Case Of the Month

Cholelithiasis & Post-Hepatic Obstruction

Cholelithiasis & Post-Hepatic Obstruction In A Dog.

By Dr. Johanna Frank (DACVIM) of New Jersey Mobile Associates

Cholelithiasis & Post-Hepatic Obstruction In A Dog.

By Dr. Johanna Frank (DACVIM) of New Jersey Mobile Associates

History (Vaquez RVT/Frank DVM, DACVIM): An 8-year-old FS Cavalier King Charles Spaniel presented for anorexia for 3 days, decreased drinking, and lethargy. There was prior history of foreign body removal and cholecystectomy owing to cholelithiasis four months earlier. The owner reported that the patient never fully recovered from foreign body surgery and has demonstrated intermittent G.I. signs ever since. Physical examination revealed marked icterus, mucous membranes pale pink with icterus and a CRT

Outcome

(Vaquez RVT/Frank DVM, DACVIM): Due to the degree of biliary obstruction, the marked elevation in bilirubin and severity of the icterus, surgical referral to a Board Certified surgeon was advised to remove the biliary calculi, clear out bile duct, with possible transposition of the bile duct if needed. The prognosis was guarded and owners elected to euthanize the patient.

Clinical Differential Diagnosis

(Lindquist DMV DABVP): Post-hepatic obstruction of the common bile duct with associated cholangitis and surrounding omental/pancreatic inflammation.

Sonographic Differential Diagnosis

(Frank DVM, DACVIM): Hemolytic anemia, biliary obstruction due to a cholelith in the bile duct or a papillary mass at the duodenal papilla, cholangiohepatitis, severe pancreatitis with extra-hepatic bile duct obstruction and neoplasia.

Image Interpretation

(Lindquist DMV, DABVP): Strongly shadowing calculi are present that the duodenal papilla and within the common bile duct (CBD) causing marked dilation (0.97 cm) and post-hepatic obstruction. Periductile hyperechoic fat and adhesions are also present suggestive for friability and inflammation of the double walled duct (CBD). Power flow Doppler demonstrates positive flow in the portal vein (PV) dorsal to the duct and lack of uptake within the common bile duct.