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Chik C, Buote NJ. Feasibility of open cholangioscopy with disposable flexible endoscopes. Vet Surg 2024. [PMID: 38940529 DOI: 10.1111/vsu.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/30/2024] [Accepted: 05/19/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To determine the feasibility of open cholangioscopy using disposable flexible endoscopes in canine cadavers and describe the surgical approach. STUDY DESIGN Ex vivo experimental cadaveric study. SAMPLE POPULATION Eight canine cadavers. METHODS Cadavers ranging from 5.8 to 43.8 kg underwent open transcholecystic cholangioscopy using a disposable flexible endoscope with a 3.8 mm outer diameter and 1.2 mm working channel and the surgical approach was described. The most distal anatomical region of the biliary tree towards the duodenal papilla that was visualized with the endoscope was recorded in each cadaver. A 2.7 mm rigid endoscope and a 1.9 mm flexible endoscope were also trialed and findings recorded. Endoscopic tools were trialed and their usage recorded. RESULTS The disposable flexible endoscope was feasible for visualization of the junction of the common bile duct, cystic duct, and hepatic ducts in all eight dogs. Cholangioscopy using a 2.7 mm rigid endoscope did not provide further distal visualization. The 1.9 mm flexible endoscope was able to traverse down to the level of the major duodenal papilla in a 43.8 kg cadaver. Use of certain endoscopic tools can be considered through the disposable flexible endoscope although fluid instillation was affected. CONCLUSION A 3.8 mm disposable flexible endoscope could be placed through an open transcholecystic approach to provide intraluminal endoscopic evaluation up to the level of the junction of the common bile duct, cystic duct, and hepatic ducts in dogs without cholecystic disease. CLINICAL SIGNIFICANCE Open transcholecystic cholangioscopy with a disposable flexible endoscope could provide a low-cost diagnostic and therapeutic tool in cases of obstructive biliary disease up to the level of the common bile duct.
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Affiliation(s)
- Colin Chik
- Department of Clinical Science, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Nicole J Buote
- Department of Clinical Science, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
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2
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Kim SH, Lee S. Determining the patency of biliary tracts in dogs with gallbladder mucocele using near-infrared cholangiography with indocyanine green. PLoS One 2024; 19:e0300395. [PMID: 38776340 PMCID: PMC11111041 DOI: 10.1371/journal.pone.0300395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 05/24/2024] Open
Abstract
Cholecystectomy is indicated for gallbladder mucoceles (GBM). Evaluating the patency of the biliary duct and precise biliary tree visualization is crucial for reducing the risk of compromised bile flow after surgery. Therefore, intraoperative cholangiography (IOC) is recommended during cholecystectomy to prevent biliary tract injury. Although indocyanine green (ICG) cholangiography has been extensively reported in human medicine, only one study has been conducted in veterinary medicine. Therefore, this study aimed to demonstrate the use of ICG for IOC to identify fluorescent biliary tract images and determine the patency of the common bile duct during cholecystectomy in dogs. This study comprised 27 dogs, consisting of 17 with gallbladder mucoceles (GBM) and 10 controls, specifically including dogs that had undergone elective cholecystectomy for GBM. ICG injection (0.25 mg/kg) was administered intravenously at least 45 minutes before surgery. During the operation, fluorescent images from cholangiography were displayed on the monitor and obtained in black-and-white mode for the comparison of fluorescence intensity (FI). The FI values of the gallbladders (GBs) and common bile duct (CBD) were measured using FI analyzing software (MGViewer V1.1.1, MetapleBio Inc.). The results demonstrated successful CBD patency identification in all cases. Mobile GBM showed partial gallbladder visibility, whereas immobile GBM showed limited visibility. Additionally, insights into the adequate visualization of the remaining extrahepatic biliary tree anatomy were provided, extending beyond the assessment of CBD patency and gallbladder intensity. Our study demonstrates the potential of fluorescent IOC using intravenous injection of ICG for assessing the patency of the cystic duct and common bile duct during cholecystectomy in patients with GBM, eliminating the need for surgical catheterization and flushing of the biliary ducts. Further research is warranted to investigate and validate the broader applicability of ICG cholangiography in veterinary medicine.
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Affiliation(s)
- Su-Hyeon Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
- Department of Veterinary Surgery, Heamaru Referral Hospital, Seongnam, Korea
| | - Sungin Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
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3
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Azuma K, Monnet E. Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study. Vet Surg 2024; 53:695-700. [PMID: 37985468 DOI: 10.1111/vsu.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To compare the effect of three-dimensional (3D) and two-dimensional (2D) laparoscopy on surgical time and intraoperative complications during cholecystectomies in canine cadavers. STUDY DESIGN Experimental prospective study. ANIMALS Twelve canine cadavers. METHODS The laparoscopic cholecystectomies were performed in canine cadavers with four cannulas and with either 2D or 3D cameras by a single surgeon. The following surgical times were recorded: time from insertion of laparoscopic instruments to first endoclip placement, time from first endoclip placement to second endoclip placement, time from second endoclip placement to complete gall bladder dissection, and total surgical time. The cystic duct length distal to the first endoclip, intraoperative complications, and the amount of liver attached to the gall bladder were also recorded. RESULTS Time from the insertion of the instruments to the application of the first endoclip was shorter for the 3D group than for the 2D group (p = .016). Other surgical times were not different between groups. There was no difference in the cystic duct length distal to the first endoclip, intraoperative complications, or the amount of liver attachment. CONCLUSION Three-dimensional laparoscopy shortened the time from insertion of the laparoscopic instruments to placement of the first endoclip. However, total surgical time was not affected by the type of camera in laparoscopic cholecystectomy. CLINICAL SIGNIFICANCE Three-dimensional laparoscopy may be beneficial when performing procedures requiring enhanced spatial orientation. However, this technique did not shorten the total surgical time in this cadaveric study. Further studies in a clinical setting are necessary for the optimization of the future use of 3D laparoscopy.
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Affiliation(s)
- Kazushi Azuma
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, Colorado, USA
| | - Eric Monnet
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, Colorado, USA
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4
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Bergen JL, Travis BM, Pike FS. Clinical use of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary tract obstructions in cats and dogs: 11 cases (2012-2022). Vet Surg 2024; 53:320-329. [PMID: 37792320 DOI: 10.1111/vsu.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To describe the application of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary obstructions (EHBOs) and the outcomes for dogs and cats treated for EHBO with this technique. STUDY DESIGN Retrospective single institutional study. ANIMALS Eight dogs and three cats treated at the Veterinary Specialty Hospital of San Diego for EHBO between January 2012 and February 2022. METHODS Data collected from the medical records included signalment, presenting complaint, laboratory and imaging findings, surgical findings, hospitalization time, complications, and follow-up information. RESULTS Median duration of short-term follow up was 16 days (6-45 days). Improved biochemical abnormalities and resolution of clinical signs were recorded in 10/11 cases. Two dogs died within 2 weeks of surgery. One dog developed systemic inflammatory response syndrome 5 days postoperatively and was euthanized; the cause of death in the second case was unknown. Long-term follow up was available in seven cases, with a median duration of 307.5 days (62-2268 days). Bile-duct patency was maintained for at least 356-622 days (median: 446 days) in three cats and 62-2268 days (median: 650.5 days) in four dogs with long-term follow up available. One cat had recurrent obstruction with choledocholiths 446 days postoperatively. One stent was removed 614 days postoperatively due to recurrent cholangiohepatitis. CONCLUSION Uncovered balloon-expandable metallic biliary stents were placed successfully and relieved EHBO in all cases that survived to discharge. CLINICAL SIGNIFICANCE Use of uncovered balloon-expandable metallic biliary stents should be considered as an alternative to temporary choledochal luminal stenting or cholecystoenterostomy to manage EHBO.
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Affiliation(s)
- Julia L Bergen
- Department of Small Animal Surgery, VCA West Los Angeles Animal Hospital, Los Angeles, California, USA
| | - Blake M Travis
- Department of Small Animal Surgery, Bluff City Veterinary Specialists, Memphis, Tennessee, USA
| | - Fred S Pike
- Department of Small Animal Surgery, Veterinary Specialty Hospital of San Diego, San Diego, California, USA
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5
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Brunori L, Dolan C, Elias Santo‐Domingo N. Occurrence and clinical relevance of postoperative hypernatremia in dogs undergoing cholecystectomy. J Vet Intern Med 2023; 37:2171-2177. [PMID: 37682033 PMCID: PMC10658579 DOI: 10.1111/jvim.16847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients undergoing cholecystectomy have not been reported previously to develop clinically relevant postoperative hypernatremia. OBJECTIVES Describe the frequency of postoperative hypernatremia in dogs undergoing cholecystectomy and its clinical relevance (duration of hospitalization and survival). ANIMALS Thirty-seven dogs undergoing cholecystectomy at 2 private referral hospitals. METHODS Retrospective study of dogs undergoing cholecystectomy with available preoperative and postoperative serum sodium concentrations. RESULTS Postoperative hypernatremia (>150 mEq/L) was common (56%; 95% confidence interval [CI], 40%-70%) and was associated with significantly higher mortality compared to nonhypernatremic patients (52%; 95% CI, 30%-70% vs 12.5%; 95% CI, 2%-40%; P = .02). Nonsurvivors had higher mean postoperative peak serum sodium concentrations (155 mEq/L; range, 146-172) than survivors (150 mEq/L; range, 142-156; P = .01). Dogs developing hypernatremia within 6 hours after surgery had 7.7 higher odds of nonsurvival (odds ratio [OR], 7.7; 95% CI, 5.9-9.4). A delta value (serum sodium concentration on admission [T0] - serum sodium concentration 6 hours postoperatively [T2]) of ≥10 mEq/L carried 3.3 higher odds of mortality (OR, 3.3; 95% CI, 1.6-5.1). All dogs with a postoperative peak sodium concentration >160 mEq/L did not survive. Admission acute patient physiologic laboratory evaluation fast (APPLEfast ) scores were not different between survivors and nonsurvivors or between postoperative hypernatremic and normonatremic patients. Hospitalization time was no different between hypernatremic and normonatremic patients (6 days vs 4.5 days; P = .15). Dogs with gallbladder mucocele were more likely to develop postoperative hypernatremia and have poorer outcomes. CONCLUSIONS Hypernatremia was a common and clinically relevant postoperative complication in dogs after cholecystectomy. Detection of hypernatremia within 6 hours after surgery may be associated with poorer outcomes.
