A 6-year-old MN Cocker Spaniel dog with history of anxiety was presented for one episode of vomiting, anorexia, decreased drinking, lethargy, tachypnea, and restless behavior. Physical exam found patient painful in the mid-abdomen. Blood chemistry revealed elevated total protein, hyperbilirubinemia, hypercholesterolemia, hyperglobulinemia, elevated Alkaline Phosphatase, elevated ALT, elevated AST and elevated GGTP. CBC found leukocytosis consisting of neutrophilia, high bands and monocytosis, and thrombocytopenia. Patient was admitted for I.V. fluid therapy and supportive care.
A 6-year-old MN Cocker Spaniel dog with history of anxiety was presented for one episode of vomiting, anorexia, decreased drinking, lethargy, tachypnea, and restless behavior. Physical exam found patient painful in the mid-abdomen. Blood chemistry revealed elevated total protein, hyperbilirubinemia, hypercholesterolemia, hyperglobulinemia, elevated Alkaline Phosphatase, elevated ALT, elevated AST and elevated GGTP. CBC found leukocytosis consisting of neutrophilia, high bands and monocytosis, and thrombocytopenia. Patient was admitted for I.V. fluid therapy and supportive care.
Case Study
Gall bladder mucocele, cholangiohepatitis in a 6 year old MN Cocker Spaniel dog
DX
Sonographic Differential Diagnosis
Inflamed gall bladder mucocele and inflammatory hepatopathy. Minor potential for infiltrative hepatic disease.
Image Interpretation
The gall bladder is moderately distended with suspended stellate debris. The tissue near the neck of the gall bladder is hyperechoic and ill-defined suggestive for inflammation. In my experience, this is the most frequent area of inflammation associated with mucoceles and prospective site of rupture. Hepatic parenchyma has a coarse architecture and increased portal markings suggestive for fibrosis, remodeling and chronic inflammatory disease.
Outcome
Immediate emergency exploratory surgery was strongly recommended, with the possibility of cholecystectomy, anaerobic and aerobic cultures, and liver/gallbladder biopsy. Surgery was not performed; patient was discharged to the owner and never pursued further treatments. The patient was lost follow-up.
Comments
No video is available for this patient.
Clinical Differential Diagnosis
Liver pathology: hepatitis- infectious, chronic active, hepatopathy-toxic, biliary mucocele, extrahepatic bile duct obstruction, cholecystitis; Pancreatic pathology: pancreatitis, suspected infection (hepatic or pancreatic abscess); GI pathology: gastroenteritis; possible initial stages of DIC with platelet consumption
Sampling
None taken
Patient Information
Clinical Signs
- Anorexia
- Lethargy
- Vomiting
History
- Anxiety
Exam Finding
- Abdominal Pain
Images
Blood Chemistry
- Alkaline Phosphatase (SAP), High
- ALT (SGPT), High
- AST (SGOT), High
- Cholesterol, High
- GGT High
- Globulin, High
- Total Bilirubin, High
- Total Protein, High
CBC
- Bands
- Monocytes, High
- Neutrophils, High
- Platelet Count, Low
Clinical Signs
- Anorexia
- Lethargy
- Vomiting