Case Study

03_00246 Bullwinkle A Hepatitis, mucocele BK

A 15 year old female spayed mixed canine with a history of decreased appetite, diarrhea, and ataxia was presented for evaluation of being unable to walk, weak and lethargic, anorexic, and possible seizures. Abnormalities on serum biochemistry were severely elevated liver enzyme activity, bilirubinemia, hypokalemia, and elevated pre-prandial bile acids. Systolic blood pressure was normal.

A 15 year old female spayed mixed canine with a history of decreased appetite, diarrhea, and ataxia was presented for evaluation of being unable to walk, weak and lethargic, anorexic, and possible seizures. Abnormalities on serum biochemistry were severely elevated liver enzyme activity, bilirubinemia, hypokalemia, and elevated pre-prandial bile acids. Systolic blood pressure was normal.

Sonographic Differential Diagnosis

This is consistent with acute on chronic hepatitis with gallbladder mucocele. This is surgical. The gallbladder measured 5.7 x 3.6 cm. This is most consistent with inflamed gallbladder mucocele with acute on chronic hepatitis. Recommend immediate cholecystectomy and common bile duct lavage. Coagulation panel would be recommended with plasma expanders and potential plasma transfusion. Aggressive antibiotic therapy would also be warranted. This is considered a surgical emergency.

Image Interpretation

The liver in this patient presented increased portal markings. Mineralization was noted in the lobar duct as well. The common bile duct was mildly dilated at 0.41 cm. The gallbladder was significantly distended with pericapsular hyperechoic, inflammatory pattern mainly at the neck of the gallbladder. Suspended immobile debris that was mineralizing and/or calculi were noted in the middle of the gallbladder. Free fluid was noted in the gallbladder fossa.

DX

This is consistent with acute on chronic hepatitis with gallbladder mucocele.

Outcome

The patient was euthanized.

Comments

No video is available on this patient.

Clinical Differential Diagnosis

Liver – acute hepatitis (viral/bacterial/fungal/toxic), neoplasia, abscess, chronic hepatitis, cirrhosis Gall bladder – cholecystitis, mucocele, rupture, liths