Gall stones in cats!

Re: Gall stones in cats!

Sarah Keir — Thu, 25 Jun 2015 17:36:08 GMT

Thanks guys. I'll get the cat started on some meds.

Any reason why I cannot find any articles on cytoliths in cats - one brief magazine article is all I could find. Perhaps I should write something up?

Sarah

Re: Gall stones in cats!

Martin Atkinson — Thu, 25 Jun 2015 11:13:58 GMT

+1 for what Andrew said. Interestingly I had a client in yesterday with a dog with severe liver disease (actually the one that I reported a 0 ALP on in another thread). That is on Destolit as part of its protocol and has improved dramatically but the owner questioned the use of it as he'd read on t' interweb that it was contraindicated in liver disease. I explained in simplistic terms about good bile acids and bad bile acids likening it to good and bad cholesterol and he was happy. Just goes to show a little knowledge (and Dr Google) can be a bad thing.

Re: Gall stones in cats!

Andrew Kent — Thu, 25 Jun 2015 10:08:18 GMT

[quote user="Sarah Keir"]The bile duct appears distended and tortuous on the scan so although the jaundice disappeared quickly I think there is still a significant degree of bile duct obstruction. Would Destolit be completely out of use in this situation.?[/quote]

I would still use destolit, people used to think it was contraindicated if there was complete obstruction but thats not really still the case. It just changes the nature of the bile so no reason it would cause any issues. Equally you know you don't have a complete obstruction, otherwise your bloods wouldn't be improving.

I would give medical management a go before considering surgery and would, anecdotally, say that we only need surgery in 30% of cases - unfortunately the stones probably increase this cat's risk of needing it at some point.

I would give destolit and start a diet trial (on the assumption that many of these cats get these problems because of concurrent GI inflammation) and keep an eye on the bloods in a few weeks. If the cat becomes unwell again then it is likely to be a different story.

Andy

Re: Gall stones in cats!

Sarah Keir — Wed, 24 Jun 2015 20:24:46 GMT

I got the FNA back today for the mass. Very unhelpful - cannot tell cell type, looks like might be epithelial or neuroendocrine, could be hyperplasia or neoplasia. Here are some photos taken down the microscope (on crappy practice camera) of a Diff-Quick stained slide that I kept behind. Any ideas?

There was definitely some areas of inflammation - mixed neutrophils and macrophages. Plus some cells that looked like eosinophilic granules in cytoplasm - eosinophils? Then most of the population is monomorphic cells with small basophilic nucleus and mottleds eosinophilic cytoplasm.

Re: Gall stones in cats!

Sarah Keir — Wed, 24 Jun 2015 20:17:37 GMT

[quote user="Martin Atkinson"]

+1 for what Andrew says. The surgery is perfectly possible for a competent surgeon but is not for the faint hearted.

[/quote]

Not me then! I mean the not for the faint hearted!

The bile duct appears distended and tortuous on the scan so although the jaundice disappeared quickly I think there is still a significant degree of bile duct obstruction. Would Destolit be completely out of use in this situation.?

I spoke to the 'owner'/charity yesterday and they report the cat is 100% back to normal and are reluctant to consider surgery. But I am concerned that medical management won't help this cat in the long term.

Re: Gall stones in cats!

Martin Atkinson — Tue, 23 Jun 2015 09:07:16 GMT

+1 for what Andrew says. The surgery is perfectly possible for a competent surgeon but is not for the faint hearted.

Re: Gall stones in cats!

Andrew Kent — Mon, 22 Jun 2015 23:36:16 GMT

Hi Sarah,

we see them fairly frequently in cats, likely associated with other biliary tract diseases (pancreatitis being the most likely.

if not obstructed (and the reducing tbil suggests not - probably it was passing a stone before) then medical management with ursodeoxycholic acid is an option and would need to watch closely for improvement.

if obstructs again or no impvt in a few months then surgery - likely cholecystectomy - would be indicated.

would be nice to see the pictures if easy enough!

Andy