Try to decompress biliary occlusion

Try to decompress biliary occlusion

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Jul 01, 2004

Signalment:

Feline, Himalayan, 12.5 years old, female spayed, 6.6 lbs.

Clinical history:

The owner stepped on the cat about three days ago, and it has been lethargic without eating or drinking since then. The cat has lost 0.6 lbs in the past month and has been diagnosed with hip dysplasia.

Physical examination:

The findings show rectal temperature 102.8°F, heart rate 140 beats/min, sinus rhythm, respiration 20 breaths/min, pink tacky mucous membranes, no heart murmur heard, ear disease and arthritis. Therapy has included prednisone, Rimadyl and ketoprofen.

Laboratory results:

A complete blood count, serum chemistry profile and urinalysis were performed and are outlined in Table 1.

Radiographic review:

Survey thoracic and abdominal radiographs are done. The thoracic radiographic views are unremarkable (Images 1-7).

My comments:

The abdominal radiographs show an enlarged liver, a prominent spleen, radiodense area in the location of the gall bladder, hip dysplasia and moderate spondylosis.

Ultrasound examination:

Thorough abdominal ultrasound is performed with the cat positioned in dorsal recumbency.

My comments:


Image 1
The liver shows an inhomogeneous texture in its parenchyma.


Image 2
Multiple secondary bile ducts are dilated with possible calcified walls and acoustic shadowing noted. No masses noted within the liver parenchyma. The gall bladder is mildly distended, and its walls are not thickened or hyperechoic.


Image 3
The gall bladder does contain a lot of sludge material. The common bile duct is greatly dilated with large amount of accumulated sludge material in its lumen and possible calcified walls with some acoustic shadowing noted.


Image 4
The spleen shows an inhomogeneous texture in its parenchyma, and no masses are noted. The left and right kidneys are similar in size, shape and echotexture. Each kidney shows an inhomogeneous texture in the renal cortex.


Image 5
No masses or calculi were noted in either kidney. The urinary bladder is distended with urine and contains some urine sediment material - no masses or calculi noted.


Image 6
The left and right adrenal glands are similar in size and shape. The stomach, small intestine and colon are normal. The pancreas is prominent and shows an inhomogeneous texture in its parenchyma.

Case management:

The tentative diagnosis is chronic cholangitis and biliary tract occlusion. There was no obvious evidence of cancer noted during this abdominal ultrasound study.