Skip to content
Customize Consent Preferences

We use cookies to help you navigate efficiently and perform certain functions. You will find detailed information about all cookies under each consent category below.

The cookies that are categorized as "Necessary" are stored on your browser as they are essential for enabling the basic functionalities of the site. ... 

Always Active

Necessary cookies are required to enable the basic features of this site, such as providing secure log-in or adjusting your consent preferences. These cookies do not store any personally identifiable data.

No cookies to display.

Functional cookies help perform certain functionalities like sharing the content of the website on social media platforms, collecting feedback, and other third-party features.

No cookies to display.

Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics such as the number of visitors, bounce rate, traffic source, etc.

No cookies to display.

Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.

No cookies to display.

Advertisement cookies are used to provide visitors with customized advertisements based on the pages you visited previously and to analyze the effectiveness of the ad campaigns.

No cookies to display.

Biliary obstruction in a 8 year old FS Cavalier King Charles Spaniel dog

Case Study

Biliary obstruction in a 8 year old FS Cavalier King Charles Spaniel dog

An 8-year-old FS Cavalier King Charles Spaniel dog was presented for anorexia of 3 days duration, decreased drinking, and lethargy. There was prior history of foreign body removal and cholecystectomy owing to cholelithiasis four months earlier. The owner reported that the patient never fully recovered from foreign body surgery and has demonstrated intermittent G.I. signs ever since. Physical examination revealed marked icterus, mucous membranes pale pink with icterus and a CRT <2 sec, mildly enlarged submandibular lymph nodes and 4% dehydration. The patient was admitted for I.V.
An 8-year-old FS Cavalier King Charles Spaniel dog was presented for anorexia of 3 days duration, decreased drinking, and lethargy. There was prior history of foreign body removal and cholecystectomy owing to cholelithiasis four months earlier. The owner reported that the patient never fully recovered from foreign body surgery and has demonstrated intermittent G.I. signs ever since. Physical examination revealed marked icterus, mucous membranes pale pink with icterus and a CRT <2 sec, mildly enlarged submandibular lymph nodes and 4% dehydration. The patient was admitted for I.V. fluid therapy, supportive care, and further diagnostics. Blood chemistry revealed hyperphosphatemia, high ALT, hyperamylasemia, elevated BUN, increased cholesterol, hyperglobulinemia, marked hyperlipasemia, marked hyperbilirubinemia, and hypokalemia. CBC found leukocytosis, monocytosis, anemia (decreased HCT and RBC) and thrombocytosis. The dog was initially treated with gastroprotectants, steroids, anti diarrheal medication, and antibiotics. After 24 hours of fluid therapy, the PCV was 17% with a total protein of 8.0 mg/dl with no evidence of auto agglutination. At that point, the dog was QAR with persistent diarrhea but no vomiting or nausea.

DX

Biliary obstruction

Sonographic Differential Diagnosis

Post-hepatic obstruction of the common bile duct with associated cholangitis and surrounding omental inflammation.

Image Interpretation

Strongly shadowing calculi are present at the duodenal papilla and within the common bile duct (CBD) causing marked dilation (0.97 cm) and post-hepatic obstruction. Periductal hyperechoic fat and adhesions are also present suggestive for friability and inflammation of the double walled duct (CBD). Power flow Doppler demonstrates positive flow in the portal vein (PV) dorsal to the duct and lack of flow within the common bile duct.

Outcome

Due to the degree of biliary obstruction, the marked elevation in bilirubin and severity of the icterus, surgical referral to a board certified surgeon was advised to remove the biliary calculi, clear out bile duct, with possible transposition of the bile duct if needed. The prognosis was guarded and owners elected to euthanize the patient.

Clinical Differential Diagnosis

Hemolytic anemia; Liver pathology: biliary obstruction due to a cholelith in the bile duct or a papillary mass at the duodenal papilla, cholangiohepatitis, neoplasia; Pancreatic pathology: severe pancreatitis with extra-hepatic bile duct obstruction and neoplasia.

Patient Information

Patient Name : Layla B
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Book : yes
Status : Complete
Liz Wuz Here : Yes
Code : 03_00112

Clinical Signs

  • Anorexia
  • Decreased Drinking
  • Lethargy

History

  • Cholecystectomy

Exam Finding

  • Dehydration
  • Enlarged Lymph Nodes
  • Icterus
  • Pale Mucous Membranes

Images

Layla_1_11152009084250layla5_11152009084227

Blood Chemistry

  • ALT (SGPT), High
  • Amylase, High
  • BUN high
  • Cholesterol, High
  • Globulin, High
  • Lipase, High
  • Phosphorus, High
  • Potassium, Low
  • Total Bilirubin, High

CBC

  • Hematocrit, Low
  • Monocytes, High
  • Platelet Count, High
  • WBC, High

Clinical Signs

  • Anorexia
  • Decreased Drinking
  • Lethargy