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03_00322 Gina Marie H Partial biliary obstruction

Case Study

Case Study

03_00322 Gina Marie H Partial biliary obstruction

An 11-year-old SF Lhasa Apso was presented for evaluation of icterus and vomiting. Urinalysis revealed severe bilirubinuria. Abnormalities on CBC and serum biochemistry were leukocytosis, and elevated GGT and ALP activity, and total bilirubin. On survey radiographs splenomegaly and gas within the colon were evident.  

An 11-year-old SF Lhasa Apso was presented for evaluation of icterus and vomiting. Urinalysis revealed severe bilirubinuria. Abnormalities on CBC and serum biochemistry were leukocytosis, and elevated GGT and ALP activity, and total bilirubin. On survey radiographs splenomegaly and gas within the colon were evident.  

Sonographic Differential Diagnosis

Partial, extrahepatic biliary obstruction. Given that the patient’s jaundice is decreasing and the patient appears to be improving overall, and the fact that the calculi are multiple and small, they may be passing. Recommend continuing medical treatment with a follow-up ultrasound if the patient returns to being acutely jaundiced or fails to continue improving. Surgical intervention may be necessary at that time.

Image Interpretation

The liver was mildly heterogeneous. This is a non-specific change. There was evidence of post hepatic biliary obstruction with multiple small calculi with pre-obstructive dilation of the common bile duct and tortuosity. The dilated portion of the common bile duct is 1.37 cm. The post calculi measurement was 0.57 cm. There were no signs of gallbladder rupture or peritonitis visible at this time.

DX

Small, obstructive biliary calculi with clinical improvement

Outcome

None

Clinical Differential Diagnosis

Liver – acute hepatitis (viral, bacterial, trauma, toxins), neoplasia, abscess, granuloma,
Gall bladder – cholecystitis, mucocele, obstruction (lith, neoplasia, duodenal/pancreatic disease)
Pancreas – pancreatitis, neoplasia, abscess

Sampling

None

Video

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Patient Information

Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Status : Complete

Clinical Signs

  • Icterus
  • Vomiting

Images

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Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • GGT High
  • Total Bilirubin, High

CBC

  • WBC, High

Clinical Signs

  • Icterus
  • Vomiting

Urinalysi

  • Bilirubin Present