Primary diseases biliary disorders have recently been recognized as more common than previously thought. However, reports of them are still rare.
Diseases of the gallbladder (calculous and non-calculous cholecystitis, mucocele, cholelithiasis, neoplasia, etc.) are quite difficult to diagnose in dogs and cats on early stages, since the symptoms are nonspecific and are often associated with obstruction and/or inflammation of the common bile duct, inflammatory liver diseases, etc. Therefore, they were previously identified in neglected form and were confirmed during surgery and/or autopsy.
In addition to the progressive deterioration of the animal's condition, severe cholecystitis can lead to rupture of the gallbladder and subsequent biliary peritonitis. All this requires a more thorough diagnosis in patients with symptoms indicating cholecystitis, and an individual approach when choosing treatment.
Cholecystitis is an inflammation of the gallbladder. According to the etiology, there are three categories of gallbladder injuries: obstructive, non-obstructive and ruptures of the bladder and/or bile ducts, as well as acute and chronic forms of the disease.
Obstructive cholecystitis develops most often due to compression of the cystic duct and/or common bile duct by the altered pancreas (in this case, the disease can be considered secondary), less often - the development of mucocele, thickening of bile, neoplasia of the intestine, liver, biliary tract, diaphragmatic hernia and even less often - the formation of gallstones.
Pneumocholecystitis (emphysematous cholecystitis) is caused by gas-producing bacteria such as E. coli or Clostridium perfringens. Often observed in combination with acute cholecystitis, diabetes mellitus and against the background of traumatic ischemia of the gallbladder.
Ruptures of the gallbladder can occur due to serious injuries (road accidents, falls from a height, impacts) or as a result of perforation of the altered wall of the gallbladder during chronic inflammatory processes.
According to the WSAVA Liver Standardization Group, gallbladder diseases include neutrophilic, lymphoplasmacellular, follicular cholecystitis, mucocele and gallbladder infarction.
Neutrophilic cholecystitis is common in cats and less commonly in dogs and is generally associated with bacterial infection; can be observed as an independent disease or in combination with neutrophilic cholangitis. The damage is characterized by the appearance of neutrophils in the bladder cavity, epithelium and wall of the gallbladder, with chronic course– mixed inflammatory infiltrate containing neutrophils, lymphocytes, plasma cells.
Lymphoplasmacellular and follicular cholecystitis arise as a result of the formation of lymphoplasmacellular infiltrate and/or lymphoid follicles in the mucous membrane of the gallbladder.
Gallbladder infarction occurs due to occlusion of the cystic artery. Complete or partial gallbladder infarction has been described in dogs. Histological examination reveals necrosis of the entire thickness of the gallbladder wall without signs of concomitant cholecystitis and (often) arterial thrombosis.
In most cases, cholecystitis is observed as acute illness. Owners note that the animal has nausea, vomiting, refusal to feed, and pain in the abdominal area. Jaundice is an optional symptom, especially if the common bile duct is open, and may not appear immediately. Its appearance in this case is explained by the development of nonspecific reactive hepatitis and intrahepatic cholestasis in response to endotoxins from the inflamed gallbladder. Cholecystitis, accompanied by stagnation of bile, can lead to acholia and discoloration feces. The appearance of fever, syndrome against the background of these symptoms acute abdomen and signs septic shock(shallow breathing, hypothermia, pale gums and a weak but rapid pulse) may indicate a ruptured gallbladder and requires urgent attention.
Cholecystitis can be chronic and manifest itself as periodic nausea in the animal, signs of discomfort after eating, loss of appetite, weight loss, diarrhea, or occur without any symptoms at all (and changes in gallbladder will be an incidental finding during ultrasonography).
Data from the anamnesis and physical examination can only suggest the described pathology in the animal, but do not make it possible to make a diagnosis. Besides clinical picture does not fully reflect the degree of damage to the gallbladder, and, accordingly, does not allow determining best way treatment and prognosis of the disease.
