I have a 7 year old Yorkie mix female dog who has progressively elevating liver enzymes. She is not clinical. Her ultrasound appeared normal aside from these 2 cystic type lesions in the gall bladder and a very enlarged gall bladder. My question is whether this gall bladder needs to come out or whether draining these lesions is a more appopriate intervention.
Thanks,
Suzanne
I have a 7 year old Yorkie mix female dog who has progressively elevating liver enzymes. She is not clinical. Her ultrasound appeared normal aside from these 2 cystic type lesions in the gall bladder and a very enlarged gall bladder. My question is whether this gall bladder needs to come out or whether draining these lesions is a more appopriate intervention.
Thanks,
Suzanne
Comments
The GB has mucocele aspects
The GB has mucocele aspects on it for sure and the cystic changes are likely mural benign lesions as they have a defined wall likey a uracocele would in the ub. This is odd and I am not sure I have ever seen this particular scenario before re the cysts. Functionally though I would do a GB motility study first to assess if the Gb is functioning and if not then preventively remove it and flush the cbd and bx the liver. Other option is tx with actigall and reassess in 6 weeks and maybe run 3 weeks baytril metro and see what you have since the pet is stable. Also remember the ALT is likely deriving from parenchyma because the GB has minimal cells in it and nothing that spills ALT only SAP and minimal at that. When the sap and alt are involved in light of post hepatic disease it means the parenchyma is now in play and not just the GB. I doubt this GB will be worth anything in the future so if my dog I am removing it preventively as it presents a risk but that’s me:)
For more insight check out our abstract on surgical biliary disease….
This dog may have low grade signs of adr and not reported. At times when these GB are removed the owner has a “new dog.”
Thanks for the response. I
Thanks for the response. I did recommend a cholecystectomy but wanted to make sure I wasn’t over-reacting. He does have a positive Murphy sign that I forgot to mention. The owner doesn’t perceive any clinical signs.
Thank you!
Suzanne
The GB has mucocele aspects
The GB has mucocele aspects on it for sure and the cystic changes are likely mural benign lesions as they have a defined wall likey a uracocele would in the ub. This is odd and I am not sure I have ever seen this particular scenario before re the cysts. Functionally though I would do a GB motility study first to assess if the Gb is functioning and if not then preventively remove it and flush the cbd and bx the liver. Other option is tx with actigall and reassess in 6 weeks and maybe run 3 weeks baytril metro and see what you have since the pet is stable. Also remember the ALT is likely deriving from parenchyma because the GB has minimal cells in it and nothing that spills ALT only SAP and minimal at that. When the sap and alt are involved in light of post hepatic disease it means the parenchyma is now in play and not just the GB. I doubt this GB will be worth anything in the future so if my dog I am removing it preventively as it presents a risk but that’s me:)
For more insight check out our abstract on surgical biliary disease….
This dog may have low grade signs of adr and not reported. At times when these GB are removed the owner has a “new dog.”
Thanks for the response. I
Thanks for the response. I did recommend a cholecystectomy but wanted to make sure I wasn’t over-reacting. He does have a positive Murphy sign that I forgot to mention. The owner doesn’t perceive any clinical signs.
Thank you!
Suzanne
If + Murphy then my bet is it
If + Murphy then my bet is it comes out and they have a perkier dog…. To me its a time bomb but some stay this way…. still don’t know what to think of that cyst but discussed it with Remo as well last night here at ECVIM in Liverpool and he hasnt seen it either…. zebra territory… 🙂 but in itself we don’t think its pathological unless its causing some sort of GB dysfunction predisposing to mucocele. You could do the due diligence and do a Gb motility study to prove or disprove function or just remove it. I never suggest keeping a GB that has true deep pain on the probe as long as its a repeatable pain and not iatrogenic by our probe pressure. The key is here is to see him react or not with the same manual position on the probe throughout the rest of the abdomen and if you keep coming back to the subxyphoid position on the GB (usually at the neck) and he reacts then that’s a true + murphy and it usually has fuzzy fat or other GB changes to support painful pathology or at least discomfort.
please let us know how it pans out but if the do nothing then be sure to monitor any adr onset or rapid rise in sap alt and bili or wbc. I would recheck this in 4-6 week while on actigal.
If + Murphy then my bet is it
If + Murphy then my bet is it comes out and they have a perkier dog…. To me its a time bomb but some stay this way…. still don’t know what to think of that cyst but discussed it with Remo as well last night here at ECVIM in Liverpool and he hasnt seen it either…. zebra territory… 🙂 but in itself we don’t think its pathological unless its causing some sort of GB dysfunction predisposing to mucocele. You could do the due diligence and do a Gb motility study to prove or disprove function or just remove it. I never suggest keeping a GB that has true deep pain on the probe as long as its a repeatable pain and not iatrogenic by our probe pressure. The key is here is to see him react or not with the same manual position on the probe throughout the rest of the abdomen and if you keep coming back to the subxyphoid position on the GB (usually at the neck) and he reacts then that’s a true + murphy and it usually has fuzzy fat or other GB changes to support painful pathology or at least discomfort.
please let us know how it pans out but if the do nothing then be sure to monitor any adr onset or rapid rise in sap alt and bili or wbc. I would recheck this in 4-6 week while on actigal.
The owner is consulting with
The owner is consulting with a surgeon today. I’m sure he will have his radiologist repeat the study and follow their recommendations but I’ll let you know what happens. I like occasional zebras – keeps it all interesting!
Thanks again,
Suzanne
Just to update – the owners
Just to update – the owners did have the cholecystectomy performed. Histopathology showed a mucocele along with serosal cysts and mild lymphocytic/plasmacytic cholangiohepatitis. Thanks for your help!
Suzanne
The owner is consulting with
The owner is consulting with a surgeon today. I’m sure he will have his radiologist repeat the study and follow their recommendations but I’ll let you know what happens. I like occasional zebras – keeps it all interesting!
Thanks again,
Suzanne
Just to update – the owners
Just to update – the owners did have the cholecystectomy performed. Histopathology showed a mucocele along with serosal cysts and mild lymphocytic/plasmacytic cholangiohepatitis. Thanks for your help!
Suzanne
Awesome thanks for the
Awesome thanks for the follow-up!!!… serosal cysts perfect.
Awesome thanks for the
Awesome thanks for the follow-up!!!… serosal cysts perfect.