Hello there,
Ginger is a 6 year old DSH F/S that presented with cranial pain and vomiting. All liver enzymes are moderatelly elevated same with Calcium ( protein normal). I measured the CBD at 0.47 cm and it’s dilated all the way to papila. It looks to me there is a faint shadow suggesting urolith or insipating bile.
Would you recheck in in 3-5 days or consider referral right away for surgery( cat is not icteric and already on antibiotics for suspected cholangiohepatitis)
Thank you,
Calin
Hello there,
Ginger is a 6 year old DSH F/S that presented with cranial pain and vomiting. All liver enzymes are moderatelly elevated same with Calcium ( protein normal). I measured the CBD at 0.47 cm and it’s dilated all the way to papila. It looks to me there is a faint shadow suggesting urolith or insipating bile.
Would you recheck in in 3-5 days or consider referral right away for surgery( cat is not icteric and already on antibiotics for suspected cholangiohepatitis)
Thank you,
Calin
Comments
Attached also 2 stls of the
Attached also 2 stls of the CBD
Attached also 2 stls of the
Attached also 2 stls of the CBD
That meets surgical
That meets surgical criteria for cbd obstruction really depends on how the cat is responding clinically. Its a small stone and may dissolve with ursodiol over 6-8 weeks. No study just have seen it work. If focally painful (murphy sign) then I would cut. If no murphy then try medical but keep a close ye on the bili sap alt wbc and anorexia. Rescan in 5 days if stable. You could go out of the box and try a shot of dexamethasone… cringe cringe as long as you have a probe on the cat daily and that small of a stone may pop through. If the d-pap were old and lupped up like 12 year old cats have then I would say no steroids owing to potential perforation. But a 6 year old cat likely has could d-pap function and looks pretty clean there to me and can likely handle a single dexameth injection…..disclaimer…disclaimer…disclaimer….may be contraindicated… but I’ve seen it work with grit and sand and small stone obstructions in patients that had owners that said “No Surgery.” But have a probe on it to watch.
That meets surgical
That meets surgical criteria for cbd obstruction really depends on how the cat is responding clinically. Its a small stone and may dissolve with ursodiol over 6-8 weeks. No study just have seen it work. If focally painful (murphy sign) then I would cut. If no murphy then try medical but keep a close ye on the bili sap alt wbc and anorexia. Rescan in 5 days if stable. You could go out of the box and try a shot of dexamethasone… cringe cringe as long as you have a probe on the cat daily and that small of a stone may pop through. If the d-pap were old and lupped up like 12 year old cats have then I would say no steroids owing to potential perforation. But a 6 year old cat likely has could d-pap function and looks pretty clean there to me and can likely handle a single dexameth injection…..disclaimer…disclaimer…disclaimer….may be contraindicated… but I’ve seen it work with grit and sand and small stone obstructions in patients that had owners that said “No Surgery.” But have a probe on it to watch.
That is a great suggestion!
That is a great suggestion! Thank you. Cat is stable so I will rescan in 3-4 days and see…. wait more or dex or sx.
Like to get also “out of the box but risky…..aren’t they all risky suggestions”?
Calin
That is a great suggestion!
That is a great suggestion! Thank you. Cat is stable so I will rescan in 3-4 days and see…. wait more or dex or sx.
Like to get also “out of the box but risky…..aren’t they all risky suggestions”?
Calin
yeh can do no right or wrong
yeh can do no right or wrong here someone would have an issue with every choice:)
yeh can do no right or wrong
yeh can do no right or wrong here someone would have an issue with every choice:)