At the first stage of diagnosis, clinical and biochemical (as complete as possible) blood tests are required; urine is an optional test. Laboratory tests can detect an increase alkaline phosphatase, hypercholesterolemia, hyperbilirubinemia without signs hemolytic anemia. Hyperbilirubinemia ultimately leads to bilirubinuria. Increased levels of bile acids, glutamate dehydrogenase and leukocytosis are very characteristic of this pathology and additionally indicate the need for bile testing. An increase in transaminases will be detected only if the liver parenchyma is involved in the inflammatory process.
When choosing a method for diagnosing cholecystitis directly, preference is given to visual studies and mainly ultrasound diagnostics. X-ray is less sensitive for this pathology and is informative only in the case of calcification of the gallbladder wall or the formation of radiopaque stones (Photos 6 and 7).
Photos 6 and 7.
In this section we will consider changes in the ultrasound picture of the gallbladder and biliary system observed with cholecystitis, without affecting possible changes pancreas, neoplasia of other organs, etc.
Photos 1 and 2.
Photos 3 and 4.
Photo 5.
If there is any change in the gallbladder or the appearance of bile heterogeneity on ultrasound, it is necessary to perform a fine-needle biopsy in order to aspirate bile for cytological and bacteriological research. 22-25 gauge needles can be used for this, and during this procedure it is necessary to remove as much bile as possible to prevent bile from leaking through the puncture hole. The likelihood of such a complication is extremely low; we have not encountered this in our practice, but in the presence of undiagnosed obstruction of the extrahepatic biliary tracts, the risk increases. We also recommend collecting liver parenchyma material for histological examination (the procedure for collecting a biopsy specimen for histological examination is not much more complicated in comparison with a fine-needle liver biopsy, but the result is many times more informative).
One of the modern informative methods is radionuclide scanning of the gallbladder (scintigraphy), which allows you to evaluate the functioning of the gallbladder and determine the location of duct obstruction. Unfortunately, this method is not yet available in our practice.
If biliary peritonitis is suspected, it is indicated diagnostic laparoscopy or laparotomy.
The choice between therapeutic and surgical method treatment for this disease is carried out on the basis of a comprehensive assessment of the animal’s condition, the presence of concomitant diseases in the anamnesis, the presence of diseases that provoked the development of cholecystitis and, of course, the severity and duration of this disease, the effectiveness of previous treatment, if any, and the occurrence of relapses.
There is no point in carrying out conservative treatment and waiting for the disease to improve in an animal in critical condition, following the lead of its owners who want to preserve the organ. Without an inflamed gallbladder, the animal can live just fine. At the same time, if circumstances allow, intensive drug therapy, in many situations – successful.
So, if the owner of a cat or dog contacts us, who has the above symptoms and the animal’s condition is satisfactory, there is no fever, cachexia and uncontrollable vomiting, blood tests indicate an inflammatory process, and ultrasound reveals non-obstructive cholecystitis, possibly with a small amount of bile sludge in the cavity, then we carry out the following actions:
In the event that the animal is in critical condition due to acutely developed cholecystitis, or we are dealing with recurrent cholecystitis, or we have every reason to suspect obstructive cholecystitis and/or rupture of the gallbladder and/or common bile duct, we carry out surgical treatment. Selecting a method surgical correction depends on the expected pathology, the capabilities of the clinic and the experience of the doctor performing the manipulation. IN lately cholecystectomy in our clinic is performed exclusively laparoscopically, which reduces the trauma of the operation, minimizes complications and speeds up recovery period. At the same time, we make sure to conduct a contrast study of the gallbladder to ensure the patency of the bile ducts, and wash the common bile duct. Unfortunately, due to anatomical features in cats and dogs, it is currently impossible to use endoscopic retrograde cholangiopancreatography for the same purposes, so we use more invasive methods. Of course, in situations involving rupture of the gallbladder or obstruction of the common bile duct, we resort to the classic method - laparotomy. There are several options for operations on the gallbladder, and the choice of surgeon is determined by the condition of the gallbladder, the pathology that has developed, etc. But this topic requires a separate article, so it will be omitted here.
