Miss Katsy is a 14 1/2 year old DMH with a history of weight loss, intermittent vomiting and hypoalbuminemia. X-rays were mostly unremarkable except for a small L kidney which was confirmed on US.
Lab work: abnormals
UA: Sg 1.036, pH 6.5. 1+ hematuria and trace protein. Sed clear
Profile:
Albumin 2.2 (2.6-3.9)
Calcium 8.4 (8.6-10.6)
T4 7.9
CBC: WNL
SPECfPL 3.9 (0-3.9)
Leuk/FIV negative
Miss Katsy is a 14 1/2 year old DMH with a history of weight loss, intermittent vomiting and hypoalbuminemia. X-rays were mostly unremarkable except for a small L kidney which was confirmed on US.
Lab work: abnormals
UA: Sg 1.036, pH 6.5. 1+ hematuria and trace protein. Sed clear
Profile:
Albumin 2.2 (2.6-3.9)
Calcium 8.4 (8.6-10.6)
T4 7.9
CBC: WNL
SPECfPL 3.9 (0-3.9)
Leuk/FIV negative
I know the hyperthyroidism accounts for the weight loss and possibly intermittent vomiting- but not the low albumin. I did not see any obvious changes in wall layering or thickening of the small bowel. I am posting a few pictures that I would like some feedback.
1. Am I looking at a dilated and torturous common bile duct?
2. If so- why are the bilirubin numbers not higher. I would suspect some sort of obstruction if the duct is that dilated.
3. Do others have trouble following the duct to the find the sourse of obstruction?
4. Do you see suspected protein losing enteropathy very often with normal looking bowel?
5. Are those tiny stones causing the shadowing distal to the bowel?
Thanks
Comments
Hi Randy yes the cbd can
Hi Randy yes the cbd can be tough to follow but you got it nicely here. Its a bit dilated (0.4 cm max in cat) but is also a common finding in older cats just like the panc duct… something about getting older dilates the ducts.
I attached long arrow to the cbd and short arrow to the tortuous CD which happens in older cats too. Not necessarily pathological.
The other image the arrow points to the duodenal papilla or sphincter of Odi. If you adjust that angle slightly you will see the crater in the duodenal wall. I go to hi res linear when I want to see th ed-pap clearly with the cbd. Like you did I drop color over ithe portal hilus and the pv is color + and the cbd above it on the screen (ventral) is CF -.
Re the albumin since only trace proteinuria then the loss is eiotehr liver or Gi and the liver I see is nsf. PLE will occur in IBD cats and may have maldigestion/dysbiosis which can contribute to the weight loss. I also see a lot of GI LSA with PLE in cats but no evidence of that here.
I attached a nice cbd stone obstruction on hi res linear to show you what I mean here. This was done by Dr. Casey in Vancouver on a telemed case.
Hi Randy yes the cbd can
Hi Randy yes the cbd can be tough to follow but you got it nicely here. Its a bit dilated (0.4 cm max in cat) but is also a common finding in older cats just like the panc duct… something about getting older dilates the ducts.
I attached long arrow to the cbd and short arrow to the tortuous CD which happens in older cats too. Not necessarily pathological.
The other image the arrow points to the duodenal papilla or sphincter of Odi. If you adjust that angle slightly you will see the crater in the duodenal wall. I go to hi res linear when I want to see th ed-pap clearly with the cbd. Like you did I drop color over ithe portal hilus and the pv is color + and the cbd above it on the screen (ventral) is CF -.
Re the albumin since only trace proteinuria then the loss is eiotehr liver or Gi and the liver I see is nsf. PLE will occur in IBD cats and may have maldigestion/dysbiosis which can contribute to the weight loss. I also see a lot of GI LSA with PLE in cats but no evidence of that here.
I attached a nice cbd stone obstruction on hi res linear to show you what I mean here. This was done by Dr. Casey in Vancouver on a telemed case.
Thank you EL. It’s obvious
Thank you EL. It’s obvious you like to teach. I plan on using your Telemed services. It seems like I need to do many more cineloops for that service.
Thank you EL. It’s obvious
Thank you EL. It’s obvious you like to teach. I plan on using your Telemed services. It seems like I need to do many more cineloops for that service.
Thx Randy, teaching is a
Thx Randy, teaching is a character trait I guess….I just have an archive of info to share on line and in my head so I guess it just comes out:)
Re our telemed/tele-education there is a protocol to follow but you won’t have a problem if you are getting the portal hilus like this. Looking forward to seeing you in the next sonopath inner layer:)
Thx Randy, teaching is a
Thx Randy, teaching is a character trait I guess….I just have an archive of info to share on line and in my head so I guess it just comes out:)
Re our telemed/tele-education there is a protocol to follow but you won’t have a problem if you are getting the portal hilus like this. Looking forward to seeing you in the next sonopath inner layer:)