KikoAcc#161481

Kiko 3yo DSH 4.2011- Unclassified cardiomyopathy, heart

failure ITP-Severe thrombocytopenia with ecchymosis/pechteciation/subdermal hemorrhage Regenerative anemia Hyperglobulinemia Elevated liver/cholestatic enzymes: ALT, ALP, GGT Bilirubinemia Low BUN▪ AUS- dilated hepatic veins, suspect congestion▪ Moderate pleural effusion

Represented 7.5.11- Elevated liver/cholestatic enzymes: ALT, ALP, GGT,at rDVM- resolved on presentation. Focal AUS- choledocholithiasis, liver

aspirates normal 11.10.11- 5 days of intermittent

anorexia, Bloodwork unremarkable Ultrasound▪ Choledocholithiasis▪ Chronic pancreatitis

Cholelithiasis is uncommon in all species except humans

Often incidental Several risk factors in humans, no

definitive risk factors in veterinary patients

Causes malabsorption of vitamin K Deficiencies of Vit K dependent

coagulation factors

Cholesterol stones▪ Pure cholesterol or mixed with material▪ protein, bilirubin, bile salts and inorganic material

▪ High rates of cholesterol secretion with low rates of bile acid secretion▪ Cholesterol precipitates around other particles▪ Salts, sloughed gall bladder mucosal cells, bacteria, bilirubin,

parasite fragments and ova▪ Humans- obesity, high caloric diets, malabsorption of bile acids, estrogens, age,

pregnancy, diabetes, high fat diets, N. European or N. or S. American ancestry Pigment stones▪ Dried and precipitated bilirubin▪ Due to increased uncongugated bilirubin in bile▪ Humans- hemolysis, alchoholic cirrhosis, biliary infection, age, Oriental ancestry

Calcium carbonate

Infection Bacterial nidus Cholangiohepatitis can occur secondarily to damage caused

by bile duct obstruction Associated with pancreatitis and IBD in cats d/t bile duct

and pancreatic duct both opening into papilla▪ Extension of enteric bacteria into biliary tree and pancreas most

likely source of infection Foreign material

ova Hemolysis?

Frequent cause of bilirubin cholelithiasis in humans▪ Liths often 100% bilirubin

Pyruvate kinase deficiency in cats?▪ Abyssinians and Somalians▪ Erythrocytes destroyed due to inability to maintain normal

metabolism▪ Cholelithiasis and EHBO may be sequelae to hemolytic anemia

(Journal of Feline Medicine and Surgery, 2007)

Ultrasound Mineral?

EHBO- sensitive, though can have false positives▪ 5mm

Cholangiohepatitis or infiltrative disease can appear sonographically normal

Cholangiography

Contrast placed within the gall bladder under ultrasound guidance▪ Bile peritonitis

Cholangiography

Retrograde cholangio-pancreatography

•Gold standard for diagnosing pancreaticobiliary disorders in people•Endoscopy and fluoroscopy•Less invasive•Can be used to remove intraluminal structures, place stents, etc.

VRUS, 2005

MR cholangiopancreatography Considered as accurate as retrograde

technique without the associated risks

T2 FS VRUS

2011

CT cholangiography

meglumine iotroxate

European Radiology, 2007

Cholescintigraphy HIDA scan

hepatobiliary iminodiacetic acid scan Radiopharmaceutical concentrates in bile Can calculate ejection fraction

Fast appropriately to prevent gall bladder contraction Lack of visualization within the gall bladder

implies inflammation- cholecystitis Delayed transit due to obstruction ‘Detection of a suspected bronchobiliary fistula

by hepatobiliary scintigraphy’ biliptysis

Treatment

Antibiotics EHBO

Surgery Morbidity and mortality associated with

cholecystectomy reported to be low

Kiko

Bile and liver aspirates normal Conservative fluid therapy over the

weekend Hairball?