Hi, just wanted to try my first case on forum. I am fairly new to ultrasounding and would appreciate advice on all aspect (techinque, image quality, forum posting and thoughts on further diagnostics).
Charlie is a 15 year old Shih tzu male neutered.
- He has had chronic liver enzyme elevations (ALP [~500]) and elevated bile acids since 2013. Zentonil since 2013.
- Off and on diarrhea – gastro-intestinal diets most of his past 4 years
- ALT elevation in 2014 (ALT 164)
- Fast forward to 2017 (ALT – 260; ALP – 1400).
- Did ultrasound 1 month ago and noticed very inflammed gall bladder; cystic kidneys; urinary calculi (very small) and enlarged liver and left adrenal gland had focal nodule in center in one pole (couldn’t locate right adrenal gland).
- Tested negative for cushings disease.
- Started on ursodiol; hypoallergenic HP and Z/D diet; aventiclav.
- These are new images from today for a brief rescan/recheck if improvement of inflammed gall bladder. Still seems inflammed. Noted something that makes me suspicious of a mass in gall bladder wall? He wasnt sedated for this exam and is very vocal during exam, so could only rescan a portion of his body before we gave up.
Thoughts on his gall bladder? Clinically he has had off and on diarrhea but good otherwise. The bloodwork was done to evaluate him for a dental (Fx carnassial and moderate dental dz). Since new diet the diarrhea has greatly improved on how often diarrhea relapses. I am suspecting cholecystitis, potentially from IBD and trying to protect liver/gall bladder with supplements and keep on hypoallergenic diet.
Thanks,
Layne
Comments
Gall bladder wall is hyperechoic and although there may be a mass, could also be adherent sediment. Any possiblity of uploading some short video clips of the gall bladder?
This is what we call a “porcelain gall bladder.” This usually results from chronic cholecystitis and then mural fibrosis and then even mineralizes at times cauusing the echogenicity to the wall and enhances in the far field like the second image. Its not overdistended or obstructed and im not seeing ill defined reactivity around it so likely quiescent or low grade. Often GB stones occur as well and theres a little benign polyp.. You can always cholecystocentesis from subxyphoid or right intercostal approach and culture the bile but many dogs are completely fine living with this type of gb. If rapid SAP rises occur or ALT is an issue or poort appetite and “ADR” then you may want to remove it but not likely necessary and at 15 years its basically an occupational hazard being a Shihtzu. You canm also shotgun treeat with 3 weeks baytril metronidazole and 6 weeks ursodiol and see what happens… I’ve had some minor improvement in these cases wiht this protocol but tough to medically treat fibrosis. I don’t see a mass.
Here’s a quick variety of GB disease in our patients form the basic search on porcelain GB
http://sonopath.com/members/case-studies/search?text=porcelain+gall+bladder&species=All
Thank you! I will try to get a video of gall bladder for better visualization. I will speak to the owners about further diagnostics but I suspect they will be happy with monitoring based on your thoughts.
Cheers,
Layne