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Affiliation(s)
- Lara Brunori
- Emergency & Critical Care Specialist ServiceVetsNow 24/7 Pet Emergency & Specialty HospitalGlasgowUnited Kingdom
| | - Cormac Dolan
- Emergency & Critical Care Specialist ServiceVetsNow 24/7 Pet Emergency & Specialty HospitalGlasgowUnited Kingdom
| | - Neus Elias Santo‐Domingo
- Emergency & Critical Care Specialist ServiceVetsNow 24/7 Pet Emergency & Specialty HospitalGlasgowUnited Kingdom
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6
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Assawarachan SN, Ongvisespaibool T, Hakhen B, Chuchalermporn P, Maneesaay P, Thengchaisri N. Predictive Factors for Two-Year Survival in Dogs with Hepatobiliary Diseases: Importance of Clinical and Laboratory Monitoring. Animals (Basel) 2023; 13:2677. [PMID: 37627468 PMCID: PMC10451749 DOI: 10.3390/ani13162677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Long-term outcomes and survival predictors for different clinicopathologies (idiopathic chronic hepatitis, liver fibrosis, vacuolar hepatopathy) in dogs with hepatobiliary diseases are poorly described. In this study, ninety dogs were followed up for up to five years to investigate clinical factors that predict two-year survival in canine patients after liver biopsy. Univariate and multivariate analyses were performed based on clinical and laboratory data to determine the association between clinical and laboratory data and mortality rates. Overall, the one-, two-, and five-year mortality rates were 28.9%, 45.6%, and 78.9%, respectively. Univariate analysis indicated that male gender, ascites, elevated serum gamma-glutamyl transpeptidase (GGT), hypercholesterolemia, hypoalbuminemia, prolonged activated partial thromboplastin clotting time (aPTT), and prolonged thrombin clotting time (TT) were associated with an increased two-year mortality rate. Results from multivariate analysis demonstrated a significant association between male gender (p = 0.022), elevated serum GGT (p < 0.001), hypoalbuminemia (p < 0.001), and prolonged aPTT (p < 0.001) and an increased two-year mortality rate, regardless of the specific type of liver pathology. Elevated GGT was associated with the highest risk for increased two-year mortality (95% CI: hazard ratio 6.02-41.21). In conclusion, various clinical factors in dogs with liver diseases are useful for prognosis prediction.
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Affiliation(s)
- Sathidpak Nantasanti Assawarachan
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand;
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand;
| | - Thodsapol Ongvisespaibool
- Endocrinology and Gastroenterology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand;
| | - Benjang Hakhen
- Surgical Unit, Kasetsart Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand;
| | - Piyathip Chuchalermporn
- Radiology Unit, Kasetsart University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand;
| | - Phudit Maneesaay
- Department of Pathology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand;
| | - Naris Thengchaisri
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand;
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Pavone G, Castellucci B, Pavone S, Stefanetti V, Vitolo C, Mangiaterra S. Unusual Case of Biliary Peritonitis in a Dog Secondary to a Gastric Perforation. Vet Sci 2023; 10:384. [PMID: 37368770 DOI: 10.3390/vetsci10060384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Biliary peritonitis is a pathological condition representing a medical emergency with a high risk of mortality. This condition is reported in both human and veterinary medicine following biliary tract rupture, extrahepatic biliary obstructions, gallbladder rupture, trauma, or duodenal perforation. In this report, the first-ever case of biliary peritonitis due to gastric perforation in a Bobtail purebred dog is described, which was probably induced by the administration of nonsteroidal anti-inflammatory drugs (NSAIDs). After an elective splenectomy and castration, the dog was referred to our hospital for medical management for inappetence, mental depression, and multiple episodes of gastric vomits with traces of blood. Clinical diagnostic tests showed the presence of biliary peritonitis. Due to worsening clinical conditions, the patient was subjected to euthanasia. Macroscopic examination showed a free brownish abdominal effusion and the presence of perforating ulcer of the stomach pylorus region.
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Affiliation(s)
- Giovanni Pavone
- Futuravet Veterinary Referral Center, 62029 Tolentino, Italy
| | | | - Silvia Pavone
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche 'Togo Rosati', Via G. Salvemini, 1, 06126 Perugia, Italy
| | | | - Chiara Vitolo
- Futuravet Veterinary Referral Center, 62029 Tolentino, Italy
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8
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Brough A, Caraguel C, Ciaravolo S, Stickney A. Clinical findings and assessment of factors associated with survival in dogs presenting with hyperbilirubinaemia: 115 cases in Victoria, Australia (2015–2020). Vet Rec Open 2022; 9:e42. [PMID: 35990552 PMCID: PMC9380407 DOI: 10.1002/vro2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/26/2022] [Accepted: 07/07/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Hyperbilirubinaemia is an important clinicopathological finding in canine medicine. The objectives of this study were to describe the clinical presentation and outcome of dogs with hyperbilirubinaemia; also to identify factors associated with survival. Materials and methods Retrospective study of dogs with hyperbilirubinaemia from two referral centres in South Australia (2015–2020). Signalment, clinical signs, clinicopathological data, diagnosis and outcome were obtained from searching clinical records. Univariable analysis and logistic regression modelling were used to compare outcomes and overall survival. Results A total of 115 cases were included. The most common clinical signs were vomiting (63.5%), anorexia (62.6%), lethargy (55.7%) and pyrexia (18.3%). Pre‐hepatic icterus was diagnosed in 18 cases (15.7%), hepatic icterus in 51 cases (44.3%) and post‐hepatic icterus in 42 cases (36.5%). The median survival time across all cases was 40 days (95% confidence interval [CI]: 9–126 days). There was an increased risk of death in dogs with serum bilirubin greater than 60 μmol/L at diagnosis (odds ratio [OR] = 3.55; 95% CI: 1.53–8.22; p‐value = 0.003) and in dogs with pre‐hepatic icterus compared to hepatic (OR = 4.35; 95% CI: 1.18–16.0; p‐value = 0.027) and post‐hepatic icterus (OR = 6.52; 95% CI: 1.67–25.5; p‐value = 0.007). Conclusions Pre‐hepatic icterus was associated with a significantly higher risk of death than hepatic and post‐hepatic icterus. Serum bilirubin >60 μmol/L at diagnosis was associated with a significantly shorter median survival time. This cut‐off may be useful in discussions with owners regarding pursuing further diagnostic investigation and treatment. Further prospective studies are needed to prove the validity of this cut‐off.
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Affiliation(s)
- Abigail Brough
- Peninsula Vet Emergency and Referral Hospital Mornington Victoria Australia
| | | | - Susan Ciaravolo
- Peninsula Vet Emergency and Referral Hospital Mornington Victoria Australia
| | - Alison Stickney
- Peninsula Vet Emergency and Referral Hospital Mornington Victoria Australia
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9
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Long-Term Outcome after Cholecystectomy without Common Bile Duct Catheterization and Flushing in Dogs. Animals (Basel) 2022; 12:ani12162112. [PMID: 36009701 PMCID: PMC9405371 DOI: 10.3390/ani12162112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to report outcomes of dogs undergoing cholecystectomy for gall bladder mucocele (GBM) without flushing and catheterization of the common bile duct (CBD). This is a retrospective multicentric study from three veterinary referral hospitals and included 82 dogs diagnosed with GBM. Medical records were reviewed for clinical and histopathological findings. Long-term outcome was assessed with an owner questionnaire. The common bile duct was considered normal (<4 mm), mildly dilated (5−6 mm) and moderately dilated (>7 mm) in 88%, 10% and 2.4% of dogs, respectively. Surgery was uncomplicated in 83% of dogs. Intraoperative complications were recorded in 21% of dogs, with hypotension being the most common, whereas postoperative complications were documented in 20% of dogs, with vomiting/regurgitation being the most common. Ninety-six percent of dogs that underwent cholecystectomy in this study survived to discharge. Follow-up ranged from 142 to 3930 days (median: 549 days). Eighty-five percent of dogs were alive at the time of follow-up. Dogs undergoing cholecystectomy for GBM without catheterization and flushing of the CBD have a favourable prognosis for recovery and quality of life.
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10
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Work M, Allerton F, Griffin S, Kent A. Percutaneous-endoscopic rendezvous cholangiography with biliary stent placement in a dog with extra-hepatic biliary duct obstruction. J Small Anim Pract 2021; 63:416-420. [PMID: 34658028 DOI: 10.1111/jsap.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
A middle-aged male springer spaniel was presented for investigation of acute vomiting, lethargy and icterus. Marked distension of the gall bladder and common bile duct was evident at ultrasound due to obstruction by mineralised intraluminal material. After 48 hours of hospitalisation with intravenous fluid therapy, analgesia and antimicrobial therapy, intervention was deemed necessary to relieve the obstruction. A percutaneous-endoscopic rendezvous approach was used to achieve placement of a pigtail stent into the distal common bile duct, successfully relieving the obstruction. Serial biochemistry measurements postprocedure confirmed marked improvements in serum bilirubin. The patient remains clinically well 24 months postprocedure, and all hepatic enzyme activities have normalised. Based on the literature search performed, this is the first successful application of this technique in the management of canine extrahepatic biliary duct obstruction.
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Affiliation(s)
- M Work
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - S Griffin
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - A Kent
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
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11
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Pavlick M, DeLaforcade A, Penninck DG, Webster CRL. Evaluation of coagulation parameters in dogs with gallbladder mucoceles. J Vet Intern Med 2021; 35:1763-1772. [PMID: 34196054 PMCID: PMC8295708 DOI: 10.1111/jvim.16203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/05/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gallbladder mucocele (GBM) is a common biliary disorder in dogs. Limited information is available on the coagulation status of dogs with GBM. HYPOTHESIS/OBJECTIVES To determine patterns of coagulation alterations in dogs with GBM and correlate them with clinicopathologic abnormalities and ultrasonographic findings of disease severity. ANIMALS Twenty-three dogs with GBM identified on ultrasound examination were prospectively enrolled. METHODS At the time of GBM identification, blood and urine were collected for CBC, serum biochemical panel, urinalysis, prothrombin time, activated partial thromboplastin time (aPTT), factor VIII, protein C (PC), von Willebrand's factor (vWF), antithrombin activity, fibrinogen, D-dimers, and thromboelastrography (TEG). Gallbladder mucoceles were classified into ultrasound types 1 to 5. Medical records were reviewed for clinical presentation, underlying conditions and to determine if systemic inflammatory response syndrome (SIRS) was present. RESULTS Based on TEG parameters, maximal amplitude, and G, 19/23 (83%) of dogs with GBM had evaluations consistent with hypercoagulability. On plasma-based coagulation testing, dogs with GBM had increased total PC activity (20/23, 87%), fibrinogen (9/23, 39%), platelet count (9/23, 39%), and D-dimers (6/15, 40%) as well as prolongations in aPTT (9/22, 41%) and low vWF activity (5/21, 24%). No correlation was found between TEG G value and any coagulation or clinical pathology variables, ultrasound stage of GBM or disease severity as assessed by the presence of SIRS. CONCLUSIONS AND CLINICAL IMPORTANCE Dogs with ultrasonographically identified GBM have changes in whole blood kaolin-activated TEG supporting a hypercoagulable state although traditional plasma-based coagulation testing suggests that a complex state of hemostasis exists.
