-10 year old FS terrier
-history of cholecystectomy 2 years ago due to mucocele
-currently diagosed with Cushing’s and PLN
-on Vetoryl & enalapril
-presented for anorexia and intermittent vomiting
-ALT & SAP unable to be read, presumed high
-tBili 6.5
-amylase ~2000
-all other bloodwork normal or close to it
-10 year old FS terrier
-history of cholecystectomy 2 years ago due to mucocele
-currently diagosed with Cushing’s and PLN
-on Vetoryl & enalapril
-presented for anorexia and intermittent vomiting
-ALT & SAP unable to be read, presumed high
-tBili 6.5
-amylase ~2000
-all other bloodwork normal or close to it
I have not scanned many animals with a history of a cholecystectomy. There is an area in the body of the pancreas/pylorus that appears to have some cystic change (no color on Doppler) as well as some mural changes in the pylorus. Is this a real lesion or secondary to the surgery?
His liver looked typical for Cushing’s with a single focal hyperechoic lesion but no other focal lesions.
Thanks!
Comments
Surgical post hepatic
Surgical post hepatic obstruction in light of elevated Bilirubin is a cbd of > 0.4 cm and this one is sort of there and the wall of the duodenum is thickened. I would fna the liver parenchyma and consider lepto but treat for mucoduct and if not resolving medically (dexamethazone injection may reduce inflammation to liberate bile) then may nee to do a cbd lavage. Often cholecystectomy for Gb mucoceles come back for similar signs because of mucoduct and d-pap strictures but post hepatic obstruction is not overwhelming here so I would rule out causes of chepatitis first and im assuming no anemia from hemolytic disease…
Interesting! I have never
Interesting! I have never heard of mucoduct.
His PCV is over 50 so no hemolytic disease. We are treating empirically for lepto for the moment. I think CBD lavage is beyond my skill levels but have offered referral if he doesn’t improve.
Thanks!
suzanne