Case Of the Month

Chronic Cholangiohepatitis in a 1-year-old FS Australian Shepherd Mix: Our Case of The Month June 2018

A 1-year-old, FS, Australian Shepherd mixed breed canine was presented for acute onset of collapse/dizziness. This was the first episode that the patient ever had; patient was BAR prior. Hepatomegaly was seen on radiographs. Blood chemistry showed an elevated ALT, CBC/UA were WNL. 4DX heartworm test was positive, Lepto test was negative.

DX

Chronic cholangiohepatitis and free fluid. Pancreatic edema.

Outcome

The pancreatic edema and free fluid was likely owing to portal hypertension. Liver biopsy was suggested in this case. Treatment for acute on chronic cholangiohepatitis with coverage for Leptospirosis was recommended even though the patient is negative. Copper storage was a possibility. A very guarded prognosis was given. A recheck ultrasound was performed 2 days later which revealed structurally resolved cholangiohepatitis, normalized gallbladder, and largely resolved pancreatitis. The presentation was dramatically improved compared to the prior sonogram. Outpatient therapy was recommended as long as the patient was stable. The patient was treated with I.V. fluids, metronidazole, ampicillin, and Pepcid followed by heartworm treatment protocol of prednisone and doxycycline. The patient is reported to be doing great following her treatments.

Image Interpretation

The liver was swollen and hypoechoic with a double layered gallbladder. The liver revealed coarse
architecture with increased portal markings. This is consistent with acute on chronic cholangiohepatitis.