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Affiliation(s)
- Michelle Pavlick
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Armelle DeLaforcade
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Dominique G Penninck
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Cynthia R L Webster
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
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12
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Putterman AB, Selmic LE, Kindra C, Duffy DJ, Risselada M, Phillips H. Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele. Vet Surg 2021; 50:784-793. [PMID: 33797102 DOI: 10.1111/vsu.13632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/17/2021] [Accepted: 03/22/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the influence of normograde (NG) versus retrograde (RG) catheterization of the cystic duct and common bile duct (CBD) in dogs with gallbladder mucoceles (GBM) treated with open cholecystectomy. STUDY DESIGN Retrospective study. ANIMALS Dogs (n = 117) with GBM. METHODS Medical records were reviewed for signalment, history, clinical laboratory and diagnostic imaging findings, details of surgery including catheterization method, complications, and outcome. Long-term follow-up data were obtained by telephone or electronic communication. Relationships between catheterization method and clinical variables and outcome were evaluated. RESULTS Dogs catheterized RG were more likely to experience any postoperative complication (p = .0004) including persistence of gastrointestinal signs (p = .0003). Survival to discharge and long-term survival did not differ by group (p = .23 and p = .49). Total bilirubin (TB) decreased by 70.3% after NG catheterization compared to 39.1% after RG catheterization (p = .03) and increased in 14.9% dogs catheterized NG and 38.0% dogs catheterized RG (p = .004). The presence of a diplomate surgeon at surgery resulted in decreased incidences of any perioperative or postoperative complication (p = .003 and p = .05). CONCLUSION Retrograde catheterization was associated with more postoperative concerns than NG catheterization, but similar survival times. Surgery should be performed by diplomates experienced in biliary surgery to minimize complications. CLINICAL SIGNIFICANCE Although both NG and RG techniques to catheterize the cystic duct and CBD are options for treatment of GBM with low mortality, results of this study provide some evidence to recommend NG over RG catheterization.
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Affiliation(s)
- Allison B Putterman
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cameron Kindra
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
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13
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Thompson BJ, Sherman RA. Comprehensive Review of Biliary Peritonitis. Top Companion Anim Med 2021; 44:100532. [PMID: 33781985 DOI: 10.1016/j.tcam.2021.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Biliary peritonitis is a growing concern in the canine patient and a thorough understanding of the disease will lead to better treatment outcomes. This article reviews the human and veterinary literature pertaining to biliary peritonitis including both scientific reviews and original publications. Compared to human medicine, biliary peritonitis can be difficult to diagnose preoperatively. Multiple risk factors exist increasing the likelihood of development of biliary peritonitis. Treatment recommendations center on stabilization, surgical cholecystectomy, and postoperative supportive care. Clinically, further studies on treatment and prevention in veterinary medicine are warranted.
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Chmelovski RA, Granick JL, Ober CP, Young SJ, Thomson CB. Percutaneous transhepatic cholecystostomy drainage in a dog with extrahepatic biliary obstruction secondary to pancreatitis. J Am Vet Med Assoc 2021; 257:531-536. [PMID: 32808897 DOI: 10.2460/javma.257.5.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 8-year-old 36.3-kg (79.9-lb) spayed female Rottweiler was evaluated because of anorexia and vomiting. CLINICAL FINDINGS Extrahepatic biliary obstruction (EHBO) secondary to pancreatitis was suspected on the basis of results from serum biochemical analyses, CT, and cytologic examination. TREATMENT AND OUTCOME Only marginal improvement was observed after 24 hours of traditional medical management; therefore, novel continual biliary drainage was achieved with ultrasonographically and fluoroscopically guided placement of a percutaneous transhepatic cholecystostomy drainage (PCD) catheter. Within 24 hours after PCD catheter placement, the dog was eating regularly, had increased intestinal peristaltic sounds on abdominal auscultation, no longer required nasogastric tube feeding, and had decreased serum total bilirubin concentration (7.7 mg/dL, compared with 23.1 mg/dL preoperatively). Bile recycling was performed by administering the drained bile back to the patient through a nasogastric tube. The PCD remained in place for 5 weeks and was successfully removed after follow-up cholangiography confirmed bile duct patency. CLINICAL RELEVANCE Transhepatic PCD catheter placement provided fast resolution of EHBO secondary to pancreatitis in the dog of the present report. We believe that this minimally invasive, interventional procedure has the potential to decrease morbidity and death in select patients, compared with traditional surgical options, and that additional research is warranted regarding clinical use, safety, and long-term results of this procedure in veterinary patients, particularly those that have transient causes of EHBO, are too unstable to undergo more invasive biliary diversion techniques, or have biliary diseases that could benefit from palliation alone.
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Viljoen AD, Tamborini A, Watson PJ, Bexfield NH. Clinical characteristics and histology of cholecystectomised dogs with nongravity-dependent biliary sludge: 16 cases (2014-2019). J Small Anim Pract 2021; 62:478-488. [PMID: 33629392 DOI: 10.1111/jsap.13302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To report the available histology, biochemistry and clinical progression of dogs without classic overt biliary tract signs that underwent cholecystectomy for nongravity-dependent biliary sludge. MATERIALS AND METHODS Case series of client-owned dogs for which a cholecystectomy was performed for nongravity-dependent biliary sludge. In six dogs, for which nongravity-dependent biliary sludge filled less than half of gall bladder volume, gall bladder ejection fractions were measured. Available histology, biochemistry, presenting clinical signs and post-surgical clinical progression were reported. RESULTS Sixteen dogs were included in this retrospective case series. No dogs met the histological criteria for gall bladder mucocoeles or had histological evidence of primary hepatitis or cholangitis. Biochemistry was normal for 11 dogs. Hypercholesterolaemia was not noted in any dog. Twelve dogs had cholecystitis (11 lymphoplasmacytic, one neutrophilic) and nine dogs had biliary mucosal hyperplasia. Thirteen dogs had enteritis (12 lymphoplasmacytic, one eosinophilic) and nine dogs had reactive hepatitis (eight lymphoplasmacytic, one neutrophilic). All six dogs with nongravity-dependent biliary sludge that filled less than half of gall bladder volume had sub-optimal gall bladder function. Presenting clinical signs, including diurnal inappetence in the morning and exercise intolerance, resolved in 86% (12/14) of dogs after cholecystectomy and clinical improvement was noted in 81% (13/16) of dogs overall. CLINICAL SIGNIFICANCE Duodenal inflammation could potentially impact gall bladder dysmotility in dogs with nongravity-dependent biliary sludge. Furthermore, diurnal inappetence in the morning and exercise intolerance could indicate symptomatic gall bladder disease in dogs with NDBS and can potentially precede more obvious systemic clinical signs associated with gall bladder mucocoeles.
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Affiliation(s)
- A D Viljoen
- Vets4Pets Torquay, Bridge Retail Park, Hele Road, Torquay, TQ2 7AP, UK
| | - A Tamborini
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0U, UK
| | - P J Watson
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - N H Bexfield
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
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Moyer J, Lopez DJ, Balkman CE, Sumner JP. Factors associated with survival in dogs with a histopathological diagnosis of hepatocellular carcinoma: 94 cases (2007-2018). Open Vet J 2021; 11:144-153. [PMID: 33898296 PMCID: PMC8057222 DOI: 10.4314/ovj.v11i1.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer in dogs. Despite this, relatively few reports of this disease exist pertaining to prognostic factors and outcome. Aim: To evaluate factors associated with survival in dogs with all subtypes of HCC diagnosed on histopathology. Methods: A retrospective single institutional study was carried out on 94 client-owned dogs with a histopathologic diagnosis of HCC between 2007 and 2018 obtained by biopsy (21/94) or attempted definitive resection (73/94). Signalment, preoperative features, surgical findings, and postoperative outcomes were recorded. Associations between survival to discharge data were collected and univariable logistical regression was carried out. Kaplan–Meier survival analysis was carried out to identify negative risk factors for long-term prognosis. Results: The median survival time (MST) for all patients was 707 days (95% CI = 551–842). MST was not significantly different (p > 0.05) between patients who had suspected versus incidentally diagnosed HCC (695 vs. 775 days), between complete versus incomplete surgical margins (668 vs. 834 days), or between patients with massive subtype versus nodular/diffuse subtype (707 vs. 747 days). Logistical regression identified an association with the excision of the right medial lobe and risk of perioperative death (OR = 9.2, CI 1.5–55.9, p = 0.016). An American Society of Anesthesiologists score ≥4, disease present within the quadrate lobe, and elevated blood urea nitrogen, potassium or gamma-glutamyltransferase were identified as negative prognosticators during multivariable Cox regression. Preoperative imaging (ultrasound or CT) agreed with the surgical location in 91% of the cases. Preoperative cytology was consistent with a diagnosis of HCC in 15/32 (46.9%) cases. Conclusion: Type of diagnosis (incidental vs presumed), completeness of excision, and subtype were not associated with MST in this study. Preoperative identification of tumors within the central division may be related to a less favorable outcome. Results of preoperative cytology were not highly sensitive for identifying a malignancy.
