12 yo 106 lb Akita (ugh) presented with a two day history of vomiting numerous hours after eating. Is currently taking Trazadone daily.

PE:BAR T 101.2,mild dehydration otherwise normal exam.

Lab: ALT 507 (18-121), AST 264 (16-55), ALP 356 (5-160), GGT 18 (0-13) Bili Tot 0.9 (0.0-0.3), Bili Uncon 0.5 (0.0-0.2), Bili Conj 0.4 (0.0-0.1) Glob 4.4 (2.4-4.0) 

CBC:NSF

UA:1.038, 2+ protein, 3+ Bili

Spec cPL:109 (0-200)

Lept Elisa AB neg, Blood/Urine PCR pending.

Abdominal radiographs unremarkable

12 yo 106 lb Akita (ugh) presented with a two day history of vomiting numerous hours after eating. Is currently taking Trazadone daily.

PE:BAR T 101.2,mild dehydration otherwise normal exam.

Lab: ALT 507 (18-121), AST 264 (16-55), ALP 356 (5-160), GGT 18 (0-13) Bili Tot 0.9 (0.0-0.3), Bili Uncon 0.5 (0.0-0.2), Bili Conj 0.4 (0.0-0.1) Glob 4.4 (2.4-4.0) 

CBC:NSF

UA:1.038, 2+ protein, 3+ Bili

Spec cPL:109 (0-200)

Lept Elisa AB neg, Blood/Urine PCR pending.

Abdominal radiographs unremarkable

24 hrs iv fluids, IV ampicillin was eating well and no vomiting. Sent home on oral Doxycycline to cover for Lepto (tests were pending) O wanted to hold off on ultrasound until all test were back given that he was doing well and sedation would have been needed. Did I mention he was a 106 lb Akita! 🙂 

Returned 24 hours later for recurrance of vomiting though the owner reported that his urine was starting to become less brown. Wondering if the Doxy was to blame. 

O finally consented to Ultrasound (now 48 hours post initial presentation) and only abnormality I could ascertain was the Gallbladder. It was a struggle. 

Interestingly, all blood values were now back to normal or very close to it. And Dog is eating I/d and keeping it down. 

I’m now wondering how to proceed. DDX: Trazadone reaction? Cholangitis, Cholangiohepatitis. Could 24 hours of Ampicillin been enough time to reverse all those abnormal values if this was bacterial. Also normal CBC, never a fever. 

Trying to decide if I hit this hard with abs or wait it out a bit longer and recheck Gall Bladder in a week or so. 

Thanks. 

P.S. I’m guessing Eric will recommend aspirating the gall bladder, but given I’ve never done that before and given the size of this dog, I think I would refer if it comes down to that.