An 11-year-old SF Beagle was presented for evaluation of vomiting, anorexia, and lethargy for a few days that coincided with being treated with Rimadyl earlier in week. On physical examination, abdominal pain, lethargy, and icterus were evident. Abnormalities on CBC and serum biochemistry were neutrophilia, lymphopenia, hypokalemia, elevated bilirubin, and severely elevated ALP and ALT activity. cPL was within reference range. Dark hemorrhagic fluid was obtained via abdominocentesis.
Inflamed gallbladder mucocele. Irregular right adrenal gland. Differentials include pheochromocytoma, adenoma, adenocarcinoma or pronounced nodular hyperplasia. Lobar biliary calculi with granulomatous-type presentation of the left liver. Cranial abdominal peritonitis presentation. Recommend immediate exploratory surgery in this patient with expectations towards potential bile duct reconstruction. Cholecystectomy will be essential. Liberation of the common bile duct may be possible with stent placement. Right adrenalectomy is recommended or at least inspection of the right adrenal gland given the irregularity of the cranial pole. Abdominal lavage will also be necessary. Serial blood pressures are also warranted. Plasma transfusion is warranted. Recommend broad-spectrum antibiotics, plasma expanders and immediate exploratory surgery. Coagulation panel also ideal. Vitamin K supplementation will likely be necessary. Very guarded prognosis.
Left medial liver revealed a mixed echogenic nodule measuring 2.6 cm with an adjacent coalescing nodule 1.6 cm consistent with nodular hyperplasia or potential early neoplasia. FNA or surgical biopsies are recommended. Lobar biliary calculi were also noted. The liver nodule appeared to be adjacent to lobar biliary calculi and should be inspected at surgery; this may be related to a granulomatous or inflammatory process associated with lobar calculi. Fluid was noted adjacent to the liver, which was echogenic suggestive for peritonitis given the extensive inflammatory presentation.
The echogenic free fluid adjacent to the liver is consistent with bile peritonitis with significant amount of inflamed mesentery.
Gallbladder in this patient presented an inflamed gallbladder with suspended immobile debris, dilated cystic duct. Localized free fluid was noted adjacent to the apex of the gallbladder with adhesion pattern. Cystic duct was dilated. Common bile duct was dilated with echogenic debris consistent with a mucoduct; measured approximately 1 cm.
The adrenal glands appeared slightly prominent, mildly heterogenic and slightly nodular – mild. No evidence of capsular expansion or invasion into the phrenic veins were noted. No overt suspicion of neoplasia was noted. This is considered likely an age related change or hyperplasia associated with stress or adrenal endocrinopathy with the minimal potential of emerging neoplastic event. The left adrenal was uniformly swollen measuring 2.36 x 0.87 cm caudal; 0.73 cm cranial. The right adrenal was irregular measuring 2.81 x 1.56 cm cranial; 0.83 cm caudal. The cranial pole of the right adrenal gland appeared enlarged, nodular and mildly irregular. Serial blood pressures are recommended and this should be inspected at surgery if not directly removed. Reactive mesentery was noted throughout the cranial abdomen with localized free fluid.
None
Gall bladder – cholecystitis with leakage/perforation, rupture
GIT ulceration with leakage/perforation
Acute pancreatitis
Hemorrhagic free fluid