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Affiliation(s)
- James Moyer
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14850, USA
| | - Daniel J Lopez
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14850, USA
| | - Cheryl E Balkman
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14850, USA
| | - Julia P Sumner
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14850, USA
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Friesen SL, Upchurch DA, Hollenbeck DL, Roush JK. Clinical findings for dogs undergoing elective and nonelective cholecystectomies for gall bladder mucoceles. J Small Anim Pract 2021; 62:547-553. [PMID: 33587301 DOI: 10.1111/jsap.13312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to describe elective and nonelective post-cholecystectomy complications and mortality rates in dogs with a gall bladder mucocele. The secondary purpose was to report complications and mortality rates for different methods of common bile duct catheterisation. MATERIALS AND METHODS A multi-institutional retrospective case series was performed to identify dogs with a gall bladder mucocele between 2004 and 2018 that underwent a cholecystectomy. Dogs were classified into nonelective or elective based on the presence or absence, respectively, of gall bladder rupture, biliary duct distension, clinical signs or hyperbilirubinemia. Each cholecystectomy was classified into three groups: duodenotomy and retrograde catheterisation, normograde catheterisation or no catheterisation. Complications were divided into four grades based on increasing severity and mortality rates were assessed for each. RESULTS The mortality rate was 2 (6%) out of 31 for dogs undergoing an elective cholecystectomy and 21 (23%) out of 90 for dogs undergoing a nonelective cholecystectomy. The complication rate was 52% for the elective cholecystectomy and 50% for nonelective cholecystectomy. The majority of the complications in the elective category were grade 1 (mild). Post-operative hyperthermia developed in 35% of dogs that had a duodenotomy and retrograde common bile duct catheterisation, in 4% of dogs with a normograde common bile duct catheterisation and in 7% of dogs that did not have the common bile duct catheterised. CLINICAL SIGNIFICANCE Elective cholecystectomy in dogs with a gall bladder mucocele in this study carried a low mortality rate and a relatively high frequency of minor complications.
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Affiliation(s)
- S L Friesen
- Department of Clinical Science, Kansas State University, Manhattan, Kansas, 66506, USA
| | - D A Upchurch
- Department of Clinical Science, Kansas State University, Manhattan, Kansas, 66506, USA
| | - D L Hollenbeck
- Department of Clinical Science, Texas A&M University, College Station, Texas, 77843, USA
| | - J K Roush
- Department of Clinical Science, Kansas State University, Manhattan, Kansas, 66506, USA
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Piegols HJ, Hayes GM, Lin S, Singh A, Langlois DK, Duffy DJ. Association between biliary tree manipulation and outcome in dogs undergoing cholecystectomy for gallbladder mucocele: A multi-institutional retrospective study. Vet Surg 2020; 50:767-774. [PMID: 33226153 DOI: 10.1111/vsu.13542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 10/25/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether catheterization of the common bile duct (CBD) is associated with outcome in dogs undergoing cholecystectomy for gallbladder mucocele and to determine whether this association is modified by the catheterization method. STUDY DESIGN Multi-institutional retrospective cohort study. ANIMALS Dogs (n = 252) that underwent cholecystectomy for gallbladder mucocele. METHODS Dogs were identified via electronic medical record review at four veterinary teaching hospitals. Baseline dog characteristics, surgical findings, and methods including normograde vs retrograde CBD catheterization, intraoperative outcomes, and postoperative outcomes and complications were recorded. Variables were compared between dogs with and without catheterization. RESULTS Catheterized dogs had higher American Society of Anesthesiologists scores (P = .04), higher total bilirubin (P = .01), and were more likely to have dilated CBD at the time of surgery (P < .01). Incidence of major and minor intraoperative complications was similar between the two groups. Surgical time was longer for the catheterized group (P = .01). The overall incidence of postoperative complications was similar between the groups; however, postoperative pancreatitis was associated with performing CBD catheterization (P = .01). This association was retained as an independent association in a multivariable model that addressed baseline group differences (P = .04). Likelihood of developing postoperative pancreatitis was not different between normograde and retrograde catheterization (P = .57). CONCLUSION Catheterization of the CBD was associated with development of postoperative pancreatitis. This was not influenced by the method of catheterization. CLINICAL SIGNIFICANCE The requirement for catheterization of the CBD during open cholecystectomy in dogs should be carefully considered, particularly in dogs without evidence of biliary obstruction because the procedure may induce postoperative pancreatitis.
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Affiliation(s)
- Hunter J Piegols
- Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Galina M Hayes
- Cornell University Hospital for Animals, Ithaca, New York
| | - Samantha Lin
- North Carolina State University Veterinary Hospital, Raleigh, North Carolina
| | - Ameet Singh
- Ontario Veterinary College Health Sciences Centre, Guelph, Ontario, Canada
| | - Daniel K Langlois
- Michigan State University Veterinary Medical Center, East Lansing, Michigan
| | - Daniel J Duffy
- North Carolina State University Veterinary Hospital, Raleigh, North Carolina
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Palermo SM, Brown DC, Mehler SJ, Rondeau MP. Clinical and Prognostic Findings in Dogs with Suspected Extrahepatic Biliary Obstruction and Pancreatitis. J Am Anim Hosp Assoc 2020. [DOI: 10.5326/jaaha-ms-6985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Pancreatitis in dogs may lead to extrahepatic bile duct obstruction as a result of local inflammation. Medical records of 45 client-owned dogs with clinical suspicion of extrahepatic bile duct obstruction secondary to pancreatitis were reviewed to determine clinical findings, outcome, and factors associated with survival. Survival times were determined using the Kaplan-Meier product limit method. Cox multivariable survival methods were employed to determine factors associated with survival time following diagnosis. The median survival time was 241 days (95% confidence interval [CI] 25–631), with 34 of 45 dogs (76%) surviving to discharge. Dogs 9 yr of age or older with azotemia at presentation had a 9.9 greater hazard for death (95% CI 2.5–38.1; P = .001) compared with dogs younger than 9 yr old without azotemia at presentation. Dogs without subjective ultrasonographic gallbladder distension had a 4.4 greater hazard for death (95% CI 1.3–15.4; P = .018) compared with dogs with subjective gallbladder distension. Dogs with a body temperature ≥102.5°F at admission had a 3.1 greater hazard for death (95% CI 1.3–7.7; P = .013) than dogs with a body temperature <102.5°F at admission. This information may help clinicians discuss prognosis with owners of affected dogs.
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Affiliation(s)
- Shannon Marie Palermo
- From Veterinary Specialists and Emergency Services, Rochester, New York (S.M.P.); Martingale Consulting, Media, Pennsylvania (D.C.B.); Hope Veterinary Specialists, Malvern, Pennsylvania (S.J.M.); and Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (M.P.R.)
| | - Dorothy C. Brown
- From Veterinary Specialists and Emergency Services, Rochester, New York (S.M.P.); Martingale Consulting, Media, Pennsylvania (D.C.B.); Hope Veterinary Specialists, Malvern, Pennsylvania (S.J.M.); and Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (M.P.R.)
| | - Stephen J. Mehler
- From Veterinary Specialists and Emergency Services, Rochester, New York (S.M.P.); Martingale Consulting, Media, Pennsylvania (D.C.B.); Hope Veterinary Specialists, Malvern, Pennsylvania (S.J.M.); and Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (M.P.R.)
| | - Mark P. Rondeau
- From Veterinary Specialists and Emergency Services, Rochester, New York (S.M.P.); Martingale Consulting, Media, Pennsylvania (D.C.B.); Hope Veterinary Specialists, Malvern, Pennsylvania (S.J.M.); and Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (M.P.R.)
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Parkanzky M, Grimes J, Schmiedt C, Secrest S, Bugbee A. Long-term survival of dogs treated for gallbladder mucocele by cholecystectomy, medical management, or both. J Vet Intern Med 2019; 33:2057-2066. [PMID: 31490022 PMCID: PMC6766501 DOI: 10.1111/jvim.15611] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Gallbladder mucoceles (GBM) typically are treated by cholecystectomy. Medical management rarely has been reported and medical and surgical management have not been compared. HYPOTHESIS/OBJECTIVES To compare survival of dogs treated for GBM by medical management or cholecystectomy or both. ANIMALS Eighty-nine client-owned dogs diagnosed with GBM that received cholecystectomy or medical treatment or both from 2011 to 2017. METHODS Potential cases were identified by searching the medical records database. Data collected included signalment, clinicopathologic results, treatments, and ultrasonographic images and reports. Dogs were grouped according to the treatment received (medical management, surgical treatment, or both) that was chosen at the discretion of the attending veterinarian. Survival analysis was performed and prognostic variables identified and compared between treatment groups. RESULTS Of dogs surviving at least 14 days after diagnosis, median survival times were 1802 (95% confidence interval [CI], 855-not reached) days, 1340 (95% CI, 444-1340) days, and 203 (95% CI, 18-525) days, for the surgical, medical, and medical then surgical treatment groups, respectively, and differed significantly (P < .0001). Gallbladder mucocele type (P = .05), serum alkaline phosphatase activity (P = .0001), and serum creatinine (P = .002) and phosphorus (P = .04) concentrations were associated with decreased survival across groups. Suspicion of biliary rupture on abdominal ultrasound (AUS) examination was correlated with increased survival in the surgical group (P = .02). CONCLUSIONS AND CLINICAL IMPORTANCE Cholecystectomy for the treatment of GBM results in the best long-term survival in dogs surviving the immediate postoperative period (14 days) compared to medical management. Although medical management is associated with shorter survival compared to surgical treatment, it is a reasonable alternative when surgery cannot be pursued.
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Affiliation(s)
- Max Parkanzky
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia
| | - Janet Grimes
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia
| | - Chad Schmiedt
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia
| | - Scott Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, Georgia
| | - Andrew Bugbee
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia
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Martiny P, Hayes G. Placement of a temporary cholecystostomy tube to relieve pancreatic EHBDO in a dog. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Pia Martiny
- Emergency and Critical CareCornell UniversityIthacaNew YorkUSA
| | - Galina Hayes
- Small Animal Surgery SectionCornell UniversityIthacaNew YorkUSA
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Choledochotomy for Obstructive Choledocholithiasis in Two Dogs. Case Rep Vet Med 2019; 2019:4748194. [PMID: 31428511 PMCID: PMC6681613 DOI: 10.1155/2019/4748194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022] Open
Abstract
Two geriatric (> 9 years old) dogs presented for vomiting, lethargy, and anorexia. Obstructive choledocholithiasis was diagnosed based on analysis of a serum biochemical analysis and abdominal radiographs and ultrasonography. In both dogs, choledocholiths were removed from the common bile duct via a choledochotomy without a cholecystectomy, and survival without recurrence occurred in both dogs for more than 1 year.
