A 9-year-old MN Pomeranian was presented for evaluation of vomiting and elevated liver enzyme activity. Current therapy was maropitant, famotidine, sucralfate, metronidazole, ursodiol, denamarin, and Vitamin K.
A 9-year-old MN Pomeranian was presented for evaluation of vomiting and elevated liver enzyme activity. Current therapy was maropitant, famotidine, sucralfate, metronidazole, ursodiol, denamarin, and Vitamin K.
The liver presented lobar duct dilation with common bile duct obstruction by a 0.4 cm stone. The stone was lodged in a thickened common bile duct approximately 0.5 cm from the duodenal papilla. There was no evidence of active inflammation with the exception of the area adjacent to the common bile duct where mixed hypoechoic changes were noted. Low grade inflammation is likely in this region measuring approximately 1.0 cm. The gallbladder itself was unremarkable with a minor amount of debris. The liver presented uniform vacuolar hepatopathy pattern with slight dilation of the lobar biliary ducts. This is consistent with post hepatic obstruction. The right lobes of the liver appeared to be somewhat subnormal in size.
The right pancreatic limb presented some level of echogenic remodeling, yet there was no evidence of active inflammation.
Minor amount of gallbladder debris. This should be inspected at the time of surgery.
Slight low grade pancreatic inflammation in the right limb.
Ultrasound-guided FNA of the liver itself was performed without complication. The gallbladder appears to have adequate integrity for cholecystoduodenostomy if necessary. The thickness of the common bile duct along with the duodenal papilla would suggest that some level of duodenal papilla dysfunction is likely in this case. Culture of the calculus is recommended.
Liver – acute hepatitis (viral, bacterial, toxins), neoplasia, abscessation, trauma
Gall bladder – mucocele, cholecystitis
Pancreas – pancreatitis, neoplasia
