- 1 year old
- Male entire DHS, stray, 2.25Kg.
- Still eating. Poor history. Bloated abdomen but still producing poo (normal in color).
- Ultrasound: generalized organomegaly, thickened enlarged spleen, enlarged kidneys (5.2cm each, mild medullary rim in middle of medulla, mildly enhanced corticomedullary definition), thickened pancreas with only mild ductal distension (0.2cm).
- Liver: moderately enlarged with severe extrahepatic biliary ductal dilation (common bile duct 1cm with no obvious mass at duodenal papillae other than a mild increased thickeness or prominent papillae), there are round cystic structures that from the tortuosity in them appear biliary ducts extremely dilated rather than cysts (too thick wall). Abscess is also less likely as there are multiple and appear tortuous. Purulent content would be a possibility but I doubt it is a primary abcess, it would be purulent biliary duct.
- Peritoneal effusion: yellow/orange tinged, mildly dense transparent fluid. Analysis pending.
My gut feeling is this is a very severe, very chronic partial biliary tract obstruction due to severe cholangitis/cholangiohepatitis and as underlying diseases I consider FIP (FeLV/FIV are negative at this stage but only one test done) and FLUKES (not sure of the prevalence in Singapore, but there are loads of lizards and plenty of tropical rain.
Questions: do you agree with this assessment?
Would you do a bile aspirate from the largest ones for flukes diagnosis and/or pressure relief? Risk of bile peritonitis is what held me back.
Is this surgical or passed the solvable point?
I thought it would help as patient is not acute and the feces are still normal in color…and cat is of course agressive and needs domitor for handling each time we want to do anything. This is the second case I see in this state of biliary dilation. A few with severe cholangitis which were never biopsied, and lost track of; one other stray cat, very similar, initially presented with generalized thickened ducts, I thought it was severe chronic cholangitis, then it came back with a huge abdomen and I thought I missed an abscess or it was neoplasia…patient was euthanized and again, no answers… Now that I have seen this case, I think that it might be flukes…or FIP…I hope you can help.
Thank you very much.
2 responses to “Severe biliary stasis/cholangiohepatitis”
Looks like some chronic
Looks like some chronic inflammatory and mineralized tissue at the junction of the cbd with the panc duct (arrow oin my image) but may be carcinoma. Needs explore with expectation of bile duct deviation if carcinoma isnt there.
****Side note please try to keep to the concise bullet point format quick points otherwise this becomes a teleconsultation which isnt its purpose. We want all the forum participants and the specialists to be able to get to the point and open a thread wihtout effort which tends not to be the case when histories are elaborate. Thank you for understanding.
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Thank you. Apologies For long
Thank you. Apologies For long post. I did intend to make it bullet type and concise. I didn’t think this was a telemedicine question. I just wanted some input on whether the findings sounded like a fair assessment, FNA something to consider for fluke diagnosis even with the risk of bile peritonitis whether the forum community has encountered similar cases.
I was looking more for a forum discussion rather than a telemedicine case.
Apologies for that. Next time I’ll be more specific.