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Simon A, Monnet E. Laparoscopic Cholecystectomy with Single Port Access System in 15 Dogs. Vet Surg 2019; 49 Suppl 1:O156-O162. [PMID: 31389068 DOI: 10.1111/vsu.13289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the outcome of laparoscopic cholecystectomy performed with a single port access system (SPAS) in dogs. STUDY DESIGN Retrospective study. ANIMALS Fifteen client-owned dogs with nonobstructive gallbladder disease. METHODS Medical records were reviewed for signalment, clinical signs, diagnostic imaging, surgical findings, and outcome until suture removal. RESULTS The SPAS was placed 1 cm caudal to the umbilicus. The procedure was completed with the SPAS alone in two cases. An additional cannula was added in 12 cases. In the last 10 cases, the additional cannula was placed at the beginning of the procedure. Dissection began at the cystic duct in 11 dogs (73%). In three cases (20%), the SPAS procedure was converted to a laparotomy; two of these conversions were elective, and one was emergent. The risk of conversion was affected by the experience of the surgeon (odds ratio = 0.53; P = .0105), and the rate of conversion was reduced when a cannula was added at the beginning of the procedure (P = .022). Fourteen dogs were discharged from the hospital. One dog died after being discharged due to severe cholangiohepatitis, and another dog died due to leakage of a gastrostomy tube. CONCLUSIONS The use of SPAS for cholecystectomy in dogs has an acceptable outcome. The experience gained by the surgeon and the addition of a cannula reduced the risk of conversion. CLINICAL RELEVANCE/IMPACT Laparoscopic cholecystectomy can be performed with a SPAS. The placement of an additional cannula at the beginning of the procedure is highly recommended.
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Affiliation(s)
- Allen Simon
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Eric Monnet
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Jaffey JA, Pavlick M, Webster CR, Moore GE, McDaniel KA, Blois SL, Brand EM, Reich CF, Motschenbacher L, Hostnik ET, Su D, Lidbury JA, Raab O, Carr SV, Mabry KE, Fox-Alvarez W, Townsend S, Palermo S, Nakazono Y, Ohno K, VanEerde E, Fieten H, Hulsman AH, Cooley-Lock K, Dunning M, Kisielewicz C, Zoia A, Caldin M, Conti-Patara A, Ross L, Mansfield C, Lynn O, Claus MA, Watson PJ, Swallow A, Yool DA, Gommeren K, Knops M, Ceplecha V, de Rooster H, Lobetti R, Dossin O, Jolivet F, Papazoglou LG, Pappalardo MCF, Manczur F, Dudás-Györki Z, O'Neill EJ, Martinez C, Gal A, Owen RL, Gunn E, Brown K, Harder LK, Griebsch C, Anfinsen KP, Gron TK, Marchetti V, Heilmann RM, Pazzi P, DeClue AE. Effect of clinical signs, endocrinopathies, timing of surgery, hyperlipidemia, and hyperbilirubinemia on outcome in dogs with gallbladder mucocele. Vet J 2019; 251:105350. [PMID: 31492387 DOI: 10.1016/j.tvjl.2019.105350] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Abstract
Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14-8.23; P<0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19-3.77; P=0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08-3.47; P=0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10-5.50; P=0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30-0.72; P=0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01-1.04; P<0.001) and age (OR, 1.17; 95% CI, 1.08-1.26; P<0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54-0.69) and a specificity of 0.63 (95% CI, 0.59-0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.
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Affiliation(s)
- J A Jaffey
- Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, 900 East Campus Drive, Columbia, MO, 65211, USA.
| | - M Pavlick
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA, 01536, USA
| | - C R Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA, 01536, USA
| | - G E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA
| | - K A McDaniel
- Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, 900 East Campus Drive, Columbia, MO, 65211, USA
| | - S L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - E M Brand
- Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - C F Reich
- Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - L Motschenbacher
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, C-325, St Paul, MN, USA
| | - E T Hostnik
- Department of Veterinary Clinical Sciences, Veterinary Medical Center, Ohio State University, 601 Vernon L Tharp Street Columbus, OH, 43210, USA
| | - D Su
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996, USA
| | - J A Lidbury
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843, USA
| | - O Raab
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - S V Carr
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 215 Duck Pond Drive, Blacksburg, VA, 24061, USA
| | - K E Mabry
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 215 Duck Pond Drive, Blacksburg, VA, 24061, USA
| | - W Fox-Alvarez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608, USA
| | - S Townsend
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608, USA
| | - S Palermo
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Nakazono
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - K Ohno
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - E VanEerde
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50010, USA
| | - H Fieten
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - A H Hulsman
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - K Cooley-Lock
- Department of Clinical Sciences, College of Veterinary Medicine, P.O. Box 6100, Mississippi State University, Mississippi State, MS, 39762-6100, USA
| | - M Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, United Kingdom
| | - C Kisielewicz
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, United Kingdom
| | - A Zoia
- San Marco Veterinary Clinic, via Sorio 114c, 35141, Padua, Italy
| | - M Caldin
- San Marco Veterinary Clinic, via Sorio 114c, 35141, Padua, Italy
| | - A Conti-Patara
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, 99164, USA
| | - L Ross
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, 36849, USA
| | - C Mansfield
- Faculty of Veterinary Science, The University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
| | - O Lynn
- Faculty of Veterinary Science, The University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
| | - M A Claus
- Comparative Health Research Group, College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - P J Watson
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
| | - A Swallow
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
| | - D A Yool
- Division of Veterinary Clinical Sciences, Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, EH25 9RG, United Kingdom
| | - K Gommeren
- Department of Clinical Sciences, Small Animal Medicine, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - M Knops
- Department of Clinical Sciences, Small Animal Medicine, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - V Ceplecha
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Palackeho 1/3, 612 42, Brno, Czech Republic
| | - H de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - R Lobetti
- Bryanston Veterinary Hospital, P.O. Box 67092, Bryanston, South Africa
| | - O Dossin
- Department of Small Animal Clinical Sciences, ENVT and IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
| | - F Jolivet
- Department of Small Animal Clinical Sciences, ENVT and IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
| | - L G Papazoglou
- Department of Clinical Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M C F Pappalardo
- Vet Support, Small Animal Intensive Care Medicine, Sao Paulo, 04082-002, Brazil
| | - F Manczur
- Department and Clinic of Internal Medicine, University of Veterinary Medicine, H-1400, P.O. Box 2, Hungary
| | - Z Dudás-Györki
- Department and Clinic of Internal Medicine, University of Veterinary Medicine, H-1400, P.O. Box 2, Hungary
| | - E J O'Neill
- Department of Veterinary Clinical Studies, School of Veterinary Medicine, University of Dublin, Belfield, Dublin 4, Ireland
| | - C Martinez
- Department of Veterinary Clinical Studies, School of Veterinary Medicine, University of Dublin, Belfield, Dublin 4, Ireland
| | - A Gal
- School of Veterinary Science, Massey University, Palmerston North, 4410, New Zealand
| | - R L Owen
- School of Veterinary Science, Massey University, Palmerston North, 4410, New Zealand
| | - E Gunn
- University of Glasgow Small Animal Hospital, Bearsden Road, Glasgow, G61 1QH, United Kingdom
| | - K Brown
- University of Glasgow Small Animal Hospital, Bearsden Road, Glasgow, G61 1QH, United Kingdom
| | - L K Harder
- Small Animal Hospital, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
| | - C Griebsch
- University Veterinary Teaching Hospital Sydney, The University of Sydney, 65 Parramatta Road, 2050, Camperdown, New South Wales, Australia
| | - K P Anfinsen
- Department of Companion Animal Clinical Sciences, NMBU School of Veterinary Science, N-0033, Oslo, Norway
| | - T K Gron
- Department of Companion Animal Clinical Sciences, NMBU School of Veterinary Science, N-0033, Oslo, Norway
| | - V Marchetti
- Department of Veterinary Science, University of Pisa, Via Livornese lato monte, 56122, San Piero a Grado, Pisa, Italy
| | - R M Heilmann
- Small Animal Clinic, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, An den Tierkliniken 23, DE-04103, Leipzig, Saxony, Germany
| | - P Pazzi
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Old Soutpan Road, Onderstepoort, 0110, South Africa
| | - A E DeClue
- Pride Veterinary Centre, Riverside Road, Pride Park, Derby, UK
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Lee S, Lee A, Kweon OK, Kim WH. Changes in pre- and postoperative serum leptin concentrations in dogs with gallbladder mucocele and cholelithiasis. BMC Vet Res 2019; 15:215. [PMID: 31238989 PMCID: PMC6593571 DOI: 10.1186/s12917-019-1964-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/16/2019] [Indexed: 12/05/2022] Open
Abstract
Background Leptin has been shown to have various physiological and pathological roles in the canine gallbladder. In this study, we performed pre- and postoperative short-term follow-up analyses to confirm changes in serum leptin levels before and after cholecystectomy due to gallbladder mucocele (GBM) or cholelithiasis in dogs. Results Twenty-six cholecystectomized dogs (GBM: n = 14; cholelithiasis: n = 12) for prophylactic or clinical symptom relief were enrolled in the present study. Dogs were subgrouped according to clinical symptoms and prognosis after surgery as follows: 1) asymptomatic group (n = 13), 2) recovery group (n = 8), and 3) death group (n = 5). Liver enzymes, total bilirubin, lipid profiles, and leptin concentrations were determined from sera on the pre-operative day and at 1, 3, and 7 days postoperation. Serum leptin concentrations were gradually but significantly decreased in the asymptomatic group (p = 0.008, 0.004, and 0.004 on days 1, 3, and 7, respectively, compared with that before surgery) and the recovery group (p = 0.048 and 0.048 on days 3 and 7, respectively, compared with that before surgery). However, in the death group, leptin concentrations did not differ significantly over time (p = 0.564). Additionally, serum leptin levels in the recovery group (p = 0.006) and death group (p = 0.021) were significantly higher than those in the asymptomatic group. Liver enzymes and total bilirubin (T-Bil) were significantly decreased only in the recovery group, particularly on day 7. In the asymptomatic group, liver enzymes and T-Bil were not changed significantly over time, and in the death group, only T-Bil was significantly decreased on day 7. Total cholesterol and triglyceride levels were not significantly decreased over time in all groups. Conclusions These results indicate that leptin is a potential biomarker reflecting the severity and prognosis of GBM and cholelithiasis both before and after cholecystectomy in dogs.
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Affiliation(s)
- Sungin Lee
- Department of Veterinary Clinical Sciences College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea
| | - Aeri Lee
- Department of Veterinary Clinical Sciences College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea
| | - Oh-Kyeong Kweon
- Department of Veterinary Clinical Sciences College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea
| | - Wan Hee Kim
- Department of Veterinary Clinical Sciences College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea.
