A 4-year-old SF Cockapoo with a history of seizures was presented for evaluation of acute vomiting and pancreatitis. Abnormalities on serum biochemistry were elevated BUN and GGT activity and severely elevated ALP activity and lipase.
A 4-year-old SF Cockapoo with a history of seizures was presented for evaluation of acute vomiting and pancreatitis. Abnormalities on serum biochemistry were elevated BUN and GGT activity and severely elevated ALP activity and lipase.
Pancreatic necrosis, abscessation and post hepatic obstruction with distended gallbladder.
I strongly recommend ultrasound-guided drainage of the fluid coalesced within the pancreatic necrosis. FNA of the hypoechoic portion and ultrasound decompression of the gallbladder can also be considered. This patient should be monitored attentively for elevated bilirubin values as well as adequate resolution while under medical treatment. Otherwise, surgical intervention with redirection of the common bile duct may be necessary. The common bile duct was not visible owing to entrapment and obscurity of the pancreatic pathology. Guarded prognosis. Plasma transfusion, aggressive antibiotics and pain management are all warranted. Coagulation panel warranted.
The right limb of the pancreas in this patient presented aggressive, mixed echogenic hypoechoic and hyperechoic changes. This is consistent with pancreatic necrosis and pancreatitis. There is a mild potential for neoplasia. FNA of the hypoechoic portion of the pancreas is recommended. This enveloped the descending duodenum with some loss of detail and duodenal spasming. This is consistent with an acute on chronic presentation. A significant amount of gastric stasis was noted. This is likely owing to delayed outflow from tethering of the duodenum. Areas of coalesced free fluid was noted in the right limb of the pancreas. This may potentially be owing to abscessation. Ultrasound-guided drainage and appropriate antibiotic injection is recommended such as Enrofloxacin.
The liver was structurally unremarkable with minor, increased portal markings. The gallbladder was distended with suspended debris, largely immobile. This is consistent with post hepatic obstruction given the position of the pancreatic pathology.
Free fluid was noted in the cranial abdomen.
None
Pancreas – acute pancreatitis, chronic pancreatitis, neoplasia, abscessation
Focal peritonitis
Gall bladder – obstruction, cholecystitis, mucocele
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