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Comparative Gastroenterology

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Image A
Image B

 

BACKGROUND
A 34.5 lb (15.7 kg), 7 year old, male Mixed Breed dog is referred to your clinic with a 2-3 week history of lethargy, a declining appetite, daily vomiting (occasionally containing yellow bile), and being more irritable. The owner noticed that the dog had “yellow eyes” yesterday and took the dog to her veterinarian immediately. The dog had history of seizures 2-3 years ago and was treated with doxycycline approximately 2 weeks ago. The RDVM recommended referral to you. On presentation the dog has a rectal temperature of 101.2°F, heart rate of 116 beats/min and a respiratory rate of 48 breaths/min. The dog is lethargic but responsive, icteric, slightly enlarged submandibular lymph nodes, and mild tarter on the teeth. On abdominal palpation, there is an organ protruding past the last rib. Abdominal radiographs (Image A) and ultrasonographic examination (Image B) of the liver are above.

 

Authors: Silke Hecht, Dr. Med. Vet.
Frank M. Andrews, DVM, MS, DACVIM
Amy Holford, VMD
Joanne R. Smith, MA, Vet. MB, Ph.D.
George A. Henry, DVM, DACVR

 

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  • What other diagnostic tests would be helpful in determining the diagnosis?

  • What treatment(s) would be appropriate?

 
DIAGNOSIS

Lateral abdominal radiographs showed the liver extending well beyond the costal arch and rounded caudal margin. The long axis of the stomach was displaced slightly caudally. The abdomen had a pendulous appearance. Radiographic diagnosis: generalized hepatomegaly, pendulous abdomen and obesity. Ultrasonographic examination of the abdomen showed a severely enlarged liver, but within normal limits for echotexture with the exception of a 1 cm nodule with hyperechoic outer rim and a hypoechoic center associated with the left liver. The gall bladder was distended and contained a large amount of granular material. Gall bladder dimensions were at least 3.1 x 3.5 x 3.5 cm. The cystic duct was distended, measuring 1.8 cm wide, and contained sludge. The visible part of the extrahepatic bile ducts were also widened (4mm). There was no evidence of intrahepatic biliary obstruction. Associated with the common bile duct 1.5 cm proximal to the duodenal papilla, a 2.8 x 0.8 cm soft tissue mass lesion was noted. The common bile duct distal to this lesion was dilated (0.5 mm) and could be traced to the level of the duodenal papilla. A small amount of abdominal effusion was noted. The spleen was enlarged. The kidneys, the adrenal glands, the urinary bladder, the prostatic gland as well as the gastrointestinal tract were within normal limits.

A diagnosis of Bile duct dilation/functional obstruction, hepatomegaly, and acquired extrahepatic portosystemic shunts was made. An ultrasound guided aspirate of the liver and spleen showed cholestasis and extramedullary hematopoesis, respectively. There was no evidence of neoplasia. Exploratory surgery showed a distended gall bladder and common bile duct, but no evidence of obstruction was found. However, to prevent future obstructions a cholecystoduodenostomy was performed. The dog was discharged with antibiotics, tramadol, famotidine, and a diet of I/D was recommended

 
 



 

Image A
Liver extends beyond the costal arch with rounded caudal margin (black arrows). The long axis of the stomach (S) was displaced slightly caudally. The abdomen had a pendulous appearance.

Image B
 Ultrasonographic examination of the abdomen showed a distended gall bladder (GB) and cystic duct (CD) with a large amount of granular material (sludge). The liver had normal echogenecity.