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Youn G, Waschak MJ, Kunkel KAR, Gerard PD. Outcome of elective cholecystectomy for the treatment of gallbladder disease in dogs. J Am Vet Med Assoc 2019; 252:970-975. [PMID: 29595398 DOI: 10.2460/javma.252.8.970] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine mortality rates for dogs undergoing cholecystectomy and variables associated with failure to survive to hospital discharge. DESIGN Retrospective cohort study. ANIMALS 70 dogs that underwent cholecystectomy for biliary tract disease at a companion animal referral hospital from 2009 through 2015. PROCEDURES Medical records of dogs were reviewed and data collected; dogs with biliary diversion surgery were excluded. Included dogs were grouped by whether cholecystectomy had been elective (ie, dogs with no or mild clinical signs, with no indication of biliary obstruction, or that initially underwent surgery for a different procedure) or nonelective (ie, dogs with icterus and questionable patency of the biliary system). Mortality rates (proportions of dogs that failed to survive to hospital discharge) were compared between various groups. RESULTS 45 (64%) dogs were included in the elective group and 25 (36%) in the nonelective group. Group mortality rates were 2% (1/45) and 20% (5/25), respectively, and differed significantly. Overall mortality rate was 9% (6/70). Serum albumin concentration was significantly lower and serum alanine aminotransferase activity and total bilirubin concentration were significantly higher in nonsurviving versus surviving dogs. Dogs with vomiting, signs of lethargy or anorexia, icterus, or azotemia were less likely to survive than dogs without these signs. CONCLUSIONS AND CLINICAL RELEVANCE Dogs that underwent elective cholecystectomy had a considerably lower mortality rate than previously reported. Elective cholecystectomy may be an appropriate recommendation for dogs with early signs of biliary disease to avoid the greater mortality rate associated with more advanced disease and nonelective cholecystectomy.
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Wennogle SA, Randall EK, Priestnall SL, Twedt DC, Simpson KW. Eubacterial fluorescence
in situ
hybridisation and histologic features in 25 dogs with gallbladder mucocele. J Small Anim Pract 2019; 60:291-297. [DOI: 10.1111/jsap.12982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 11/11/2018] [Accepted: 01/02/2019] [Indexed: 01/07/2023]
Affiliation(s)
- S. A. Wennogle
- Department of Clinical Sciences, College of Veterinary MedicineColorado State University Fort Collins Colorado 80523 USA
| | - E. K. Randall
- Department of Environmental and Radiological Health SciencesColorado State University Fort Collins Colorado 80523 USA
| | - S. L. Priestnall
- Department of Pathobiology and Population Sciences, Royal Veterinary CollegeUniversity of London Hatfield AL9 7TA UK
| | - D. C. Twedt
- Department of Clinical Sciences, College of Veterinary MedicineColorado State University Fort Collins Colorado 80523 USA
| | - K. W. Simpson
- College of Veterinary MedicineCornell University Ithaca New York 14853 USA
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Rimpo K, Tanaka A, Ukai M, Ishikawa Y, Hirabayashi M, Shoyama T. Thrombin-antithrombin complex measurement using a point-of-care testing device for diagnosis of disseminated intravascular coagulation in dogs. PLoS One 2018; 13:e0205511. [PMID: 30304025 PMCID: PMC6179255 DOI: 10.1371/journal.pone.0205511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/26/2018] [Indexed: 11/24/2022] Open
Abstract
Reference interval for thrombin-antithrombin complex (TAT) level was determined using an in-house TAT measurement device, and its validity for diagnosis of disseminated intravascular coagulation (DIC) was evaluated in dogs. One hundred and two clinically healthy dogs and 247 diseased dogs with conditions that potentially caused DIC were recruited in the study. Six diagnostic testing for DIC were evaluated in diseased dogs and the diseased dogs were categorized into five groups depending on abnormal findings. TAT was measured in all study animals and between-group differences were evaluated. TAT level was positively associated with severity of DIC. There were no significant differences in TAT levels among clinically healthy dogs, diseased dogs without any abnormal finding and diseased dogs with one abnormal finding in the DIC diagnostic testing. TAT levels in groups with two or more abnormal findings were significantly higher than clinically healthy dogs. Reference interval of TAT level for clinically healthy dogs was ≤ 0.25 ng/ml. Validity of using TAT for early detection of DIC was evaluated. In-house TAT measurement was suggested to be a clinically relevant and useful tool for early detection of canine DIC.
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Affiliation(s)
- Kenji Rimpo
- Saitama Animal Medical Center, Iruma-shi, Saitama, Japan
- * E-mail:
| | - Aki Tanaka
- Department of Wildlife Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Masayasu Ukai
- Saitama Animal Medical Center, Iruma-shi, Saitama, Japan
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Kanai H, Hagiwara K, Nukaya A, Kondo M, Aso T. Short-term outcome of laparoscopic cholecystectomy for benign gall bladder diseases in 76 dogs. J Vet Med Sci 2018; 80:1747-1753. [PMID: 30232303 PMCID: PMC6261809 DOI: 10.1292/jvms.18-0266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is widely accepted as the standard treatment for benign gall bladder diseases in humans because it has proven to be less invasive and safer than are
traditional methods. However, the efficacy of LC in dogs remains unclear. The present study aimed to examine the short-term outcome of LC for benign gall bladder diseases in dogs. We
enrolled 76 consecutive dogs that underwent LC for benign gall bladder diseases at our hospital between April 2008 and October 2016. Dogs with jaundice, gall bladder ruptures, abdominal
effusion, or extrahepatic biliary obstruction were not excluded from the indication. Factors including age, body weight, sex, clinical sign, disease, operative time, conversion to open
surgery, perioperative complications, and postoperative hospital stay were investigated. The median age of the dogs was 11 years, and the median body weight was 5.4 kg. Fifty percent of the
dogs exhibited no symptoms at the initial visit. Preoperative elevation of total bilirubin levels was observed in 16 dogs (21%). LC was successfully completed in 71 dogs (93%); the median
operative time was 124 min. Although gall bladder ruptures were observed in 2 (2.6%) dogs, the operations were completed successfully. Three dogs (4.1%) had to be converted to open
cholecystectomy and 2 (2.6%) underwent reoperation. Two dogs (2.6%) died intraoperatively and 2 (2.6%) died postoperatively. LC was a feasible, safe, and appropriate procedure considering
the current operative indications for benign gall bladder diseases in dogs.
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Affiliation(s)
- Hiroo Kanai
- Kanai Veterinary Surgery, 569-1 Nozato, Himeji-shi, Hyogo 670-0811, Japan.,Study Group of Small Animal Minimal Invasive Treatment (SAMIT), 569-1 Nozato, Himeji-shi, Hyogo 670-0811, Japan
| | - Ken Hagiwara
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo 101-8309, Japan.,Study Group of Small Animal Minimal Invasive Treatment (SAMIT), 569-1 Nozato, Himeji-shi, Hyogo 670-0811, Japan
| | - Aya Nukaya
- Aya Animal Hospital, 4-1-17 Fujinokidai, Nara-shi, Nara 631-0044, Japan.,Study Group of Small Animal Minimal Invasive Treatment (SAMIT), 569-1 Nozato, Himeji-shi, Hyogo 670-0811, Japan
| | - Motoki Kondo
- Apple Tree Animal Hospital, 52-2 Hiruta, Takatanacho, Anjo-shi, Aichi 446-0053, Japan.,Study Group of Small Animal Minimal Invasive Treatment (SAMIT), 569-1 Nozato, Himeji-shi, Hyogo 670-0811, Japan
| | - Toshihide Aso
- Animal Medical Center ALOHA, 5-12-5 Hikino, Fukuyama-shi, Hiroshima 721-0942, Japan.,Study Group of Small Animal Minimal Invasive Treatment (SAMIT), 569-1 Nozato, Himeji-shi, Hyogo 670-0811, Japan
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Harrison JL, Turek BJ, Brown DC, Bradley C, Callahan Clark J. Cholangitis and Cholangiohepatitis in Dogs: A Descriptive Study of 54 Cases Based on Histopathologic Diagnosis (2004-2014). J Vet Intern Med 2017; 32:172-180. [PMID: 29131399 PMCID: PMC5787197 DOI: 10.1111/jvim.14866] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/10/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
Background Cholangitis in dogs appears to be more common than previously thought, but understanding of the disease remains incomplete. Objective To describe a population of dogs with cholangitis or cholangiohepatitis. Animals Fifty‐four client‐owned dogs with cholangitis or cholangiohepatitis. Methods Medical records of dogs with cholangitis or cholangiohepatitis confirmed by histopathology between January 2004 and December 2014 were identified using a computer‐based search and retrospectively reviewed. Results Clinical signs included vomiting (72.2%), lethargy (70.4%), and inappetence (64.8%). Most dogs (49/50) had increased liver enzyme activities, hyperbilirubinemia (32/50), and hypercholesterolemia (24/43). Ultrasonographic abnormalities of the hepatobiliary system were seen in 84% of cases. On histopathology, 53 of 54 affected dogs had neutrophilic cholangitis (NC) or cholangiohepatitis, whereas 1 dog had lymphocytic cholangitis. Most cases (42/54) were chronic. Evidence of concurrent biliary disease (46.2%) and biliary tract obstruction (42.6%) was common. Seventeen of 36 biliary and 11 of 25 liver cultures were positive for bacterial growth; Escherichia coli and Enterococcus spp. were most common. Median patient survival was 671 days (95% confidence interval [CI]: 114–1,426). On Cox regression, dogs that did not have a cholecystectomy performed had a 2.1 greater hazard for death (P = 0.037; 95% CI: 1.0–4.3) compared to cholecystectomized dogs. Dogs >13 years old had a 5.0 greater hazard for death (P = 0.001; 95% CI: 1.9–13.2) compared to younger dogs. Conclusions and Clinical Significance Chronic NC or cholangiohepatitis was most common. Cholecystitis and biliary tract obstruction often occurred in conjunction with cholangitis. Cholecystectomized dogs had decreased risk of death; thus, cholecystectomy may improve patient outcome.
