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Post hepatic bile duct obstruction in a 14 year old MN DSH cat

Case Study

Post hepatic bile duct obstruction in a 14 year old MN DSH cat

A 14-year-old neutered male DSH cat was presented for evaluation of weight loss, anorexia over a 2-week period, icterus, dehydration, a palpable abdominal mass (possibly feces), and severe dental disease. The only abnormality on urinalysis was mild proteinuria. Abnormalities on CBC and serum biochemistry included leukocytosis, neutrophilia, elevated bilirubin, and severely elevated liver enzyme activity (AST 105, ALT 352, ALP 1112). 

 

Sonographic Differential Diagnosis

Pancreatic and common bile duct mass. The renal nodules are suggestive for metastatic disease.
Suspect bile duct carcinoma.

Image Interpretation

The pancreas in this patient revealed a mixed echogenic and cystic mass that measured 3.8 x 2.33 cm at the right base with obstruction of the common bile duct. Variable areas of the pancreas appeared inflamed and irregular.
The kidneys presented mild to moderate degenerative changes. Cortical hypoechoic nodules were noted. This is strongly suggestive for metastatic disease. An overt mass was noted in the caudal pole and measured 1.75 cm. The left kidney measured 4.15 cm and the right kidney measured 3.9 cm.

DX

Mass in the common bile duct causing post hepatic bile duct obstruction

Outcome

Unknown.

Clinical Differential Diagnosis

Hepatic disease: cholangio-hepatitis complex, lipidosis, neoplasia, granuloma, abscess, acute hepatitis (bacterial, fungal, toxins); Gall bladder disease: cholecystitis, neoplasia, obstruction; Pancreatic disease: pancreatitis, neoplasia. Mass: neoplasia, cyst, abscess or granuloma of any internal organ; Hydronephrosis.

UA PH

6.5

UA PH

6.5

Sampling

Ultrasound-guided FNA of the renal nodules and pancreatic mass is recommended. Exploratory surgery could be considered. However, resection of this mass would be significantly difficult.

UA Specific Gravity Range

1.047

Patient Information

Patient Name : Ike M
Gender : Male, Neutered
Species : Feline
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 05_00164

Clinical Signs

  • Anorexia
  • Dehydration
  • Icterus
  • Palpable Mass
  • Weight loss

Images

mayton_ike_panc_mass_post_hepatic_obstructionmayton_ike_panc_mass_post_hepatic_obstruction_rk

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • ALT (SGPT), High
  • AST (SGOT), High
  • Glucose, High
  • Total Bilirubin, High

CBC

  • Neutrophils, High
  • WBC, High

Clinical Signs

  • Anorexia
  • Dehydration
  • Icterus
  • Palpable Mass
  • Weight loss

Urinalysi

  • Protein Present