Faith is a 10 yr FS Poodle, non-clinical for waxing/waining liver values (highest= ALT 211, ALP 142). On pred for presumed IMHA (5 mg daily). Ultrasound on 12/27 revealed early mucocele appearance in GB (last image). No other abnormalities. GB contents same or slightly worsened despite adding ursodiol and Denamarin. NO antibiotics yet. Any thoughts on more aggressive medical treatment?
Faith is a 10 yr FS Poodle, non-clinical for waxing/waining liver values (highest= ALT 211, ALP 142). On pred for presumed IMHA (5 mg daily). Ultrasound on 12/27 revealed early mucocele appearance in GB (last image). No other abnormalities. GB contents same or slightly worsened despite adding ursodiol and Denamarin. NO antibiotics yet. Any thoughts on more aggressive medical treatment?
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Im not seeing a full mucocele
Im not seeing a full mucocele development here …GBM definition : overdistention and striating immobile bile.. would need video and of course the appearances changes with the angle. The most dramatic dilation usually occurs from right intercostal poosition. I would do a Gb motility study first and remember that the gb will change content differently based on the post prandial status. ursodiol is pretty much the only thing that will have effect and after that its sx but Im not seeing a surgical GBM her eyet.
Ok, thank you. The
Ok, thank you. The striations in this GB extend to the edges, but it is not overdistended. To do a motility study, scan pre-feeding and post feeding? Looking for change in the size?
I saw another case yesterday that I don’t have clips for, but is related to this case – patient had a cholecystectomy about a year ago for a mucocele. Liver bx showed hepatocellular vacuoloization. Dog started acutely vomiting yesterday. Ultrasound showed a heterogenous liver w/ increased portal markings, mild enlargement, biliary ducts not prominent. There were some enlarged and rounded lymph nodes nearby. FNAs are pending. Dog was painful when scanning over the liver – I haven’t appreciated dogs being uncomfortable in the past without other pathology in the region (pancreatitis), but wondering if you see this with inflammatory liver disease? Obviously may be more than inflammatory liver disease, but just didn’t all fit for me.
Here’s the gb motility study
Here’s the gb motility study in interventional procedures
http://sonopath.com/resources/interventional-procedures
on the other case look at the cbd as they can be painful there if ill defined wall and fat is present. Wiht the GBM history then CBD is often a place of recurrent issues post cholecystectomy.
Very helpful! For the first
Very helpful! For the first case, with the appearance in the images, would you not pursue any treatment at this time if the motility study shows a decrease in size post-prandial? Or should I just continue with ursodiol and denamarin indefinitely? The finger like projections were what were concerning to me and that the material was not gravity dependent. Unfortunately, I didn’t save any videos. I was all set to do C&S, but sounds like I should hold off.
I’m attaching a couple of stills I was able to obtain re the second case (wanted to send videos, but don’t see that option from this screen). I think it looks like you are spot on with the CBD – lots of fuzzy fat in this area. Is this a somewhat expected complication from surgery? Something that can be managed with supportive care as needed?
I dont see the gb in these
I dont see the gb in these views but I do see reactive mesentery around the hepatic capsule and no inflammation in your gb image above which leads me to nbelieve the problem is in the liver parenchyma or extending from the pancreas in this post op case… but tough call because of still vs video. I would fna the liver here to be sur ethere sint more than post op inflammation unless you hav eliver bx already. they shouldnbt be painful there after 4-5 days post op.
Based on the stilkl image in your first case the gb is an emerging gbm at best. Ursidiol for 8 weeks and recheck it… baytril metro for 3 weeks if ast/alt are components.
If you have the video on these please start another thread because you cant add video, only stills to a thread unfortunately its an IT thing.