Cool case i read out and followed the other day of a cat with pancreatitis and cholangitis. You can see the dilated cbd and ill-defined fuzzy fat involving the surrounding pancreas and the cbd. The cat had a bili of 11, ALt 780 and SAP of 309.

This was of course a money case and owners wouldnt sample the liver but nothing said overt neoplasia and lsa is usually an SAP/bili thing more than an ALT/bili thing so the chem profile said more inflammatory with congestion given the ALT being the higher component.

Cool case i read out and followed the other day of a cat with pancreatitis and cholangitis. You can see the dilated cbd and ill-defined fuzzy fat involving the surrounding pancreas and the cbd. The cat had a bili of 11, ALt 780 and SAP of 309.

This was of course a money case and owners wouldnt sample the liver but nothing said overt neoplasia and lsa is usually an SAP/bili thing more than an ALT/bili thing so the chem profile said more inflammatory with congestion given the ALT being the higher component.

So I recommended zithromax & metronidazole (covering biliary infection with some immune modulating and anaerobic coverage), supportive fluids, pain management and a single dose of dexamethazone 1/4 mg/kg.

You can see the effects 24 hours later on the dissappearance of the fuzzy fat on the cbd and pancreas and less turgid cbd with the cat doing much better. I’m assuming the bili dropped but am wiating on bloodwork will add it to this thread. 

The duodenum is a bit thick and can’t rule out an emerging lsa (no significant lymph nodes up anywhere) but it calmed down with dex too which technically lsa or similar can do and this likely helped bile flow through the duodenal papilla.

I just wanted to show the immediate effects of dex on this presentation.

Still images: pre tx and post dex tx images of the cbd and surrounding pancreas.

The first 2 videos are pre tx and the last one post tx.