Feline extrahepatic bile duct obstruction help

RE: Feline extrahepatic bile duct obstruction help

Anthony Dennison — Fri, 31 Dec 2021 18:43:13 GMT

With regards to antibiotic choice, I often prefer metronidazole given that it is excreted in bile compared to amoxyvlac which is renally excreted. Tend to see better responses this way.

I would work up as Andy has said - biopsies are the way forward.

RE: Feline extrahepatic bile duct obstruction help

Andrew Kent — Sun, 26 Dec 2021 09:42:46 GMT

Hi Ian

i would wonder if this is more hepatic than post-hepatic given the imaging findings and fact ALT is much higher than ALP (although this is less reliable in cats).

Ultrasound is often better at evaluating this area in cats in the right hands than CT so that may be a good option.

but I agree I would look at sampling lymph nodes and liver in the first instance. You could consider a liver FNA first to exclude diffuse infiltrative disease but may ultimately need liver biopsy.

understandable the owners are reluctant given lack of clinical signs but the cat is unlikely to remain well forever if this persists!

Andy

RE: Feline extrahepatic bile duct obstruction help

Ian Hopkins — Fri, 24 Dec 2021 16:22:29 GMT

Yes on pred 5mg daily.

Am discussing rpt imaging and liver biopsy with owners but they think he is well and aren't keen.

Likely to continue medical tx

RE: Feline extrahepatic bile duct obstruction help

Sarah Wheadon — Fri, 24 Dec 2021 15:27:55 GMT

Any suspicion of lymphocytic cholangitis - used to see these quite commonly when I first qualified and the 'yellow cat with good appetite' raises suspicions? Is he on an anti-inflammatory dose pf pred?

RE: Feline extrahepatic bile duct obstruction help

Thomas Johnson — Fri, 24 Dec 2021 08:35:07 GMT

[quote userid="25919" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/30129/feline-extrahepatic-bile-duct-obstruction-help"]The owners are not keen on biliary diversion as he is eating well.[/quote]

I think going with the suggestions of continued medical management sounds sensible, but I wondered if anyone had any experience of placing bile duct stents in cats?

RE: Feline extrahepatic bile duct obstruction help

Kate Richardson — Thu, 23 Dec 2021 17:49:49 GMT

I would potentially get him back on abs and give a full 3-4 weeks, plus/minus pred

RE: Feline extrahepatic bile duct obstruction help

Ian Hopkins — Thu, 23 Dec 2021 17:01:34 GMT

On Noroclav for 1 wk. Stopped when had negative bile culture.

I could re ultrasound and fna lymph nodes if can reach them- challenging! Thanks

RE: Feline extrahepatic bile duct obstruction help

Kate Richardson — Thu, 23 Dec 2021 16:54:38 GMT

How long was he on Noroclav for? and what dose of pred did he have?

Consider liver biopsies?

Not heard of high doses of destolit, I'm always unsure if it actually does anything tbh! Any biliary surgery can be quite high risk I believe, so I can understand their reluctance, but it may be the best option if there is no underlying liver pathology. Possibly rescan to see if any changes have progressed.

Sorry not much help!