This is a 10year FS Boston Terrier – just diagnosed with PDH – pot-belly, PU/PD, lower energy levels but otherwise eating well and happy – ALP mildly elevated ALT 3x’s normal limit – other parameters normal – the adrenals were plump but no evidence of tumors – LDDST consistent with hyperadrenocortism – I am concerned that she is trying to form a mucocele What do you think of this gall bladder?
This is a 10year FS Boston Terrier – just diagnosed with PDH – pot-belly, PU/PD, lower energy levels but otherwise eating well and happy – ALP mildly elevated ALT 3x’s normal limit – other parameters normal – the adrenals were plump but no evidence of tumors – LDDST consistent with hyperadrenocortism – I am concerned that she is trying to form a mucocele What do you think of this gall bladder?
Comments
This Gb is a bit sludgy and
This Gb is a bit sludgy and mildly distended but no inflammation and if no pain on US (+ murphy) then likely stable. ” Emerging mucocele” is correct i think here. Always measure or view the GB both in long and short axis subxyphoid and also from right intercostal approach as they will be more dramatic often in right intercostal. Steroid dogd get mucoceles as 2 studies have shown that as well as our abstract (Clinical Parameters in Dogs with Sonographically Diagnosed Surgical Biliary Disease.) You can do a GB motility study (Sharon Center Stuff ACVIM 2010 I think) as well measuring out the GB in those views at 12 hour fast, then feed AD or similar and measure again at 15 and 30 min and see if the Gb contracts or not and cholecystikinin is actually working against anything functional. I don’t think this is surgical yet but you can try actigal as well for 6-8 weeks and recheck.
More on this subject I did a survey a few years ago to define this issue amongst my experienced colleague clinical sonographers when this was more of a hot controversial issue. So here is the insight on defining a GB mucocele by some very talented folks: Defining A Gall Bladder Mucocele.
This Gb is a bit sludgy andThis Gb is a bit sludgy and mildly distended but no inflammation and if no pain on US (+ murphy) then likely stable. ” Emerging mucocele” is correct i think here. Always measure or view the GB both in long and short axis subxyphoid and also from right intercostal approach as they will be more dramatic often in right intercostal.You can do a GB motility study (Sharon Center Stuff ACVIM 2010 I think) as well measuring out the GB in those views at 12 hour fast, then feed AD or similar and measure again at 15 and 30 min and see if the Gb contracts or not and cholecystikinin is actually working against anything functional. I don’t think this is surgical yet but you can try actigal as well for 6-8 weeks and recheck.
More on this subject I did a survey a few years ago to define this issue amongst my experienced colleague clinical sonographers when this was more of a hot controversial issue.
Thanks Eric – nice Q and A on
Thanks Eric – nice Q and A on opinions on managing mucoceles! Practical and helpful. I think I will start this patient on actigal because of her risk along with trilostane therapy. She is definitely not clinical for a mucocele and only has mild liver enzymes changes. Bilirubin is wnl. Her energy levels are low but I think this is the PDH. No Murphy. Will watch her monthly however.
I have a chance to rescan her this week so will try some positional changes to look for sludge mobility and take a better look through the right intercostal window.
Is it overkill to consider antibiotics at this stage? Do you ever sample the bile (centesis) in these patients?
Jacquie
Thanks Eric – nice Q and A on
Thanks Eric – nice Q and A on opinions on managing mucoceles! Practical and helpful. I think I will start this patient on actigal because of her risk along with trilostane therapy. She is definitely not clinical for a mucocele and only has mild liver enzymes changes. Bilirubin is wnl. Her energy levels are low but I think this is the PDH. No Murphy. Will watch her monthly however.
I have a chance to rescan her this week so will try some positional changes to look for sludge mobility and take a better look through the right intercostal window.
Is it overkill to consider antibiotics at this stage? Do you ever sample the bile (centesis) in these patients?
Jacquie
If there is evidence of
If there is evidence of inflammation sonographically or ALT, WBC elevations then I would. I usually dont cysto mucoceles but this is an early emerging one so likely OK but you will only get something back if there is mobile debris with a 22g. Otherwise it would be the same as trying to suck out secretions from an anal gland with a needle.
But the general consensus is not to stick mucoceles. I only stick cholecystitis swirling bile edematous GB as those are the ones you can usually get a culture +. But if the GB wall is compromised at all then just get it out of there.
I would likely stick this type of GB that has suspended mobile debris (can’t tell in a still just have to trust me) and a porcelain GB wall even though this had some aspects of mucocele too. The following 3 images from the pathology CD I would not stick and are surgical inflamed or classic mucoceles.
Don’t Stick This:)
Don’t Stick This:)
If there is evidence of
If there is evidence of inflammation sonographically or ALT, WBC elevations then I would. I usually dont cysto mucoceles but this is an early emerging one so likely OK but you will only get something back if there is mobile debris with a 22g. Otherwise it would be the same as trying to suck out secretions from an anal gland with a needle.
But the general consensus is not to stick mucoceles. I only stick cholecystitis swirling bile edematous GB as those are the ones you can usually get a culture +. But if the GB wall is compromised at all then just get it out of there.
I would likely stick this type of GB that has suspended mobile debris (can’t tell in a still just have to trust me) and a porcelain GB wall even though this had some aspects of mucocele too. The following 3 images from the pathology CD I would not stick and are surgical inflamed or classic mucoceles.
Don’t Stick This:)
Don’t Stick This:)
Or This Collapsing and
Or This Collapsing and slightly leaking GB mucocele….
Or This Collapsing and
Or This Collapsing and slightly leaking GB mucocele….
or this inflamed mixed bag
or this inflamed mixed bag mucocele cholecystitis with inflammation and leakage or inflammatory fluid accumulation….. These last 3 and arguable 4 just need to find another home outside the body.
Nice post!
or this inflamed mixed bag
or this inflamed mixed bag mucocele cholecystitis with inflammation and leakage or inflammatory fluid accumulation….. These last 3 and arguable 4 just need to find another home outside the body.
Nice post!