Case Study

03_00199 Xena P Cholangitis, choleliths, peritonitis

An 11-year-old FS Chihuahua with a history of polydipsia, bright yellow urine, anorexia and protracted vomiting was presented for evaluation. Abnormalities of physical examination were serous ocular-nasal discharge and pyrexia. Urine appeared orange and on analysis showed 3+ bilirubin and bacteruria. Abnormalities on CBC and serum biochemistry were leukocytosis, neutrophilia, elevated liver enzyme activity, elevated bilirubin, elevated cholesterol and hypoglycemia.

An 11-year-old FS Chihuahua with a history of polydipsia, bright yellow urine, anorexia and protracted vomiting was presented for evaluation. Abnormalities of physical examination were serous ocular-nasal discharge and pyrexia. Urine appeared orange and on analysis showed 3+ bilirubin and bacteruria. Abnormalities on CBC and serum biochemistry were leukocytosis, neutrophilia, elevated liver enzyme activity, elevated bilirubin, elevated cholesterol and hypoglycemia. Recheck bloods a week later showed elevated creatinine, ongoing hypoglycemia, progressive elevation in AST and ALT activity and elevated bilirubin and some improvement in ALP and GGT activity.

Sonographic Differential Diagnosis

Acute cholangitis with GB calculi and emerging mucocele formation. Free fluid suggests localized peritonitis.

Image Interpretation

The liver is coarse with mildly subnormal size. Minor free fluid is noted in the near field. Echogenic fat is noted in the portal hilus suggestive for inflammation. The gall bladder is dilated with suspended debris and small echogenic calculi stone passage has likely been an issue in this patient. The common bile duct (CBD) is dilated to the point of the duodenal papilla but only mural thickening and hypertrophy of the CBD is noted without focal obstruction by a stone or mass.

DX

Cholangitis Gall bladder stones, peritonitis

Outcome

The patient was lost to follow-up.

Clinical Differential Diagnosis

Liver – acute hepatitis, vacuolar hepatopathy, neoplasia, infectious (bacterial/viral), chronic-active hepatitis, cirrhosis, toxic. Gall bladder – mucocele, cholangitis, partial obstruction.