Hi, just wanted to try my first case on forum. I am fairly new to ultrasounding and would appreciate advice on all aspect (techinque, image quality, forum posting and thoughts on further diagnostics).
Charlie is a 15 year old Shih tzu male neutered.
- He has had chronic liver enzyme elevations (ALP [~500]) and elevated bile acids since 2013. Zentonil since 2013.
- Off and on diarrhea – gastro-intestinal diets most of his past 4 years
- ALT elevation in 2014 (ALT 164)
- Fast forward to 2017 (ALT – 260; ALP – 1400).
- Did ultrasound 1 month ago and noticed very inflammed gall bladder; cystic kidneys; urinary calculi (very small) and enlarged liver and left adrenal gland had focal nodule in center in one pole (couldn’t locate right adrenal gland).
- Tested negative for cushings disease.
- Started on ursodiol; hypoallergenic HP and Z/D diet; aventiclav.
- These are new images from today for a brief rescan/recheck if improvement of inflammed gall bladder. Still seems inflammed. Noted something that makes me suspicious of a mass in gall bladder wall? He wasnt sedated for this exam and is very vocal during exam, so could only rescan a portion of his body before we gave up.
Thoughts on his gall bladder? Clinically he has had off and on diarrhea but good otherwise. The bloodwork was done to evaluate him for a dental (Fx carnassial and moderate dental dz). Since new diet the diarrhea has greatly improved on how often diarrhea relapses. I am suspecting cholecystitis, potentially from IBD and trying to protect liver/gall bladder with supplements and keep on hypoallergenic diet.