to do with the urinary calculi (transient urethral blockage? Another stone that passed?) or gall bladder, or is unrelated. How significant are the opacities I am seeing? Thanks for any thoughts on the case or on the ultrasound images. Pam
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Comments
Hi Pam and welcome to the
Hi Pam and welcome to the forum. I am thinking he may be painful owing to the gas and fluid in the stomach to the right. That being said the Gb is an “emerging Gb mucocele as the debris is still moving but not likely causing clinical signs. Could try some actigall for good measure and see what he does in 4 weeks but I am more concerned with the stomach here.
For more on when Gb disease is clinical check out number 2 ecvim 2009 and “Defining a gb mucocele” here in resources:
nice post. try turning up your gain about 6 points as the images are just a bit dark.
Hi Pam and welcome to the
Hi Pam and welcome to the forum. I am thinking he may be painful owing to the gas and fluid in the stomach to the right. That being said the Gb is an “emerging Gb mucocele as the debris is still moving but not likely causing clinical signs. Could try some actigall for good measure and see what he does in 4 weeks but I am more concerned with the stomach here.
For more on when Gb disease is clinical check out number 2 ecvim 2009 and “Defining a gb mucocele” here in resources:
nice post. try turning up your gain about 6 points as the images are just a bit dark.
Hi Pam and Eric, I got a
Hi Pam and Eric, I got a question while seeing this case, Do you perform cholecystocentesis on emerging mucoceles? is it an option or is it contraindicated? Thanks
Got a similar case, emerging mucocele (some debris still moving but most static and with small attachments to wall) post image here (blurry, dog panting lots) also with diffuse hyperechoic hepatomegaly and I’m not sure if both changes are related, although no clinical signs on this dog and mild elevation of ALT. FNA performed (havent heard from results yet) but I am interested in if should I do further investigation on that GB or just recheck in a month? should I recommend actigall too? is this already a mucocele and not an emerging one?(Nice articles on mucocele on the website Eric!! Thanks!
Hi Pam and Eric, I got a
Hi Pam and Eric, I got a question while seeing this case, Do you perform cholecystocentesis on emerging mucoceles? is it an option or is it contraindicated? Thanks
Got a similar case, emerging mucocele (some debris still moving but most static and with small attachments to wall) post image here (blurry, dog panting lots) also with diffuse hyperechoic hepatomegaly and I’m not sure if both changes are related, although no clinical signs on this dog and mild elevation of ALT. FNA performed (havent heard from results yet) but I am interested in if should I do further investigation on that GB or just recheck in a month? should I recommend actigall too? is this already a mucocele and not an emerging one?(Nice articles on mucocele on the website Eric!! Thanks!
Hi Pam and everyone,
I have
Hi Pam and everyone,
I have seen dogs with sludgy gallbladder be asymptomatic despite of this, and others with Murphy’s sign or abdominal pain with half this much. I think it is important to correlate the findings to the clinical signs, and in the case of mucocele I personally like to rescan every 3-4 weeks if the animal is doing fine to monitor progression.
I believe the degree of compression of a distended gallbladder over the hepatic parenchyma will produce an increase of ALT up to some extent.
Cheers,
Silvana
Hi Pam and everyone,
I have
Hi Pam and everyone,
I have seen dogs with sludgy gallbladder be asymptomatic despite of this, and others with Murphy’s sign or abdominal pain with half this much. I think it is important to correlate the findings to the clinical signs, and in the case of mucocele I personally like to rescan every 3-4 weeks if the animal is doing fine to monitor progression.
I believe the degree of compression of a distended gallbladder over the hepatic parenchyma will produce an increase of ALT up to some extent.
Cheers,
Silvana
The thing with the ALT and
The thing with the ALT and SAP can be highly variable. Theoretically speaking if the liver parenchyma (where all the cells are) is not insulted and the mucocele is the main issue there are not a a lot of cells in the GB and cbd to spill ALT from the cytosol or AST from the mitochondria and the amount of SA from brush border cells is debatable to really spike those numbers above normal reference ranges. At least this is how I explain it out based on our study where there were many cases where the sap and alt were minimally elevated and a couple that had no LE elevations at all but resolved the clinical signs after cholecystectomy. I think the LE spike gets us to do the sonogram where we ca see the mucocele, its degree of distention and level of periGB inflammation and the presence of a murphy sign.
Check these studies out
Defining a GB mucocele and ECVIM 2009 number 1.
The thing with the ALT and
The thing with the ALT and SAP can be highly variable. Theoretically speaking if the liver parenchyma (where all the cells are) is not insulted and the mucocele is the main issue there are not a a lot of cells in the GB and cbd to spill ALT from the cytosol or AST from the mitochondria and the amount of SA from brush border cells is debatable to really spike those numbers above normal reference ranges. At least this is how I explain it out based on our study where there were many cases where the sap and alt were minimally elevated and a couple that had no LE elevations at all but resolved the clinical signs after cholecystectomy. I think the LE spike gets us to do the sonogram where we ca see the mucocele, its degree of distention and level of periGB inflammation and the presence of a murphy sign.
Check these studies out
Defining a GB mucocele and ECVIM 2009 number 1.