- 9 yr old fs Cocker Spaniel
- Acute vomiting 1 month ago, normal labwork, responded to supportive tx
- Over the weekend had vomiting/collapse episode; e-clinic found T=105 and mild rise in ALKP (300’s)
- Con’t vomiting and depression; recheck labwork at regular clinic 2 days later showed ALKP>1000 and increased WBC ct
- 9 yr old fs Cocker Spaniel
- Acute vomiting 1 month ago, normal labwork, responded to supportive tx
- Over the weekend had vomiting/collapse episode; e-clinic found T=105 and mild rise in ALKP (300’s)
- Con’t vomiting and depression; recheck labwork at regular clinic 2 days later showed ALKP>1000 and increased WBC ct
- Abdominal ultrasound showed a 7 x 6.5 cm mass of mixed echogenicity in the right liver at location of the gall bladder. The walls of the presumed gall bladder were poorly defined. The adjacent hepatic and fatty tissues were hyperechoic/reactive. There were also nodules present in the tail of the spleen. Adrenal glands were normal in size and shape.
- R/O’s include gall bladder mucocele, cholangiohepatitis, hepatic neoplasia
- Exploratory surgery revealed a severely inflammed gall bladder. The adjacent liver tissue was necrotic. Gall bladder contents were solid. Omental fat was adhered to the gall bladder and liver. Histopathology is pending. A splenectomy was also done. Surgeon’s tentative diagnosis is severe cholangiohepatitis, necrotizing, potentially septic. Prognosis is guarded.
- The hepatic/GB changes were so dramatic, I thought this case would make a good post. Best images of the right side of the liver were obtained via the normal left liver. Had lots of shadowing when trying a direct right sided approach…was this due to inflammation?gas producing bacteria? Dog was most painful when trying to get images of the normal right kidney… I suspect the pressure was being translated up to his liver/gb.
Comments
Melissa, image 3 is the key
Melissa, image 3 is the key here. 9 o’clock position is inflamed fat. Please upload video when you get a minute by my suspicion is ruptured GB mucocele and regional adhesions. The body walls off bile peritonitis and the gb collapses like a flat tire when a mucocele ruptures. Hasn’t been written up as I know of but I have a number of these in the archive just no time to publish. The surgeons don’t call it a mucocele because its a flat tire and if the bile peritonitis was cleaned up by the body and empirical tx already then you are left with a blob and adhesions which looks like what this dog had. Besides its a Cocker and they hang with Shelties in the mucocele social club:) Attached is the classic mucocele from the pathology 400 cd and will upload progressive examples of GB ruptures…
Melissa, image 3 is the key
Melissa, image 3 is the key here. 9 o’clock position is inflamed fat. Please upload video when you get a minute by my suspicion is ruptured GB mucocele and regional adhesions. The body walls off bile peritonitis and the gb collapses like a flat tire when a mucocele ruptures. Hasn’t been written up as I know of but I have a number of these in the archive just no time to publish. The surgeons don’t call it a mucocele because its a flat tire and if the bile peritonitis was cleaned up by the body and empirical tx already then you are left with a blob and adhesions which looks like what this dog had. Besides its a Cocker and they hang with Shelties in the mucocele social club:) Attached is the classic mucocele from the pathology 400 cd and will upload progressive examples of GB ruptures…
An inflamed small mucocele.
An inflamed small mucocele.
An inflamed small mucocele.
An inflamed small mucocele.
Bile peritonitis and ruptured
Bile peritonitis and ruptured GB
Bile peritonitis and ruptured
Bile peritonitis and ruptured GB
Ruptured and collapsed GB and
Ruptured and collapsed GB and adhesed (big arrow) to adjacent tissue owing to chronic bile stone obstruction.
Ruptured and collapsed GB and
Ruptured and collapsed GB and adhesed (big arrow) to adjacent tissue owing to chronic bile stone obstruction.