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Affiliation(s)
- J L Harrison
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - B J Turek
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - D C Brown
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Bradley
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Callahan Clark
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Gordon CR, Fernandez N, Schwarz T. CT findings of gall bladder rupture in two dogs with gall bladder mucocele. VETERINARY RECORD CASE REPORTS 2017. [DOI: 10.1136/vetreccr-2017-000481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Caroline Rose Gordon
- Hospital for Small AnimalsRoyal (Dick) School of Veterinary StudiesUniversity of EdinburghRoslinUnited Kingdom
| | - Nuria Fernandez
- Hospital for Small AnimalsRoyal (Dick) School of Veterinary StudiesUniversity of EdinburghRoslinUnited Kingdom
| | - Tobias Schwarz
- Hospital for Small AnimalsRoyal (Dick) School of Veterinary StudiesUniversity of EdinburghRoslinUnited Kingdom
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Bargellini P, Orlandi R, Paloni C, Rubini G, Fonti P, Peterson ME, Rishniw M, Boiti C. EVALUATION OF CONTRAST-ENHANCED ULTRASONOGRAPHY AS A METHOD FOR DETECTING GALLBLADDER NECROSIS OR RUPTURE IN DOGS. Vet Radiol Ultrasound 2016; 57:611-620. [DOI: 10.1111/vru.12404] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 01/29/2023] Open
Affiliation(s)
| | | | - Chiara Paloni
- Tyrus Clinica Veterinaria; Via Bartocci 1G 05100 Terni Italy
| | - Giuseppe Rubini
- Ultravet Diagnostic; Via E. Fermi 59 40017 S. Giovanni in Persiceto Bologna Italy
| | - Paolo Fonti
- Centro Veterinario Specialistico; Via S. Giovannini 51 00137 Roma Italy
| | | | - Mark Rishniw
- Veterinary Information Network; 777 W Covell Blvd Davis CA
| | - Cristiano Boiti
- Dipartimento di Medicina Veterinaria; Università di Perugia; Via S. Costanzo 4 06126 Perugia Italy
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Scott J, Singh A, Mayhew PD, Brad Case J, Runge JJ, Gatineau M, Kilkenny J. Perioperative Complications and Outcome of Laparoscopic Cholecystectomy in 20 Dogs. Vet Surg 2016; 45:O49-O59. [DOI: 10.1111/vsu.12534] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/26/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Jacqueline Scott
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Ameet Singh
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - J. Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Jeffrey J. Runge
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia Pennsylvania
| | | | - Jessica Kilkenny
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
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The use of shape memory compression anastomosis clips in cholecystojejunostomy in pigs – a preliminary study. ACTA VET BRNO 2015. [DOI: 10.2754/avb201584040403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper reports on the use of compression anastomosis clips (CAC) in cholecystoenterostomy in an animal model. Cholecystojejunostomy was performed in 6 pigs using implants made of nickel-titanium alloy in the form of elliptical springs with two-way shape memory. The applied procedure led to the achievement of tight anastomosis with a minimal number of complications and positive results of histopathological evaluations of the anastomotic site. The results of the study indicate that shape memory NiTi clips are a promising surgical tool for cholecystoenterostomy in cats and dogs.
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Smalle TM, Cahalane AK, Köster LS. Gallbladder mucocoele: A review. J S Afr Vet Assoc 2015; 86:1318. [PMID: 26824341 PMCID: PMC6138112 DOI: 10.4102/jsava.v86i1.1318] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/11/2015] [Accepted: 09/08/2015] [Indexed: 12/25/2022] Open
Abstract
Gallbladder mucocoele (GBM) is an abnormal, intraluminal accumulation of inspissated bile and/or mucous within the gallbladder. Older, small- to medium-breed dogs seem to be predisposed, but no sex predilection has been identified. Clinical signs are often non-specific and include vomiting, lethargy, anorexia, abdominal pain, icterus and polyuria-polydipsia. Results of a complete blood count may be unremarkable, but serum biochemistry usually reveals increased liver enzymes. The ultrasonographic appearance is diagnostic and well described in the literature. Surgical intervention for the treatment of GBM remains the therapeutic gold standard, with short- and long-term survival for biliary surgery being 66%. The worst outcome is seen in those dogs requiring cholecystoenterostomy. With GBM becoming an apparently increasingly common cause of extrahepatic biliary disease in canines, it is essential that clinicians become familiar with the current literature pertaining to this condition. Numerous predisposing factors are highlighted in this review article and the role of certain endocrinopathies (e.g. hyperadrenocorticism and hypothyroidism) in the development of GBM is touched upon. Furthermore, the aetiopathogenesis of this disease is discussed with reference to the latest literature. Cholecystectomy remains the treatment of choice, but other options are considered based on a current literature review.
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Affiliation(s)
- Tesh M Smalle
- Department of Companion Animal Clinical Studies, University of Pretoria.
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Berent A, Weisse C, Schattner M, Gerdes H, Chapman P, Kochman M. Initial experience with endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting for treatment of extrahepatic bile duct obstruction in dogs. J Am Vet Med Assoc 2015; 246:436-46. [PMID: 25632818 DOI: 10.2460/javma.246.4.436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe techniques for endoscopic retrograde cholangiography (ERC) and endoscopic retrograde biliary stenting of the common bile duct (CBD) for minimally invasive treatment of extrahepatic bile duct obstruction (EHBDO) in dogs. DESIGN Experimental study and clinical report. ANIMALS 7 healthy research dogs and 2 canine patients. PROCEDURES ERC and endoscopic retrograde biliary stenting were performed in healthy purpose-bred research dogs and client-owned dogs with a diagnosis of EHBDO that underwent an attempted biliary stent procedure. Research dogs were euthanized after completion of the procedure and underwent necropsy. With dogs under general anesthesia, the pylorus was cannulated with a side-view duodenoscope, and the duodenum was entered. The major duodenal papilla (MDP) and minor duodenal papilla were then identified, and the MDP was cannulated. Endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting were attempted with the aid of endoscopy and fluoroscopy in all dogs. Procedure time, outcome for duodenal and MDP cannulation, and success of stent placement were recorded. RESULTS Endoscopic retrograde cholangiography was successfully performed in 5 of 7 research dogs and in 1 of 2 patients. Biliary stenting was achieved in 4 of 7 research dogs and 1 of 2 patients, with a polyurethane (n = 4) or self-expanding metallic stent (1). One patient had a mass such that visualization of the MDP was impossible and no attempt at biliary cannulation could be made. After placement, stent patency was documented by means of contrast cholangiography and visualization of biliary drainage into the duodenum intra-operatively. No major complications occurred during or after the procedure in any patient. Follow-up information 685 days after stent placement in 1 patient provided evidence of biliary patency on serial repeated ultrasonography and no evidence of complications. CONCLUSIONS and CLINICAL RELEVANCE ERC and endoscopic retrograde biliary stenting were successfully performed in a small group of healthy dogs and 1 patient with EHBDO, but were technically challenging procedures. Further investigation of this minimally invasive technique for the treatment of EHBDO in dogs is necessary before this may be considered a viable alternative to current treatment methods.
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Affiliation(s)
- Allyson Berent
- Department of Diagnostic Imaging and Interventional Radiology, Animal Medical Center, 510 E 62nd St, New York, NY 10065
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Huynh M, Guillaumot P, Hernandez J, Ragetly G. Gall bladder rupture associated with cholecystitis in a domestic ferret (Mustela putorius). J Small Anim Pract 2014; 55:479-82. [PMID: 25168742 PMCID: PMC7166623 DOI: 10.1111/jsap.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 02/11/2014] [Accepted: 03/24/2014] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- M Huynh
- Centre Hospitalier Vétérinaire Frégis, 94110, Arcueil, France
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Burns BR, Hofmeister EH, Brainard BM. Anesthetic complications in dogs undergoing hepatic surgery: cholecystectomy versus non-cholecystectomy. Vet Anaesth Analg 2014; 41:186-90. [DOI: 10.1111/vaa.12100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/31/2013] [Indexed: 11/29/2022]
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Mayhew PD, Savigny MR, Otto CM, Brown DC, Brooks MB, Bentley AM, Runge JJ, Callan MB. Evaluation of coagulation in dogs with partial or complete extrahepatic biliary tract obstruction by means of thromboelastography. J Am Vet Med Assoc 2013; 242:778-85. [PMID: 23445288 DOI: 10.2460/javma.242.6.778] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize in vitro coagulation status in a cohort of dogs with extrahepatic biliary tract obstruction (EHBO) and to evaluate these patients for hypercoagulability by means of thromboelastography. DESIGN Prospective cohort study. Animals-10 dogs with EHBO and 19 healthy control dogs. PROCEDURES Partial or complete EHBO was confirmed via exploratory celiotomy. Venous blood samples were collected for evaluation of prothrombin time (PT) and activated partial thromboplastin time (APTT); fibrinogen and D-dimer concentrations; protein C and antithrombin activities; and factor VII, VIII, and XI coagulant activities in plasma as well as thromboelastography in whole blood. Thromboelastography variables were measured from the thromboelastography tracing, and a coagulation index was calculated. Thromboelastography results were compared with those of healthy control dogs previously evaluated by the same laboratory. RESULTS Hypercoagulability was diagnosed in all dogs with EHBO on the basis of a high coagulation index. Thromboelastography variables, including maximal amplitude, α-angle, and coagulation index, were significantly higher, and K (clot formation time) and R (reaction time) were significantly lower in these dogs than in control dogs. All dogs with EHBO had PT and APTT within respective reference ranges. Plasma D-dimer and fibrinogen concentrations were above reference ranges in 8 and 7 dogs, respectively, and protein C and antithrombin activities were below reference ranges in 3 and 1 dogs, respectively. CONCLUSIONS AND CLINICAL RELEVANCE In vitro hypercoagulability was commonly detected in dogs with naturally occurring EHBO. The traditional view of EHBO as a disease that causes hypocoagulability may need to be reconsidered.
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Affiliation(s)
- Philipp D Mayhew
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Malek S, Sinclair E, Hosgood G, Moens NMM, Baily T, Boston SE. Clinical findings and prognostic factors for dogs undergoing cholecystectomy for gall bladder mucocele. Vet Surg 2013; 42:418-26. [PMID: 23330871 DOI: 10.1111/j.1532-950x.2012.01072.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report clinical findings and explore prognostic factors for dogs that had cholecystectomy for gall bladder mucocele. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 43) with gall bladder mucoceles. RESULTS Diagnosis of gall bladder mucoceles was confirmed by histopathology and 74% were diagnosed based on preoperative abdominal ultrasonography. Intraoperative evidence of gall bladder rupture was noted in 10 dogs (23%), and 16 (37%) had evidence of previous leakage in the abdominal cavity. One dog had positive bacterial growth from the gall bladder content. The most common histopathologic findings in liver biopsies obtained at surgery were cholangiohepatitis, biliary hyperplasia, or cholestasis. Univariate analysis showed evidence of postoperative hypotension (P = .05) to be significantly negatively associated with survival. Significant difference in mean postoperative serum lactate (P = .034) and postoperative packed cell volume (P = .063) between dogs that survived and died was also noted. CONCLUSIONS Elevations in postoperative serum lactate concentrations and immediate postoperative hypotension in dogs undergoing cholecystectomy for gall bladder mucoceles are associated with poor clinical outcome.
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Affiliation(s)
- Sarah Malek
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Canada.
