A two-year-old female intact Pitbull-type dog was presented to Cornell’s Emergency Service on referral for elevated liver enzymes. A few days prior to presentation, she vomited several times and became lethargic and anorectic. Upon presentation to her primary care veterinarian, she was found to have elevated liver enzymes. She was hospitalized on antibiotics and liver protectants and was referred to Cornell when her liver and cholestatic enzymes continued to worsen despite therapy.

On presentation to the Emergency Service, she was quiet, alert, and responsive with moderate jaundice and normal vital parameters. She was hospitalized overnight on intravenous fluids, antibiotics (ampicillin-sulbactam, enrofloxacin, metronidazole), liver antioxidant (N-acetylcysteine), anti-nausea medication (maropitant), and vitamin K1 before transfer to the Internal Medicine Service.

A chemistry panel predominantly showed an increase in the cholestatic liver enzymes (ALP, GGT, total bilirubin) with evidence of hepatocellular damage (increased ALT). An abdominal ultrasound showed a dilated common bile duct, but no obvious obstruction could be visualized. Because of the progression of disease despite medical management and concern for biliary obstruction, abdominal exploratory surgery was performed. A duodenal foreign body was discovered causing obstruction of the common bile duct at the major duodenal papilla; it was removed via duodenotomy. Liver histopathology revealed cholangiohepatitis with peribiliary fibrosis consistent with extrahepatic bile duct obstruction. The dog recovered uneventfully from surgery and her liver enzymes normalized over the following weeks.