Canine Biliary Diseaseâ€¨ - Gallbladder mucocoeles, Cholangitis, Extrahepatic bile...
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Canine Biliary DiseaseGallbladder mucocoeles, Cholangitis, Extrahepatic bile duct obstructionDr Dave Collins, BVSc FANZCVSdcollins@sashvets.comBiliary diseaseClinical Signs: abdominal pain, jaundice, vomiting, lethargy, +/- pyrexiaLab: elevated liver enzymes, bilirubin, +ve snap cPL, neutrophiliaDDx: GI, PancreatitisHepatitis/cholangiohepatitis: infectious, drugs, toxic CholangitisPancreatitis cyst, abscess, neoplasiaBiliary disease: cholangitis, cholecystitis, biliary mucocoele, cholelithiasis, neoplasia, EHBDOUltrasound findingswww.sashvets.comBiliary tree
www.sashvets.comGallbladder MucocoelesProgressive accumulation of tenacious mucin-laden bileMay extend into cystic, hepatic & common bile ducts variable EHBDOConsequences: GB ischaemic necrosis, bile peritonitis +/- opportunistic infectionIBD much more prevalent in dogs with GB mucocoeleClinical Signs: vomiting, inappetance, lethargy, PU/PD, diarrhoea; severity of signs relating to degree of EHBDO, rupture or infectionPhysical examination: Abdominal pain, icterus, pyrexiaLaboratory Findings: ALP elevation, hyperbilirubinaemia 60%, mature neutrophilia, monocytosisDiagnosis: ultrasonographic appearance, clinical signs, clin path
www.sashvets.comGallbladder Mucocoeles Risk factorsBreed :Shetland Sheepdog (ABCB4 mutation) , mixed, Bichon, poodles, WHWT, Dachsund, GSD, Cocker Spaniels, Miniature SchnauzersAge: average 11 years, no gender predispositionEndocrinopathies: hyperA, hypoT, diabetes mellitusPancreatitisGallbladder dysmotilityHigh fat dietProtein losing nephropathyGallbladder neoplasiaHyperlipidaemiaGlucocorticoid treatment in predisposed dogs
www.sashvets.comGallbladder rupture Bile peritonitis
www.sashvets.comCanine Bacterial CholangitisCholangitis: inflammation of the intrahepatic bile ducts and ductules restricted to the portal areas Bacterial cholangitis rarely reported in the dog, cholecystitis also uncommonIs canine and feline bile sterile in the absence of biliary tree pathology??Potential bacterial invasion via: ascension from duodenum; haematogenous via hepatic portal venous bloodBiliary defense mechanisms: mechanical (biliary stasis and increased biliary pressure predispose an animal to biliary infection) immunological (enteric bacteria normally gain entry to portal circulation and are extracted by hepatic Kupffer cells)www.sashvets.comCanine Bacterial CholangitisLimited reports in literature, few single case reports, case series of 4 (4/95 cases with chronic hepatopathy Bristol)Inclusion criteria: positive bile culture, concurrent liver histopathology demonstrating periportal neutrophilic infiltrateMay occur much more frequently than reported190 dogs Madison-Wisconsin: 28% biliary cultures, 5% hepatic cultures positivePositive bile cultures may occur in health or may be secondary to other chronic hepatopathyAetiopathogenesis: ascending gut infection or translocation from portal circulationMay be concurrent cholangitis in cases of cholecystitis or biliary mucocoelewww.sashvets.comCanine Bacterial Cholangitis - ClinicalOlder animals (8-10), no sex predilectionVomiting, icterus, inappetance, lethargy, diarrrhoea +/- pyrexiaMarked liver enzyme elevation and hyperbilirubinaemia in mostInflammatory leukogram with mature neutrophilia typicalUltrasonography: thickening, increased echogenicity of gallbladder wall +/- diffuse changes in hepatic parenchyma; (may be concurrent choleliths, mucocoeles; concurrent cholecystitis common)Diagnosis: neutrophilic infiltrate in periportal areas, positive hepatobiliary bacteriological culture (anaerobic & aerobic), bile more sensitive4-6 weeks antimicrobials based on C & S, repeat culture post therapy+/- UDCA, cholecystectomyGood prognosiswww.sashvets.comOther DifferentialsEmphysematous cholecystitis
www.sashvets.com13 FN Chihuahua crossPyrexia 40.4, abdominal painBlirubin 128 umol/L (0-7); ALP 5546 IU/L (1-150) AST 715 IU/L (18-80); ALT 1601 IU/L (16-90) Cholesterol 14.3 mmol/L (3.5-9.0);Neutrophilia 18x10^9/L (3.5-12); Canine Pancreas Specific Lipase 627 ug/L (