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Liver. CANINE AND FELINE GASTROENTEROLOGY 2013. [PMCID: PMC7161409 DOI: 10.1016/b978-1-4160-3661-6.00061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Harison E, Langston C, Palma D, Lamb K. Acute azotemia as a predictor of mortality in dogs and cats. J Vet Intern Med 2012; 26:1093-8. [PMID: 22882549 DOI: 10.1111/j.1939-1676.2012.00985.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 05/24/2012] [Accepted: 06/27/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) has been shown to be a predictor of mortality in human medicine. Published studies in the veterinary literature evaluating relative changes in serum creatinine concentration as a prognostic factor are limited. OBJECTIVE To evaluate an AKI grading system based on serum creatinine concentration to determine if it correlates with outcome prediction in dogs and cats. ANIMALS Six hundred forty-five dogs and 209 cats that had at least 2 serum creatinine concentration measurements measured within 7 days. METHODS Retrospective study. Dogs and cats with an initial serum creatinine concentrations of ≤ 1.6 mg/dL and that had more than 1 concentration measured within 2, 3, and 7 days were placed into levels (0-2) based on absolute changes. Mortality then was determined at 30 and 90 days. RESULTS Based on odds ratios calculated with a 95% confidence interval, dogs placed in level 1 within 2 days were approximately 3 times more likely to die within 90 days. Dogs placed in level 2 within 2, 3, or 7 days were approximately 3 times more likely to die within 30 or 90 days. Cats placed in level 2 within 3 or 7 days were approximately 3 times more likely to die at 30 days and 4 times more likely to die if placed in this level within 7 days. If placed in level 2 within 2 or 3 days, cats were approximately 3 times more likely to die within 90 days. CONCLUSIONS AND CLINICAL IMPORTANCE Detecting increasing severity of azotemia helps predict mortality in dogs and cats.
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Affiliation(s)
- E Harison
- Internal Medicine, Animal Medical Center, New York, NY, USA.
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Daneze ER, Terra GA, Terra JA, Campos AGD, Silva AAD, Terra SA. Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines. Acta Cir Bras 2012; 26 Suppl 2:31-7. [PMID: 22030812 DOI: 10.1590/s0102-86502011000800007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To induce a total extra-hepatic obstructive jaundice in swines, by ligation of the common bile duct by laparoscopic surgery. METHODS Eight swines of the Landrace race, 36-day-old, originated from the same matrix, distributed in two groups. Group A: was used titanium metal clip to the common bile duct ligation in three animals; group B: were ligated with 2-0 cotton thread in five animals. RESULTS The ligation of the biliary ducts was performed successfully in all animals, with easy identification of the common bile duct by laparoscopy. There weren't difficulties in the procedures, mainly due to the increased surgical field provided by the excellent quality of light and image of the appliance. The clinical signs of jaundice were evident in the animals in seven days. In group A, two animals showed bile duct perforation near the clip, probably due to ischemic necrosis, progressing to peritonitis and death. In group B, five animals showed obstructive jaundice without any amendment. CONCLUSION Under the conditions of this study, we therefore recommend the use of unabsorbed wires to experimental biliary obstruction, in order to avoid complications, such as ischemia and necrosis, followed by perforation of the wall of the bile ducts.
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Kavanagh C, Shaw S, Webster CRL. Coagulation in hepatobiliary disease. J Vet Emerg Crit Care (San Antonio) 2012; 21:589-604. [PMID: 22316251 DOI: 10.1111/j.1476-4431.2011.00691.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the pathogenesis and clinical consequences of coagulation abnormalities accompanying hepatobiliary disorders and to highlight the need for further studies to characterize these derangements and their treatment options in small animal patients. DATA SOURCES Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent texts. SUMMARY The liver plays an important role in the production and clearance of many components of coagulation. A wide range of hemostatic derangements can occur in patients with hepatobiliary disease including alterations in platelet number and function, coagulation factor levels, anticoagulants, vascular endothelial function, and fibrinolysis. As these hemostatic alterations include both pro- and anticoagulation pathways, the net result is often a rebalanced hemostatic system that can be easily disrupted by concurrent conditions resulting in either clinical bleeding or thrombosis. Conventional coagulation tests are inadequate at identifying the spectrum of coagulation alterations occurring in patients with hepatobiliary disease, but their evaluation is necessary to assess bleeding risk and provide prognostic information. A paucity of information exists regarding the treatment of the coagulation derangements in small animals with hepatobiliary disease. Extrapolation from human studies provides some information about potential treatment options, but further studies are warranted in this area to elucidate the best management for coagulation abnormalities in dogs and cats with hepatobiliary disease. CONCLUSION Hepatobiliary disease can have profound effects on coagulation function leading to hypercoagulable or hypocoagulable states. Overall coagulation status with hepatobiliary disease depends on both the type and severity of disease and the presence of associated complications.
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Affiliation(s)
- Carrie Kavanagh
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
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Mehler SJ. Complications of the extrahepatic biliary surgery in companion animals. Vet Clin North Am Small Anim Pract 2011; 41:949-67, vi. [PMID: 21889694 DOI: 10.1016/j.cvsm.2011.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgery of the biliary tract is demanding and is associated with several potentially life-threatening complications. Veterinarians face challenges in obtaining accurate diagnosis of biliary disease, surgical decision-making, surgical hemostasis and bile peritonitis. Intensive perioperative monitoring is required to achieve early recognition of common postoperative complications. Proper treatment and ideally, avoidance of surgical complications can be achieved by gaining a clear understanding physiology, anatomy, and the indications for hepatobiliary surgery.
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Affiliation(s)
- Stephen J Mehler
- Veterinary Specialists of Rochester, 825 White Spruce Boulevard, Rochester, NY 14623, USA.
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Hauptman K, Jekl V, Knotek Z. Extrahepatic biliary tract obstruction in two ferrets (Mustela putorius furo). J Small Anim Pract 2011; 52:371-5. [PMID: 21671943 DOI: 10.1111/j.1748-5827.2011.01068.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This report describes extrahepatic bile duct obstruction in two ferrets, which were presented with anorexia, chronic weight loss and general weakness. Physical examination revealed lethargy, cachexia, dehydration, abdominal pain and icterus. Marked haematological, serum chemistry and urinalysis abnormalities included hyperbilirubinaemia (65·5 and 114·2 μmol/L), high concentrations of alanine transaminase (1327·53 and 2578·88 IU/L) and biluribinuria. Abdominal ultrasonography revealed thickening of the bile duct together with the gall bladder wall. The common bile duct was obviously distended. Choledochotomy revealed inspissated bile with fragile green gelatinous plugs that was removed to allow the bile to flow into the duodenum. Cytology and culture of the biliary tract contents were negative for bacteria. Laboratory analyses of biliary plugs showed presence of only protein substances, without detectable mineral composition. Histopathological examination of the liver showed diffuse steatosis and non-specific cholangiohepatitis in both cases.
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Affiliation(s)
- K Hauptman
- Avian and Exotic Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Palackého 1-3, Brno, Czech Republic
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Baker SG, Mayhew PD, Mehler SJ. Choledochotomy and primary repair of extrahepatic biliary duct rupture in seven dogs and two cats. J Small Anim Pract 2010; 52:32-7. [DOI: 10.1111/j.1748-5827.2010.01014.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mesich MLL, Mayhew PD, Paek M, Holt DE, Brown DC. Gall bladder mucoceles and their association with endocrinopathies in dogs: a retrospective case-control study. J Small Anim Pract 2010; 50:630-5. [PMID: 19954439 DOI: 10.1111/j.1748-5827.2009.00811.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the relationship between endocrinopathies and diagnosis of gall bladder mucocele in dogs via a retrospective case-control study. METHODS Records of 78 dogs with a surgical or ultrasonographic diagnosis of gall bladder mucocele were examined for the presence or absence of hyperadrenocorticism, hypothyroidism and diabetes mellitus. Two age- and breed-matched controls for each gall bladder mucocele dog (156 total control dogs) were examined for the same concurrent diseases. A matched case-control analysis was performed using conditional logistic regression. RESULTS The odds of mucocele in dogs with hyperadrenocorticism were 29 times that of dogs without hyperadrenocorticism (P=0.001; 95 per cent CI 3.8, 219.9). No difference was found between dogs with and without diabetes mellitus. Although a significant association was found between gall bladder mucocele and hypothyroidism, potential observation bias was also identifi ed. CLINICAL SIGNIFICANCE Hyperadrenocorticoid dogs that were presented for acute illness with laboratory evidence of hepatobiliary disease should undergo evaluation for the presence of a biliary mucocele. Dogs diagnosed with a gall bladder mucocele should be screened for concurrent hyperadrenocorticism if clinical suspicion exists.
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Affiliation(s)
- M L L Mesich
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104-6010, USA
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Thompson LJ, Seshadri R, Raffe MR. Characteristics and outcomes in surgical management of severe acute pancreatitis: 37 dogs (2001-2007). J Vet Emerg Crit Care (San Antonio) 2009; 19:165-73. [PMID: 19691567 DOI: 10.1111/j.1476-4431.2009.00401.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Describe clinical characteristics and outcomes associated with canine patients undergoing surgical intervention for treatment of acute pancreatitis. DESIGN Retrospective outcome study from 2001 to 2007. ANIMALS Thirty-seven dogs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The following data were collected for dogs who underwent surgical intervention in the course of treatment for severe acute pancreatitis: preoperative clinicopathologic and physical data, ultrasonographic findings, surgical procedure detail, histopathologic findings, and transfusion requirements. The survival rate was 80.8% in dogs with extrahepatic biliary obstruction, 64.3% in dogs undergoing necrosectomy, and 40.6% with pancreatic abscess. Overall survival was 63.6%. Surgical complications included intraoperative and postoperative hemorrhage in 12 dogs, postoperative development of diabetes mellitus in 3 dogs, exocrine pancreatic insufficiency in 1 dog, and bacterial peritonitis in 2 dogs. CONCLUSION Surgical intervention and aggressive postoperative care may be pursued in select dogs with severe acute pancreatitis. In dogs with extrahepatic biliary obstruction secondary to acute pancreatitis, surgical intervention may be associated with a good prognosis whereas dogs with pancreatic abscess formation may have a more guarded prognosis.
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Affiliation(s)
- Lisa J Thompson
- Advanced Critical Care and Internal Medicine, 3021 Edinger Ave, Tustin, CA 92780, USA.
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Lisciandro GR, Lagutchik MS, Mann KA, Fosgate GT, Tiller EG, Cabano NR, Bauer LD, Book BP, Howard PK. Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma. J Vet Emerg Crit Care (San Antonio) 2009; 19:426-37. [DOI: 10.1111/j.1476-4431.2009.00459.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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