- 6 year old FS Cairn Terrier on Actigall for an emerging gallbladder rmucocele fist diagnosed in October of 2014.
- Ultraound done in Jan of 2015 showed no significant changes, however, the dog was asymptomatic and the liver enzymes had improved with medical management (antibiotics and ursodiol).
- CBC and chem profile done 2 weeks ago were all within normal reference range.
- Dog presented yesterday for inappetence and loose stool. Chem profile showed ALT=1381 mcu/L, ALKP=992mcu/L, and TBil=0.9mg/dl.
- 6 year old FS Cairn Terrier on Actigall for an emerging gallbladder rmucocele fist diagnosed in October of 2014.
- Ultraound done in Jan of 2015 showed no significant changes, however, the dog was asymptomatic and the liver enzymes had improved with medical management (antibiotics and ursodiol).
- CBC and chem profile done 2 weeks ago were all within normal reference range.
- Dog presented yesterday for inappetence and loose stool. Chem profile showed ALT=1381 mcu/L, ALKP=992mcu/L, and TBil=0.9mg/dl.
- US done today shows a thickened gallbladder wall (2.6mm), possible pericholecystic inflammation ventral to the gallbladder body wall, and small choleliths (9mm) iin the gallbadder neck and cystic duct. The previously seen mucocele pattern (spicules) is gone. However, the gallbladder appears moderately distended. The pancreas and GI appear normal as does the rest of the abdomen with the exception of a slightly rounded splenic capsule.
- There is no Murphy’s sign, but the dog was tense and panting throughout the exam.
- I have recommended referral for evaluation for cholecystectomy.
- Medical management seems less desirable to me because of the cholelithiasis and the suddend spike in liver enzymes.
- Would you agree that this a surgical case?
Comments
With the thickened
With the thickened gallbladder wall, inflammatory reaction around the ventral aspect of the gall bladder, and cystic bile duct, surgery is indicated as this potentially is a gall bladder waiting to rupture.
Localized ree fluid around a
Localized ree fluid around a structurally compromized Gb is never a good thing. Since its collapsed rupture may have already occurred. This has a porcelain GB presentation (fibrosed and mineralized wall).
Although the posted views
Although the posted views make it look otherwise, I don’t believe there is free fluid outside the gallbladder. I think what you are seeing above is debris in the middle of the gallbladder and extension of the lumen cranially towards the diaphragm. Please see my additional clip. That being said, I agree it’s surgical and am glad to have your confirmation as the rDVM was pushing for medical managment.
Patient update: The owner is
Patient update: The owner is out of town and has declined surgery. The patient is boarding in the hospital and is reported to be doing well….for now.
good to know but I would have
good to know but I would have another probe on the Gb and cbd befire they discharge… sometimes these things do resolve medically but the Gb is usually permanently damaged..surely want to follow-up.
Ok, thanks! The owner has an
Ok, thanks! The owner has an appt at a referral institution tomorrow.