Hello,
*Ginger is a 7 years old F/S cat that has a history of recurrent pancreatitis. She is on Ursodiol, hypoallergenic diet.
* aT the time of the exam she was stable with no clinical symptoms ( recheck US due to calcification seen on X-ray)
*I can see multiple smal stones, sand in the GB and distension of the CBD ( 0.5-0.6 cm). My guestions:
1. Is this a partial obstruction?
Hello,
*Ginger is a 7 years old F/S cat that has a history of recurrent pancreatitis. She is on Ursodiol, hypoallergenic diet.
* aT the time of the exam she was stable with no clinical symptoms ( recheck US due to calcification seen on X-ray)
*I can see multiple smal stones, sand in the GB and distension of the CBD ( 0.5-0.6 cm). My guestions:
1. Is this a partial obstruction?
2. Can this be managed medically because client would not go for the surgery? What else beside Ursodiol, antibiotics, pan management and allergen restrictive/ hydrolized diet can we try for this cat?
Thank you and Happy Hollidays !
Comments
Surgical CBD is > .5 cm and
Surgical CBD is > .5 cm and clinical signs +/- bilirubin elevations or sap in cats which is always a red flag because of the short half life… dogs can do sap in benign fashion but cats do not. This is a lot of sand to dissolve medically and ursodiol, in my eyes, works well in some stone/sand cases and doesnt work in others. I would rec sx officially (CBD is about 0.5 cm) but treating underlying cholangitis (nearly always evident at some level in these cases) and adding ursodiol and watching SAP ALT bili WBC and appetite would be key and put a probe on it every 3 weeks if stable and see if any regression or progresssion as long as the patient is eating and somewhat stable and keep hydrated like you would a renal cat. I think this goes overlooked in liver cases I think its just as necessary as renal cases to maintain hydration and solid enterohepatic circulation to washout the system.
I like actigal, baytril or zithromax, metronidazole and go from there.
As there are no overt
As there are no overt clinical signs (icterus, abdominal discomfort) and if liver enzyme activity is not increasing then medical management with Ursodiol, diet, and antibiotics is warrented. Regular monitoring is, however, needed.
Are steroids ever indicated
Are steroids ever indicated to reduce inflammation- or wil they confuse the issue?
Thank you for your comments.
Thank you for your comments. I definatelly don t use enough fluids in these chronic gb/liver cases comparing to CRF cases. That is a good suggestion.
I was also wondering about prednosolone in these cases? Is it a good ideea?
Steroids usually indicated in
Steroids usually indicated in acute disease, lymphocytic hepatitis but not in EHBDO.
The only time i use steroids
The only time i use steroids in EHBDO is when right base pancreatitis is squeezing down the CBD/D-pap and I watch it carefully with US and BILI SAP ALT. Single does dexameth 1/4 mg/kg one injection if thats not working and bili not dropping then its surgical usually. But if theres a solid bile plug or stone or tumor then its direct to sx. Steroids wont do anything with these rocks unfiortunately.
Thank you both
Merry
Thank you both
Merry Christmas:)