Sonopath Forum

What is the significance of lobar calculi

12 year old FS Boxer with suspected insulinoma, doing well on pred.
Ultrasound done in June showed early GB formation-patient not clinical and liver enzymes were normal
All liver enzymes are now elevated, the dog acts painful and is dramatically less active, glucose is normal but all liver enzymes are up and there is a mild leukocytosis. The gallbladder is now showing spicules. No overt pericholecystic inflammation but mild Murphy’s sign is present.
Also a new finding is the liver lobar calculi.

12 year old FS Boxer with suspected insulinoma, doing well on pred.
Ultrasound done in June showed early GB formation-patient not clinical and liver enzymes were normal
All liver enzymes are now elevated, the dog acts painful and is dramatically less active, glucose is normal but all liver enzymes are up and there is a mild leukocytosis. The gallbladder is now showing spicules. No overt pericholecystic inflammation but mild Murphy’s sign is present.
Also a new finding is the liver lobar calculi.
What is the significance of lobar calculi? Are they a sign of liver disease, cholestasis and possibly emerging infection? Can they sometimes just be an incidental finding? Is surgery the only form of treatment?

Comments

randyhermandvm

October 18, 2016 at 11:00 am -

The same factors that are

The same factors that are causing the cholestasis are probably responsible for the changes seen in the liver.

Looks like a GB mucocele that needs to come out.

I would look into the insulinoma further and try to get this dog off the steroids if possible

Long term antibiotics and Actigal are indicated.

Electrocute

October 18, 2016 at 12:55 pm -

Thanks Randy. Seeing that

Thanks Randy. Seeing that ursodiol is contraindicated with gallbladder mucoceles, I assume that you are suggesting its use post-op.

October 18, 2016 at 1:37 pm -

Yes thats a gb mucocele with

Yes thats a gb mucocele with fuzzy fat at the neck so either active inflammation or past inflammation. The actigall may help with the lobar stones. Lobar stones are usually secondary to chronic cholangitis. Actigall may or may not help here Ive seen it dissolve it all completely in weeks in some patients and do nothing in others. Regardless the gb needs to be removed and liver bx and cbd lavage. Culture the liver and gb as well.

Electrocute

October 21, 2016 at 9:29 pm -

Thanks Eric!

Thanks Eric!