Cholestasis


Hello,

Nikki is a 12 years old papillon F/S that presented for anorexia for the last 3 days  and vomiting.She was  Icteric on presentation, She has heart murmur, she is on Pimobendan and Butorphanol for collapsing tracheea. Her heart condition is compensated

BW : severly increased all liver enzymes with ALT and ALKP at 5000. 

AUS : large distended GB, no muccocele, DPAP and CBD appear not to be obstructed . Liver is enlarged, there are 2 small hypoechoic nodules in the left liver lobe. 

Cytology of FNA liver is pending

Hello,

Nikki is a 12 years old papillon F/S that presented for anorexia for the last 3 days  and vomiting.She was  Icteric on presentation, She has heart murmur, she is on Pimobendan and Butorphanol for collapsing tracheea. Her heart condition is compensated

BW : severly increased all liver enzymes with ALT and ALKP at 5000. 

AUS : large distended GB, no muccocele, DPAP and CBD appear not to be obstructed . Liver is enlarged, there are 2 small hypoechoic nodules in the left liver lobe. 

Cytology of FNA liver is pending

Presumtive dg is Cholangiohepatitis/ Toxin. 

After 4 days of supportive treatment, Plasmalyte with Complex Vit b, Cerenia, hepatoprotectants, metronidazole 10 mg/kg, enrofloxacin 10 mg/kg , cefazolin 22 mg/kg, Zantac 1 mg/kg she appear to improve clinically, all her liver enzymes are decreasing except the ALKP and GGT which are going up. ALKP is 10000 !

My questions are :

1.if this is cholestasis, should I see distension of the CBD, and obvious intrahepatic biliary ducts distension? If this is cholsetasis due to recovery from hepatic insult when should I see resolution of ALKP/ GGT. All  the other enzymes are going down and clinically this dog is improving…?

2.what else would you do? 

 

Thank you,

 

Calin


5 responses to “Cholestasis”

  1. The size of the gall bladder,

    The size of the gall bladder, progressive elevation of ALP and GGT activity, and the visible bile duct are all indicative of obstruction. Would not think cholecystitis as the gall bladder wall is normal, bile appears normal, and the liver parechyma around the gall bladder looks normal. 

  2. The CBD looks like about 4mm

    The CBD looks like about 4mm which is upper limits of normal. Follow the cbd to the d pap and see if somthing is obstructing there. Consider Lepto we are seeing a ton of it right now.

  3. Thank you EL
    CBD has some

    Thank you EL

    CBD has some echogenic sludge but no definitive sign of obstruction. Can be partially obstructed I think as all the liver enzymes are going down, except ALP which is 12000 now!

    Did not check for Lepto as this is a Papillon ( and also already on ab’s )

    We are planning a Cholecystocentesis for GB decompression and of course C/S

     

    Calin

     

  4. Dont let the breed and

    Dont let the breed and signalment keep you from testing Lepto. I have seen it in many toy house bound patients that supposedly never touch the ground:)

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