Before performing the operation, it is necessary to ensure that there are no disorders of the blood coagulation system. This can be facilitated by prolonged stagnation and disruption of the outflow of bile (vitamin K deficiency appears, the level of coagulation factors II, VII, IX and X decreases). Therefore they carry out additional analysis blood - coagulogram. To prevent possible coagulopathy, konakion (vitamin K1) is additionally administered at a dose of 1-2 mg/kg subcutaneously, this is sufficient to normalize coagulation within 3-12 hours after administration.
With concomitant jaundice in patients, it is necessary to remember their predisposition to hypotension in postoperative period And possible development renal failure.
The tissues of the removed gallbladder are necessarily sent to the laboratory for histological examination.
It should be noted that there is still debate about choledochotomy for obstructive pathologies. This is again due to the peculiarities of the anatomy of our patients, or more precisely with the small size of the structures of the biliary tract and a large number described complications (suture leakage, stenosis in the postoperative period, high mortality during similar operations etc.). The experience of our clinic and the reports of S. G. Baker, P. D. Mayhew, S. J. Mehler (Journal of Small Animal Practice, Volume 52, Issue 1, pages 32-37, January 2011) suggest a low level of complications in these operations and require further development.
The prognosis of the disease is conditionally favorable; with adequate treatment, the function of the gallbladder will be completely preserved. The greatest danger may be complications associated with rupture of the gallbladder and the occurrence of peritonitis. If it develops, even with adequate treatment, it is possible death. It is also necessary to pay great attention to the observations of the attending physician, since clinical dynamics have their own characteristics in each specific case.
Dogs, unfortunately, are susceptible to many human diseases. One of the most common among them is cholecystitis. The disease is an inflammation of the lining of the gallbladder and may have various etiologies and occur in acute or chronic form.
Poor nutrition, heredity and bad environment affect animals just as they do people. Therefore, pet owners should be attentive to the health of their charges, feed them properly, monitor behavior, changes in mood and well-being. Detect cholecystitis in dogs initial stage difficult, so it is important to know the symptoms of the disease and at the first deviation from normal behavior, contact a veterinarian.
The gallbladder is internal organ, which is a kind of reservoir for bile. The concentration of this secretion of liver cells is increased 10 times in comparison with the same characteristics of bile when produced by the liver. Healthy dogs produce approximately 1 ml of bile per 1 kg of their weight. More than half of the liquid enters through the bile ducts into the duodenum, where it affects the process of food digestion. The remaining volume is stored in the gallbladder, gradually concentrating to the desired density.
Any violation of the walls of the gallbladder, resulting in an inflammatory process, is called cholecystitis. This disease is less common in dogs than in cats, but in recent years veterinarians note an increase in percentage acute cholecystitis and theirs. The main causes of cholecystitis:
Incorrect treatment or complete absence lead to rupture of the gallbladder, penetration of secretions into abdominal cavity, development of peritonitis and death of the animal.
The first symptom of a dog's illness is always behavior change. Lethargy, drowsiness, the animal stops playing, becoming interested in what is happening, all this should alert the owner. The pet's fur becomes dull and may experience excessive hair loss, as if she was molting. When stroking, fingerprints remain on the fur, and it loses its firmness and elasticity. This general symptoms for any animal ailment, but there is also special features cholecystitis in dogs.
Refusal to feed, vomiting bile, high temperature and rapid weight loss are the main symptoms of this particular disease. The dog lies with its back arched, mainly on its stomach, with its paws tucked under it. Subsequently, yellowness of the sclera and abdomen appears, late stages stool becomes discolored. During an external examination, pressing fingers into the area of the liver causes anxiety or severe pain in the animal.
The course of the disease can be either sharp, or chronic. In the latter case, symptoms may be nonspecific. Anemia, pale gums and sclera, decreased body temperature. At acute course the disease develops very quickly, and without urgent medical intervention it can result in rupture of the gallbladder, peritonitis and, as a consequence, death.
The chronic form of cholecystitis can occur unnoticed for a long time. Often the disease is discovered by chance, during a routine examination by a doctor. Sometimes the acute form of cholecystitis can turn into a chronic type if the pet is not fully treated.
