A 6-year-old SF Maltese mix was presented for evaluation of anorexia and vomiting. Abnormalities on serum biochemistry were severely elevated ALP (2853), ALT (1553), and GGT (56) and elevated bilirubin (3.2) and cholesterol (458).
Case Study
03_00540 Pearl P EHBDO secondary to pancreatitis
Sonographic Differential Diagnosis
Posthepatic obstruction owing to likely primary pancreatitis. Right limb pancreatitis, adhesions and common bile duct entrapment. Chronic active presentation. Cholecystoduodenostomy is recommended. Bile plug or mild potential for bile duct tumor.
Image Interpretation
Liver was subnormal in size. The liver itself was unremarkable. Gallbladder was mildly turgid. Cystic duct and common bile duct were dilated. Common bile duct revealed echogenic material within it most consistent with bile plug; however an occult neoplasia of the common bile duct could not be entirely ruled out. Recommend exploratory surgery with expectations towards cholecystoduodenostomy and debridement of pathological tissue in this region. Lobar biliary duct also dilated.
Right limb of the pancreas presented mixed hypoechoic changes with edematous ill-defined pancreatic presentation with areas of adhesions enveloping the common bile duct.
DX
EHBDO, pancreatitis
Outcome
None
Clinical Differential Diagnosis
Liver – acute hepatitis (viral, bacterial, toxins), neoplasia, inflammatory hepatopathy, trauma
Gall bladder – cholecystitis, mucocele
Pancreas – pancreatitis, neoplasia
Sampling
None
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Patient Information
Gender :
Female, Spayed
Species :
Canine
Type of Imaging : Ultrasound
Status :
Complete
Clinical Signs
- Anorexia
- Vomiting
Images
Blood Chemistry
- Alkaline Phosphatase (SAP), High
- ALT (SGPT), High
- Cholesterol, High
- GGT High
- Total Bilirubin, High
Clinical Signs
- Anorexia
- Vomiting