This is a 9 year old Schnautzer F/S with very high liver enzymes. We are suspecting an inflamatory hepatopathy with possible partial obstruction of CBD. CBD is 0.6 cm . Unfortunatelly owner declined biopsy. We are monitoring daily the CBD/GB to asess response to Tx.
My questions:
1. Is the duodenal-pyloric junction normal? I don’t see fluid moving from stomach into duodenum when stomach contracts? Also the proximal duodenum lumen seems thin….?
2.Also can’t see the duodenal papilla ( in other views)
3. Should I be concerned that this is an infiltrative mural disease that affects pylorus and prox duodenum as well as duodenal papilla ?
Thank you,
Calin
Comments
Big CBD look for striucture
Big CBD look for striucture or cbd neoplasia or stone beterrn the dfilation and the d-pap as > 0.5 cm is big in any book.
The layering is visible in the duodenum and there is movement so neoplastic criteria (layering loss, lac of peristalsis, excessive thickness) is not met for the GI here. Hypertrophic Pyloric Myopathy criteria is not completely present either. However there is some echogenic remodeling of the mucosal layer which may be related to chronic disease/fibrosis and such and maybe secondary pyloric hypertrophy. Without manual assessment or the pylorus at surgery tough to tell. Empirically this is what i do with these cases treating the treatable and dealing with delayed outflow assuming that sampling is not an option:
Helicobacter/Gastritis protocol
A clinical trial of Zithromax (Dogs: 5-10 mg/kg p.o. q24h. May increase dosing interval to q48h after 3-5 days of treatment), Metronidazole (10-20 mg/kg po bid) , Pepcid ( 0.5-1 mg/kg sid) and Sucralfate (0.5-2 g/dog PO) or Omeprazole (1 mg/kg po sid) over the next 3 weeks along with a novel-protein or hydrolyzed diet with slurry feeding bid/tid. over the next 2-4 days and then increase to canned diet bid. Dry food should be avoided over the next 4 weeks. A recheck sonogram to assess GI improvement or progression would be ideal in 4 weeks. Consider metaclopramide as well if needed as long as pancreatitis is not an issue.
Thank you.Not pancreatitis
Thank you.Not pancreatitis but sorry I have to ask: why not metoclop in pancreatitis?
Big CBD look for striucture
Big CBD look for striucture or cbd neoplasia or stone beterrn the dfilation and the d-pap as > 0.5 cm is big in any book.
The layering is visible in the duodenum and there is movement so neoplastic criteria (layering loss, lac of peristalsis, excessive thickness) is not met for the GI here. Hypertrophic Pyloric Myopathy criteria is not completely present either. However there is some echogenic remodeling of the mucosal layer which may be related to chronic disease/fibrosis and such and maybe secondary pyloric hypertrophy. Without manual assessment or the pylorus at surgery tough to tell. Empirically this is what i do with these cases treating the treatable and dealing with delayed outflow assuming that sampling is not an option:
Helicobacter/Gastritis protocol
A clinical trial of Zithromax (Dogs: 5-10 mg/kg p.o. q24h. May increase dosing interval to q48h after 3-5 days of treatment), Metronidazole (10-20 mg/kg po bid) , Pepcid ( 0.5-1 mg/kg sid) and Sucralfate (0.5-2 g/dog PO) or Omeprazole (1 mg/kg po sid) over the next 3 weeks along with a novel-protein or hydrolyzed diet with slurry feeding bid/tid. over the next 2-4 days and then increase to canned diet bid. Dry food should be avoided over the next 4 weeks. A recheck sonogram to assess GI improvement or progression would be ideal in 4 weeks. Consider metaclopramide as well if needed as long as pancreatitis is not an issue.
Thank you.Not pancreatitis
Thank you.Not pancreatitis but sorry I have to ask: why not metoclop in pancreatitis?
Metaclopramide is technically
Metaclopramide is technically contraindicated in pancreatitis… vascular issue I think.
good to know.Thanks
good to know.Thanks
Metaclopramide is technically
Metaclopramide is technically contraindicated in pancreatitis… vascular issue I think.
good to know.Thanks
good to know.Thanks
Metoclopramide may decrease
Metoclopramide may decrease blood flow to the pancreas via its antidopaminergic effect, but this has never been substantiated. Cerenia seems a better drug to control the vomiting than metaclopramide.
You mentioned that the owners declined biopsy – what about a FNA of the liver and pylorous?
Metoclopramide may decrease
Metoclopramide may decrease blood flow to the pancreas via its antidopaminergic effect, but this has never been substantiated. Cerenia seems a better drug to control the vomiting than metaclopramide.
You mentioned that the owners declined biopsy – what about a FNA of the liver and pylorous?
Unfortunatelly Emma didn t
Unfortunatelly Emma didn t respond to treatment and was euthanized . We took biopsies from the pylorus and duodenum which was abnormal. waiting for histopath results.
Thank you for following up on this case
Calin
Unfortunatelly Emma didn t
Unfortunatelly Emma didn t respond to treatment and was euthanized . We took biopsies from the pylorus and duodenum which was abnormal. waiting for histopath results.
Thank you for following up on this case
Calin
Please post the results when
Please post the results when you get them.
Please post the results when
Please post the results when you get them.
will do
will do
will do
will do