The final diagnosis of cholecystitis in animals is made on the basis of an external examination of the animal, ultrasound of the gallbladder and liver, general and biochemical analyzes blood and urine tests. Sometimes the stones in bile ducts can only be detected using x-rays.
Treatment of the disease depends on its form, neglect and nature. IN emergency situations The animal undergoes a laparotomy, but in most cases therapeutic intervention is sufficient. Self-medication when diagnosing cholecystitis in dogs is prohibited; a prescription must be prescribed by a doctor. Throughout the course of treatment, the animal must be periodically brought to the clinic for examination.
One of the most important factors in the treatment of cholecystitis in both animals and humans is a properly selected diet. First of all, you should eliminate all homemade food from your diet. The dog, in principle, should not receive the food that family members eat, and if the gallbladder is inflamed, such feeding can be disastrous.
The diet should include large number vitamin A, fresh vegetables, in particular carrots and pumpkins, lean poultry, lean beef or veal, cottage cheese, eggs, kefir, porridge from easily digestible cereals. Nothing fatty, fried, spicy, smoked or salty can be added to a dog’s food for cholecystitis.
Preventative measures to prevent your dog from becoming seriously ill with this disease:
From proper nutrition health directly depends pet. Therefore, you need to pay special attention to your diet.
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Choleretic Agents
Substances that help increase the output of bile in duodenum, are called choleretic. An increase in bile output may be due to the following reasons:
1) increasing the formation of bile in the liver and increasing its enzymatic activity. This is how essential oils, allohol, corn silk, and immortelle flowers work. These drugs have a stimulating effect on liver cells and neurohumoral regulation bile formation;
2) restoration of the tone of the bile ducts and gallbladder, and therefore the excretion of bile into the intestines increases. This is how antispasmodics (atropine, papaverine, etc.), Carlsbad salt, and magnesium sulfate act. The effect of substances of this type is reduced to mechanical facilitation of the movement of bile along the excretory tract;
3) anti-inflammatory effects of chemotherapeutic and antiseptics, also helping to restore the functioning of the liver and bile ducts and increase bile secretion.
Bile formation is regulated by the central nervous system and autonomic innervation. Substances that stimulate the central nervous system nervous system and parasympathetic innervation, increase bile formation, and substances that depress the central nervous system and stimulate sympathetic innervation reduce bile secretion. Anticholinergic substances inhibit bile formation, but by relaxing the muscle tone of the biliary tract and sphincter, they facilitate the excretion of bile. Substances that relax spasms also act smooth muscle: magnesium sulfate, Carlsbad salt. Sulfates entering the duodenum irritate its receptors and cause the so-called bladder reflex - contraction of the gallbladder and increased peristalsis of the biliary tract. Magnesium sulfate and sodium sulfate also increase bile formation.
Bile itself, bile acids and their salts, acting on the duodenum, reflexively enhance bile formation. Hydrochloric acid, many hormones and enzymes stimulate the formation of bile. To enhance the excretion of bile, substances that dilute bile are used: sodium bicarbonate, sabur, alkaline mineral waters. Many choleretic agents act in combination. Choleretic drugs are used for diseases of the liver and biliary tract.
Allohol - Allocholum. Tablets containing dried animal bile (0.08 g), dry garlic extract (0.04 g), dry nettle extract (0.005 g) and activated carbon(0.025 g). Available in tablets of 0.3 g.
Action. Allochol stimulates the secretory activity of the liver, increases the tone of the bile ducts, revitalizes secretion and intestinal motility, and has an anti-fermentation and anti-putrefactive effect in the gastrointestinal canal.
Apply for chronic inflammation of the liver, biliary tract and gallbladder.
Oral doses: dogs - 1-2 tablets, cats - 0.25-0.5 tablets. Prescribed 3 times a day after feeding.
Dehydrocholic acid - Acidum dehydrocholicum. White crystalline powder with a bitter taste. Slightly soluble in water, soluble in alcohol. Available in tablets of 0.2 g.
Action. Belongs to the group of bile acids that stimulate the production of bile by liver cells.
Apply at chronic inflammation liver, bile ducts and gallbladder. Contraindicated for use in acute and subacute liver dystrophies.
