– 9 year old MN Lhasa Apso asymptomatic with history of increasing ALP and mild elevation in ALT (200)
– pre/post bile acids pending
u/s shows a gall bladder that is developing a stellate appearance but also areas where there is some gravity dependent biliary sludge (the second clip of the GB is taken from the right intercostal position)
– there was no Murphy sign, evidence of inflamed fat or effusion
– rest u/s unremarkable – adrenal glands normal
– 9 year old MN Lhasa Apso asymptomatic with history of increasing ALP and mild elevation in ALT (200)
– pre/post bile acids pending
u/s shows a gall bladder that is developing a stellate appearance but also areas where there is some gravity dependent biliary sludge (the second clip of the GB is taken from the right intercostal position)
– there was no Murphy sign, evidence of inflamed fat or effusion
– rest u/s unremarkable – adrenal glands normal
So – my plan is medical mangement for a mucocele and rescan/monitor liver enzymes. Does this sound acceptable?
Comments
Yes I think give your
Yes I think give your criteria and “emerging mucocele” label fits here. For more info cheack out our articles on defining a GB mucocele and clinical parameters for surgical biliary disease and search Gb mucocele in the basic search.
http://sonopath.com/members/case-studies/search
Also you could do a Gb motility study:
reason: Define postprandial function of a GB
NPO
Measure the Gb long axis subcostally and right intercostal at 0 min.
Feed 1 can A/D or similar.
Measure the GB in same positions at 15 and 30 min.
If no motility or change then the Gb is not likely functional.
Need to do more studies on this but it helps define the functionality of the GB.
Yes I think give your
Yes I think give your criteria and “emerging mucocele” label fits here. For more info cheack out our articles on defining a GB mucocele and clinical parameters for surgical biliary disease and search Gb mucocele in the basic search.
http://sonopath.com/members/case-studies/search
Also you could do a Gb motility study:
reason: Define postprandial function of a GB
NPO
Measure the Gb long axis subcostally and right intercostal at 0 min.
Feed 1 can A/D or similar.
Measure the GB in same positions at 15 and 30 min.
If no motility or change then the Gb is not likely functional.
Need to do more studies on this but it helps define the functionality of the GB.
Although adrenal glands were
Although adrenal glands were normal, early Cushing’s disease should be considered.
Although adrenal glands were
Although adrenal glands were normal, early Cushing’s disease should be considered.
Thanks Eric and Remo.
I did
Thanks Eric and Remo.
I did think of Cushings – not clinical, but like you said, can not rule out early disease.
Should I also be considering liver biopsy in this one? To me the liver looked pretty normal but I know concurrent liver disease is possible. Or should I just treat for a possible mucocele and monitor for now?
Do you routinely culture the bile (would be gold standard) or just pick appropriate antibiotics?
Thanks Eric and Remo.
I did
Thanks Eric and Remo.
I did think of Cushings – not clinical, but like you said, can not rule out early disease.
Should I also be considering liver biopsy in this one? To me the liver looked pretty normal but I know concurrent liver disease is possible. Or should I just treat for a possible mucocele and monitor for now?
Do you routinely culture the bile (would be gold standard) or just pick appropriate antibiotics?
I dont sample mucoceles but i
I dont sample mucoceles but i do sample swirling bile with indications of cholecystitis. if the LEs are peristently up then some level of parenchymal disease is involved as there are few cells in the GB and cbd. SAP = congestion, alt=cytosol leak. I think actigall is the main tx here. ALT of 200 maybe metronidazole for immune mediation more than anything as lp infiltrates usually predominate in these sap and little alt cases but fna to be sure
I dont sample mucoceles but i
I dont sample mucoceles but i do sample swirling bile with indications of cholecystitis. if the LEs are peristently up then some level of parenchymal disease is involved as there are few cells in the GB and cbd. SAP = congestion, alt=cytosol leak. I think actigall is the main tx here. ALT of 200 maybe metronidazole for immune mediation more than anything as lp infiltrates usually predominate in these sap and little alt cases but fna to be sure