– 7 year old FS Shih Tzu presented to referring vet due to a night of restlessness, pacing
– otherwise eating well; no v/d/pu/pd
– abdomen painful on palpation when referring vet examined her and x-rays showed multiple stones in the area of the gall bladder
– bloodwork 2x’s elevation ALT, ALP normal, mild neutrophilia, cPLI SNAP negative
– multiple choleliths of various size on u/s but no evidence of biliary obstruction
– liver appears small (and she is a small Shih Tzu herself)
– 7 year old FS Shih Tzu presented to referring vet due to a night of restlessness, pacing
– otherwise eating well; no v/d/pu/pd
– abdomen painful on palpation when referring vet examined her and x-rays showed multiple stones in the area of the gall bladder
– bloodwork 2x’s elevation ALT, ALP normal, mild neutrophilia, cPLI SNAP negative
– multiple choleliths of various size on u/s but no evidence of biliary obstruction
– liver appears small (and she is a small Shih Tzu herself)
– both kidneys have multiple non-obstructive renoliths
– two polyp-like masses in apex of urinary bladder (have positive Doppler colour flow)
– small uroliths noted in urinary bladder that are non-shadowing so likely very small
– GI, adrenals, pancreas normal
– when scanned she showed no sign of pain on ultrasound and owner claimed that she was back to her normal self
– so what caused the pain in this patient? the choleliths? passing kidney stones? could it have been hepatic encephalopathy?
– is this a polypoid cystitis secondary to the uroliths?
– could this patient have a shunt or microvascular dysplasia?
– candidate for gall bladder removal?
I have recommended a pre/post bile acids and urinalysis to see if there is any hint of ammonium biurate or calcium oxalate crystals.
Any thoughts on putting these findings all together?
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Comments
The bladder polyps are apical
The bladder polyps are apical and 50/50 polypoid hyperplasia vs tcc but when they are in that position I have gotten underlying urachal remnant with polypoid cystitis on top… chronic inflam from the remnant??>>> cut it out.
The gb is double layered and enough stones and debris to be clinical with a + murphy sign. Small liver cah +/- portal hyperplasia. Dont see any obvious shunts but need pv cvc ao views for that to rule them out. Older shih-tzus get axygos shunts and liver with them til late in life at times—-oilder dog shunt. So if BA are high then rule out a shunt before going to cholecystectomy and apical ub resection. zthe bladder and renal stones are bright and clean so could be biurate which will happen wiht shunts or bad PV hypoplasia.
So if no shunt cholecystectomy ub resection and liver bx is what I would do. If + shunt on another image set the ameroid it as well if albumin, BUN and cholesterol are not dropping. Surgical shopping spree:)
check out our shunt study for the necessary views form ecvim 2010
The bladder polyps are apical
The bladder polyps are apical and 50/50 polypoid hyperplasia vs tcc but when they are in that position I have gotten underlying urachal remnant with polypoid cystitis on top… chronic inflam from the remnant??>>> cut it out.
The gb is double layered and enough stones and debris to be clinical with a + murphy sign. Small liver cah +/- portal hyperplasia. Dont see any obvious shunts but need pv cvc ao views for that to rule them out. Older shih-tzus get axygos shunts and liver with them til late in life at times—-oilder dog shunt. So if BA are high then rule out a shunt before going to cholecystectomy and apical ub resection. zthe bladder and renal stones are bright and clean so could be biurate which will happen wiht shunts or bad PV hypoplasia.
So if no shunt cholecystectomy ub resection and liver bx is what I would do. If + shunt on another image set the ameroid it as well if albumin, BUN and cholesterol are not dropping. Surgical shopping spree:)
check out our shunt study for the necessary views form ecvim 2010