- 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.