A 4-year-old SF Boston Terrier was presented for evaluation of anorexia and urinary incontinence. The only abnormality on physical examination was obesity. Urine SG was normal and 3+ bilirubinuria was present on urinalysis. CBC was within reference range. Mildly elevated globulins (38), ALP activity (215), and total bilirubin (7) were present on serum biochemistry.
Posthepatic obstruction with likely mucoduct and congested gallbladder.
A small calculus, labeled urolith, was noted in the duodenal papilla in this patient, yet this is not likely the complete issue regarding the common bile duct obstruction. If the patient is stable, then medical therapy could be attempted and recheck sonogram in 48 to 72 hours; however, surgical intervention will likely be necessary in this case. Hypercoagulable state should be considered. Leptospirosis should also be considered to be complete in this patient; however, ampicillin and metronidazole plus Ursodiol therapy could be attempted medically; however surgical intervention with bile duct lavage plus or minus cholecystoduodenostomy will likely be the best option in this patient.
The liver images from right and left intercostal as well as subcostal views revealed subjectively normal liver size, contour, and structure. Parenchymal echogenicity was naturally coarse and hypoechoic to the spleen. Vascular and biliary tracts were of normal volume and no evidence of congestion was noted. The gallbladder in this patient presented minor amount of over distention with dependent and mildly suspended debris with dilated cystic duct at 0.92 cm. The gallbladder was mildly echogenic and thickened consistent with low-grade cholecystitis. Common bile duct was mildly dilated at 0.53 cm. Echogenic debris was noted within the common bile duct measuring 0.64 cm. This is consistent with mucoduct as color flow Doppler did not reveal any positive signals to suggest tissue proliferation; however, tumor could not be entirely ruled out. The common bile duct at the level of the duodenal papilla appeared unremarkable; likely a stricture or bile plug is the underlying issue. A small calculus, labeled urolith, was noted in the duodenal papilla in this patient, yet this is not likely the complete issue regarding the common bile duct obstruction. Vena cava and aorta revealed sludging of blood in this patient.
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Incontinence – cystitis, urolith, polyploid cystitis
Liver disease – reactive hepatopathy, vacuolar hepatopathy, chronic-active hepatitis, neoplasia
Gall bladder – cholecystitis, liths, mucocele
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