Sonopath Forum

biliary tree choleliths

5 yr MN KCC with acute vomiting and lethargy, ALT 3000, ALP 719, bile acids WNL. GB looks ok to me. No significant inflammation that I am detecting in the region of the CBD, but is quite distended with a cholelith. Should I assume he is passing these and that is the cause of the symptoms/lab abnormalities? Aside from ursodiol, Baytril and pain meds, any other treatment recommendations? Any preventative measures regarding diet? Rest of scan was WNL. Assuming surgical when you document effusion/significant inflammation and a distended CBD containing a cholelith?

Comments

DrMac

September 22, 2020 at 10:19 pm -

The gallbladder walls are

The gallbladder walls are slightly thickened suggestive of cholecystitis although the GB doesnt look overdistended. The liver looks a little hypoechoic. I think you have an acute on chronic cholangiohepatitis with the super high ALT and the biliary tree mineralization may be a sequelae to that. I would suggest adding in Metronodazole or Amoxicillin to the Baytril to increase bacterial spectrum with GI support and monitoring of LE for evidence of increasing ALT/AST and cholestasis.

kromero

October 3, 2020 at 5:02 am -

Thank you for your input!

Thank you for your input! Thought I would add some input from a surgeon we work with:

There isn’t a defined time to address these surgically. If the stones are on the CBD they can be removed through an incision in the duct. However, as long as bile is moving through the system adequately, I would probably not recommend jumping to Sx. If there becomes a biliary obstruction, the stones could be removed and/or a cholecystoduodenostomy could be performed to redirect bile flow.