Paz is a 12 year old DMH female/spayed
History of anorexia
PE: Temp: 103.8 and aural/soft palate jaundice
Labs: ALT 162 Alk Phos 510 T. Bil 4.2 T4 7.8 BUN 10 Phos 2.8
Paz is a 12 year old DMH female/spayed
History of anorexia
PE: Temp: 103.8 and aural/soft palate jaundice
Labs: ALT 162 Alk Phos 510 T. Bil 4.2 T4 7.8 BUN 10 Phos 2.8
U/S Liver appears diffusely hyperechoic with a fine texture. The GB appears normal sized but the wall appears thickened from normal. Lumen is anechoic w/ no evidence of abnomal contents. I feel the common bile duct is dialated and the wall is thicker than normal. It appears tortous but I don’t see any obstructions. I feel that the hepatic veins are mildly-moderately dialated and the portal vasculature seems dialated to me???? The duodenum has some corrugation but looks normal otherwise and I don’t think the pancreas is abnormal although it wasn’t obvious to me in this cat (amazingly I got the pancreatic series e-mail today after I got home 🙂 )
I’m thinking this cat’s issues are more associated w/ the liver; cholecystitis, chronic cholangiohepatitis. I know there is hyperthyroidism, but I don’t think that it’s driving the liver problems.
I’m focusing on the liver now w/ antibiotics & anti-inflammatories. I’ll address the thyroid when the cat starts to eat more normally.
Am I reading the liver pathology corrrectly?? From the images I pulled from the clinical searches it looks similar.
Thanks,
Sam
Comments
I love playing the where’s
I love playing the where’s the bilirubin game:) ok so Im assuming that there is no anemia so we can rule out hemolytic disease. Prehepatic eliminated.
Post hepatic to me the cbd is normal (< 4 mm), the pancreas is nsf so no post hep obstruction from that and the Gb is uneventful. Post hepatic eliminated
Hepatic source: must be this no matter what the liver looks like with LEs up, especially sap as the primary, then its usually lipidosis or lsa and I would go towards lipidosis likely here. If ALT and AST are primary with little or no SAP then think inflammatory. These are not absolute but are solid tendencies. 25g fna tells the story so off to needles. May want to coag first as according to sharon center study 45% of lipidotic cats have coag abnormalities so when lipidosis pattern in play may wan to coag first. Then again its really tough to kill something with a 25g needle but ….:)
One red herring: salmonella poisoning (songbird fever) in cats can cause bili elevations even without LE elevations. So can chase that one too but baytril usually solves that. Please let us know what your 25g cytology says.
Thanks for the reply…
For
Thanks for the reply…
For my learning curve…I’m assuming the slight thickening to the GB is not a concern, my reference book says anything >1mm and this was just shy of 2mm.
And on the video loops, am I tracking the CBD as coming off the GB and moving in a slightly tortuous path towards the duodenum. I was getting measurements around 3.75mm…so larger than I usually see but normal none the less?
Am I correct in saying some hepatic venous congestion, or am I reaching?
Thanks again,
Sam
With the lipidosis you also
With the lipidosis you also need to nutrition into this cat and most likely via tube feeding otherwise the liver (or cat) does not recover. Also watch the anti-inflammatories as they can affect the liver. Would add SAMe and Ursodiol.
Yeh all I can say is don’t
Yeh all I can say is don’t get caught up on numbers and measurements. The key here is the gb and cbd and cd walls are well defined curvilinear patterns and cbd is less than 4 mm. The older the cat the more it approaches 4 mm even older cats can have 5 mm be normal… old dilated ducts cbd or panc duct.
I too thought the hepatic veins were a little prominent but this will happen in sedation especially with dex domitor or similar. If not sedated take a peek at the heart and ensure no right sided enlargedment or general overload or pc effusion.
If need to sample use propofol.
Here are some examples from the SonoPath search engine on CBD pathology so you have a point of reference. Just go to the clinical search and insert “CBD” and tons of post hepatic pathology comes up:)
http://sonopath.com/members/case-studies/search?text=cbd&species=All
Thanks,
as always, very
Thanks,
as always, very informative and helpful.