A 6-year-old NM Yorkshire terrier was presented for evaluation of vomiting. Abnormalities on blood work were severely elevated liver enzyme activity, total bilirubin, elevated cholesterol (876) and triglycerides.
A 6-year-old NM Yorkshire terrier was presented for evaluation of vomiting. Abnormalities on blood work were severely elevated liver enzyme activity, total bilirubin, elevated cholesterol (876) and triglycerides.
Acute on chronic pancreatitis with post hepatic obstruction.
Concurrent cholangiohepatitis.
Recommend FNA of the liver and hypoechoic portion of the pancreas for further definition. Aggressive pain management, broad spectrum antibiotics, and fluid therapy would be recommended. Single dose of Dexamethasone can be considered to attempt to reduce the bilirubin elevation owing to inflammation associated with the common bile duct. However. common bile duct deviation procedure may be necessary in this patient with debridement of the pancreatic pathology.
The right pancreatic limb and base of the pancreas revealed mixed hypoechoic parenchyma with hyperechoic surrounding fat. This is consistent with acute on chronic pancreatitis. The region measured 4 x 1.24 cm. FNAs are recommended to ensure that underlying carcinoma is not an issue, although it is not overtly suspected.
The liver presented normal size with increased portal markings. The gallbladder was slightly turgid. The common bile duct was dilated at 0.46 cm with enveloping, hyperechoic surrounding fat and pancreatic pathology. Echogenic debris was noted within the common bile duct. This is suggestive of post hepatic obstruction.
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Liver – acute hepatitis (viral, bacterial, fungal, toxins), abscess, granulomatous disease, neoplasia
Gall bladder – cholecystitis, mucocele, obstruction (lith, duodenal/pancreatitic disease), neoplasia
Pancreas – pancreatitis, abscess, neoplasia
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