A 13-year-old NM DLH was presented for evaluation of anorexia, vomiting, and dehydration. Current therapy is Ursodiol. Abnormalities on blood work were leukocytosis, band neutrophilia, and elevated ALT activity (773) and bilirubin.
Case Study
03_00396 Billy B PHBDO
Sonographic Differential Diagnosis
Post hepatic obstruction either tissue proliferation stricture or potential common bile duct infiltrative neoplasia less likely.
Surgical intervention for post hepatic obstruction with bile duct redirection. Pancreatic and hepatic biopsies recommended with cholecystectomy.
Image Interpretation
Intrahepatic biliary dilation noted. Minor coarse architecture. Gallbladder was significantly turgid with suspended debris, tortuous cystic duct. The common bile duct was dilated at 0.56 cm and was dilated to the level of the duodenal papilla. At the duodenal papilla there was echogenic tissue or bile plug which was conical in shape measuring 0.5cm. Pancreas was hypoechoic, irregular, coarse in architecture, mildly enlarged, serpentine contour with regional hyperechoic surrounding fat primarily at the caudal pole of the left limb. Duct measures 0.15 cm.
DX
Post hepatic bile duct obstruction
Outcome
None
Clinical Differential Diagnosis
Liver – cholangio-hepatitis complex, neoplasia, toxins, granulomatous disease, abscessation
Pancreas – pancreatitis, neoplasia
Sampling
None
Video
Patient Information
Gender :
Male, Neutered
Species :
Feline
Type of Imaging : Ultrasound
Clinical Signs
- Anorexia
- Dehydration
- Vomiting
Images
Blood Chemistry
- ALT (SGPT), High
- GGT High
- Total Bilirubin, High
CBC
- Neutrophils, High
- WBC, High
Clinical Signs
- Anorexia
- Dehydration
- Vomiting