Gall bladder torsion and rupture in a dog

Gallbladder torsion in an 11-month-old Labrador Retriever

An intact male Labrador Retriever was presented with signs of an acute abdomen and generalized weakness. Abdominal ultrasonography revealed a distended, horizontally orientated and caudally displaced gallbladder with a thickened wall. Computed tomography (CT) showed an abrupt tapering of the cystic duct in addition to the displacement of the gallbladder.On laparotomy a complete gallbladder torsion was diagnosed. After cholecystectomy the dog made a full recovery. Gallbladder torsion should be considered as a rare, potential differential diagnosis in dogs with an acute abdomen.

Canine extrahepatic biliary disease: what have we learned?

Extrahepatic biliary disease in dogs is commonly encountered in clinical practice worldwide. Diseases in this segment of the biliary tract are diverse and can manifest with mild clinical signs or can be life-threatening. In the last decade there have been advances in diagnostic tests, imaging modalities and therapeutic interventions as well as the identification of novel prognostic variables that could improve outcomes in dogs with extrahepatic biliary disease. Therefore, the objective of this review was to summarise clinically relevant updates of extrahepatic biliary disease in dogs.

Chronic Cholecystitis of Dogs: Clinicopathologic Features and Relationship with Liver

Simple Summary

This study on the gallbladders and livers of 219 client-owned dogs provides a benchmark for future studies on chronic canine cholecystitis. The statistical evaluation of clinical data; histopathology; histochemistry; and immunohistochemistry in this report provides insight into the etiology of chronic cholecystitis in dogs

Abstract

(1) Background: Chronic cholecystitis of dogs has not been vigorously investigated histopathologically. In addition, the relationship between gallbladder and liver diseases is not known. (2) Methods: We aimed to provide a hallmark for canine chronic cholecystitis using clinical data, histopathology, histochemistry, immunohistochemistry, and statistical analysis. (3) Results: Our investigation of 219 ultrasonographically abnormal surgically resected canine gallbladders revealed 189 cases (86.3%) of mucosal lymphoplasmacytic infiltration (chronic cholecystitis). Sludge, a gravity-dependent or nondependent fine granular hyperechoic material, was more prevalent (105/219, 47.9%) than mucocele (51/219, 23.2%) in this cohort. Mucosal lymphoid follicles were detected in 68/219 cases (31%), suggesting the influence of long-standing antigenic stimulation. Bacteria were histochemically detected in 41/60 (68.3%) of heavily inflamed gallbladders, 18/129 (14%) of lightly inflamed, and 3/18 (16.7%) of uninflamed gallbladders, suggesting a possible relationship between bacteria and chronic cholecystitis. Simultaneous liver biopsies revealed mild or no inflammation, changes consistent with primary portal vein hypoplasia, and mild hepatocellular degeneration. (4) Conclusions: Based on the results of our statistical analysis, we conclude that canine chronic cholecystitis is a long-standing inflammatory process of unknown (but possibly bacterial) etiology and that liver pathology is unlikely the cause of chronic cholecystitis in dogs.

Suspected Gallbladder Torsion in a Juvenile German Shepherd Dog

An 11 mo old intact female German shepherd dog was presented with a 1 day history of vomiting, abdominal pain, and lethargy. A complete gallbladder torsion with secondary bile leakage was diagnosed during exploratory laparotomy. The dog underwent cholecystectomy at the clearly demarcated border of the viable cystic duct and recovered with no complications. Torsion was possible as a result of the complete absence of normal connective tissue attachments to the hepatic fossa, in human medicine called a wandering gallbladder. No other abnormalities were found on complete abdominal exploration. Very few cases describe torsion of the cystic duct as a cause for extrahepatic biliary disease and secondary bile peritonitis in dogs.

Gall bladder rupture associated with cholecystitis in a domestic ferret (Mustela putorius)

A six‐year‐old neutered female albino ferret was presented with an acute episode of lethargy and anorexia. Clinical examination revealed marked cranial abdominal pain. A severe neutrophilic leukocytosis was present. Abdominal ultrasound was consistent with a diffuse peritonitis and severe bile duct inflammation. Cytology of the abdominal effusion revealed bile peritonitis. An exploratory laparotomy was performed and the gall bladder appeared inflamed with multiple perforations. A cholecystectomy was performed. The ferret recovered without complication. Bacteriological culture of the bile and gall bladder yielded a pure growth of Pseudomonas aeruginosa. Histopathological analysis of the gall bladder and liver was consistent with a marked cholecystitis and cholangiohepatitis. On the basis of sensitivity testing, the ferret was treated with marbofloxacin for one month. No complications or reoccurrence were seen up to 1 year after the diagnosis. To the author's knowledge, this is the first report of bile peritonitis secondary to gall bladder rupture in a ferret.

Torsion of quadrate and right middle liver lobes and gallbladder in a German Shepherd dog

BACKGROUND

An 11-year-old female German Shepherd was referred for assessment and management of a suspected liver tumour. Abdominal ultrasonography revealed abundant abdominal effusion and a right liver mass in continuity with a cystic structure. The dog had undergone splenectomy for a low-grade lymphoma 1 year prior.

METHODS

Serum biochemical analysis revealed only a mild increase in alanine aminotransferase. The analysis of the free abdominal fluid showed a modified transudate. Ultrasound confirmed the presence of a hypoechoic lesion involving the right liver lobes, in addition to an over-distended gallbladder. Computed tomography examination demonstrated a massively dilated gallbladder and lower attenuation of the adjacent liver lobes, with no enhancement on quadrate and right middle liver lobes. The fine needle aspirate was compatible with a mixed subacute to chronic inflammation. Based on the investigational findings, an exploratory coeliotomy was performed.

TREATMENT AND OUTCOME

The middle right and quadrate liver lobes and the gallbladder were rotated on their axes. The torsed lobes and the cystic duct were removed using a TA stapler without derotating the organs. Histopathological results were suggestive of infarction secondary to torsion of the lobes and gallbladder. The dog recovered from surgery without complications, and 20 months later was in good overall condition.

CONCLUSION

Liver lobe torsion is an uncommon condition that rarely affects the right lobes. Gallbladder torsion is even more uncommon. To our knowledge, this is the first recorded case of quadrate and right middle liver lobe and gallbladder torsion.

Emesis in dogs: a review

Emesis is a common presenting sign in small animal practice. It requires a rational approach to management that is based upon a sound understanding of pathophysiology combined with logical decision making. This review, which assesses the weight of available evidence, outlines the physiology of the vomiting reflex, causes of emesis, the consequences of emesis and the approach to clinical management of the vomiting dog. The applicability of diagnostic testing modalities and the merit of traditional approaches to management, such as dietary changes, are discussed. The role and usefulness of both traditional and novel anti-emetic drugs is examined, including in specific circumstances such as following cytotoxic drug treatment. The review also examines areas in which common clinical practice is not necessarily supported by objective evidence and, as such, highlights questions worthy of further clinical research.