A 12-year-old NM Maltese with a history of pituitary dependent hyperadrenocorticism that was being treated with Lysodren was presented for vomiting, anorexia and not doing well over a 2-day period. Urinalysis showed an inappropriate SG (1.018), proteinuria, and bilirubinuria. Abnormalities on CBC and serum biochemistry were leukocytosis, severely elevated ALT and severely elevated ALP activity, hypoalbuminemia, bilirubinemia, and azotemia. The patient was treated with antibiotics, to which there was some response.
A 12-year-old NM Maltese with a history of pituitary dependent hyperadrenocorticism that was being treated with Lysodren was presented for vomiting, anorexia and not doing well over a 2-day period. Urinalysis showed an inappropriate SG (1.018), proteinuria, and bilirubinuria. Abnormalities on CBC and serum biochemistry were leukocytosis, severely elevated ALT and severely elevated ALP activity, hypoalbuminemia, bilirubinemia, and azotemia. The patient was treated with antibiotics, to which there was some response.
Case Study
Perforated Gallbladder Mucocele in a 12 year old MN Maltese dog
DX
Sonographic Differential Diagnosis
Inflamed, perforating gallbladder mucocele with adhesions and common bile duct dilatation.
Image Interpretation
The liver was swollen in contour with mild increase in the portal markings and a severely inflamed gallbladder mucocele with adhesions and positive Murphy’s sign with a slight amount of free fluid noted between the stomach and gallbladder. The common bile duct presented minor dilation at 0.5 cm with an echogenic material in the last 3.0 cm of the common bile duct prior to the duodenal papilla. This is most consistent with a bile plug.
Outcome
Coagulation panel and immediate cholecystectomy and common bile duct lavage with potential for common bile duct deviation may be necessary. Liver biopsy and gallbladder culture is indicated.The patient went to a specialty hospital and had gallbladder removed, cystotomy and mass on back removed. The patient is currently doing well.
Clinical Differential Diagnosis
Lysodren-induced Addison’s disease Liver pathology -bacterial/viral hepatitis, toxic, neoplasia, hyperadrenocorticism Gall bladder patholog – mucocele, cholecystitis, obstruction
Sampling
None
UA Specific Gravity Range
Video
Patient Information
Clinical Signs
- "Not Doing Right"
- Anorexia
- Vomiting
History
- PDH
Images
Blood Chemistry
- Albumin, Low
- Alkaline Phosphatase (SAP), High
- ALT (SGPT), High
- Azotemia
- Total Bilirubin, High
CBC
- WBC, High
Clinical Signs
- "Not Doing Right"
- Anorexia
- Vomiting
Urinalysi
- Bilirubin Present
- Protein Present
- Specific Gravity Low