Kiko Acc#161481

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Kiko Acc#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 - PowerPoint PPT Presentation

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KikoAcc#161481

1Kiko3yo DSH4.2011- Unclassified cardiomyopathy, heart failure ITP-Severe thrombocytopenia with ecchymosis/pechteciation/subdermal hemorrhage Regenerative anemia Hyperglobulinemia Elevated liver/cholestatic enzymes: ALT, ALP, GGT Bilirubinemia Low BUNAUS- dilated hepatic veins, suspect congestionModerate pleural effusion 2

3Represented 7.5.11- Elevated liver/cholestatic enzymes: ALT, ALP, GGT,at rDVM- resolved on presentation.Focal AUS- choledocholithiasis, liver aspirates normal11.10.11- 5 days of intermittent anorexia, Bloodwork unremarkable UltrasoundCholedocholithiasisChronic pancreatitis

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5Cholelithiasis is uncommon in all species except humansOften incidentalSeveral risk factors in humans, no definitive risk factors in veterinary patientsCauses malabsorption of vitamin KDeficiencies of Vit K dependent coagulation factors

6Cholesterol stonesPure cholesterol or mixed with materialprotein, bilirubin, bile salts and inorganic materialHigh rates of cholesterol secretion with low rates of bile acid secretionCholesterol precipitates around other particlesSalts, sloughed gall bladder mucosal cells, bacteria, bilirubin, parasite fragments and ovaHumans- obesity, high caloric diets, malabsorption of bile acids, estrogens, age, pregnancy, diabetes, high fat diets, N. European or N. or S. American ancestryPigment stonesDried and precipitated bilirubinDue to increased uncongugated bilirubin in bileHumans- hemolysis, alchoholic cirrhosis, biliary infection, age, Oriental ancestryCalcium carbonate

Cmposition of liths in cats is most often mixedLow bile acid secretion dt Deficiency of bile acids due to accelerated loss, inability to synthesize bile acid or defective feedback regulation of bile synthesis

7InfectionBacterial nidusCholangiohepatitis can occur secondarily to damage caused by bile duct obstructionAssociated with pancreatitis and IBD in cats d/t bile duct and pancreatic duct both opening into papillaExtension of enteric bacteria into biliary tree and pancreas most likely source of infectionForeign materialovaHemolysis?Frequent cause of bilirubin cholelithiasis in humansLiths often 100% bilirubinPyruvate kinase deficiency in cats?Abyssinians and SomaliansErythrocytes destroyed due to inability to maintain normal metabolismCholelithiasis and EHBO may be sequelae to hemolytic anemia (Journal of Feline Medicine and Surgery, 2007)

8UltrasoundMineral?

EHBO- sensitive, though can have false positives5mmCholangiohepatitis or infiltrative disease can appear sonographically normal

The twinkling artifact is a color Doppler artifact,which is produced at or behind the surfaces of rough,strongly reflecting objects (Rahmouni et al. 1996). It mayor may not be dependent on the chemical composition ofthe reflecting object (Chelfouh et al. 1998) but its under-lying cause seems to be an extremely small, but inherentfluctuation in the ultrasound field produced by phasejitter between the elements in an ultrasound scanhead(Kamaya et al. 2003). This jitter produces enough fluc-tuations in the ultrasound field that when this field en-counters a strong reflector of sufficient roughness, thereflections produce a broadbanded, random signal, whichare displayed as a random color signal in color Dopplerimaging (Kamaya et al. 2003)

9Cholangiography

Contrast placed within the gall bladder under ultrasound guidanceBile peritonitis

10Cholangiography

Not obstructed11 Retrograde cholangio-pancreatography

Gold standard for diagnosing pancreaticobiliary disorders in peopleEndoscopy and fluoroscopyLess invasiveCan be used to remove intraluminal structures, place stents, etc. VRUS, 200512MR cholangiopancreatographyConsidered as accurate as retrograde technique without the associated risks

T2 FSVRUS 201113

CT cholangiography

meglumine iotroxateEuropean Radiology, 200714CholescintigraphyHIDA scanhepatobiliary iminodiacetic acid scanRadiopharmaceutical concentrates in bileCan calculate ejection fractionFast appropriately to prevent gall bladder contractionLack of visualization within the gall bladder implies inflammation- cholecystitisDelayed transit due to obstructionDetection of a suspected bronchobiliary fistula by hepatobiliary scintigraphybiliptysis15

16TreatmentAntibioticsEHBOSurgeryMorbidity and mortality associated with cholecystectomy reported to be low17KikoBile and liver aspirates normalConservative fluid therapy over the weekendHairball?

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