8 year old FS Aussie. Blood work has shown elevated liver values – 3/30= ALP 201, ALT 726, T bili 0.3. 4/8 ALP 234, ALT 623, T bili 0.7. 4/22=ALP 222, ALT 406, T bili 0.7, T bili unconjugated 0.4 (0-0.2), T bili conjugated 0.3 (0-0.1). Has been on ursodiol and amoxicillin since the 8th. Has been on mild thistle and another liver support med for longer. I am not able to trace the common bile duct (lots of panting and nearby gas shadowing from stomach), but not seeing any distended biliary ducts, free fluid or thickened GB wall, so leaning towards rec
8 year old FS Aussie. Blood work has shown elevated liver values – 3/30= ALP 201, ALT 726, T bili 0.3. 4/8 ALP 234, ALT 623, T bili 0.7. 4/22=ALP 222, ALT 406, T bili 0.7, T bili unconjugated 0.4 (0-0.2), T bili conjugated 0.3 (0-0.1). Has been on ursodiol and amoxicillin since the 8th. Has been on mild thistle and another liver support med for longer. I am not able to trace the common bile duct (lots of panting and nearby gas shadowing from stomach), but not seeing any distended biliary ducts, free fluid or thickened GB wall, so leaning towards recommending continuing medical management for several months, adding in enrofloxacin. Given the appearance, I don’t think this merits surgical consult at this time. Thoughts?
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As the gall bladder is there
As the gall bladder is there no overt dilation of the bile duct there is no need to rush in with surgery. Would monitor via liver enzyme activity and regular ultrasounds. What clinical signs is the dog showing?
Looks like a dependent sand
Looks like a dependent sand ball or stone… passive and not an issue. No overdistention or wall inflammation. The ALT bothers me in that there is some level of inflammatory parenchymal disease that likely has little to do with the gb. Remember biliary disease drives SAP and there are minimal real cells in the biliary tree… its a tubular system so the enzymes are coming off the brush border cells with SAP and from the hepatocytes with ALT and AST. So fna of the liver parenchyma is more effective to decide what the enzymes are coming from…The Gb isnt a player here in my opinion.