Oral doses (g): horses - 3-6, pigs - 1-3, dogs - 0.2-2.0. Prescribed 3 times a day.
Corn Silk - Stigmata Maydis. Corn stalks with silks collected during the ripening period of corn cobs. Stigmas contain stigmasterol, systosterol, essential oil, vitamins C and K.
Action. Corn silk increases the secretion of bile, reduces its viscosity, stimulates contractions of the gallbladder, enhances blood clotting and has a diuretic effect.
Apply as a choleretic and diuretic for inflammation of the liver, gallbladder, bile ducts. As a choleretic, diuretic and lactic agent, it is good to use corn silage, harvested during the milky ripeness of corn cobs, for large and small animals. Dried corn silks are used in the form of an infusion of 1:10 or 1:20.
Oral doses (g): horses - 30-60, sheep and pigs - 20-40, dogs - 10-20. Prescribed 3 times a day in the form of infusion or collection with food.
Cholenzym - Cholenzymum. Tablets containing dry bile (1 part), dried powders of the pancreas and intestines of slaughter cattle (1 part each).
Valid and used as choleretic agent with inflammation of the liver, biliary tract and gall bladder. Also prescribed for inflammation of the stomach and intestines.
Dose: dogs - 0.5-1 tablet 2-3 times a day.
Sandy immortelle flowers - Flores Helichrysi arenarii. The baskets of wild-growing immortelle (Cmina) collected before the flowers bloom contain flavonoids, glycosides, essential oil, vitamins K and C, and carotene.
Action. They stimulate the liver, increase bile formation, increase the tone of the gallbladder and bile ducts, and increase the secretory function of the stomach and pancreas.
Apply as a choleretic agent for diseases of the liver, gall bladder and bile ducts. Prescribed in the form of collection, infusion and extract.
Doses (g): cattle 15-40, pigs - 2-5, dogs 0.5-1. Prescribed 2-3 times a day.
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Cholecystitis is an inflammatory pathology affecting the gallbladder. Typically, this disease is associated with a bacterial infection. It is worth noting that cholecystitis in dogs is often combined with inflammation and blockage of the bile ducts.
Causes and nature of the disease
Clinical picture
As a rule, cholecystitis in dogs is manifested by refusal to eat, depression of the animal, vomiting, and pain in the left hypochondrium. Jaundice may appear. Its severity is influenced by the degree of inflammatory damage to the gallbladder. Cholecystitis can be complicated by the development of shock.
Diagnostics
A blood test reveals an increase in the level of white blood cells and the appearance of toxic neutrophils. An increased content of bilirubin is found in the blood and urine. In addition, there is an increase in the level of liver enzymes. If gallbladder damage is suspected, abdominocentesis is indicated. We are talking about a cytological examination of fluid from the gallbladder. To identify the pathogen bacterial infection use cultural research. Preventing complications associated with blood clotting disorders involves performing a coagulogram. To detect local or diffuse peritonitis, gallstones and its increased density carried out plain radiography. To confirm the diagnosis, it is indicated to carry out ultrasound examination. Certificate inflammatory process is the detection of a double wall of the gallbladder. In addition, ultrasound helps to detect free fluid in the abdominal cavity.
In some cases, liver biopsy and exploratory laparotomy are recommended.
Cholecystitis in dogs must be distinguished from inflammation of the pancreas, peritonitis, damage to the stomach and intestines, necrosis and abscesses of the liver, and sepsis.
Treatment of the disease
First of all, the water and electrolyte balance is restored. For this, infusion therapy (sodium chloride solution) is used. If the amount of proteins decreases, the administration of fresh frozen plasma is prescribed. When a microbial infection is detected, they are used antibacterial drugs(metronidazole, clindamycin, ampicillin, etc.). To stimulate the secretion of bile, the use of ursodeoxycholic acid is indicated.
If ineffective conservative treatment cholecystectomy is indicated. We are talking about removing the gallbladder. It is worth noting that surgical interventions on this organ may be complicated by a decrease in heart rate, decrease in pressure, etc.
Why is cholecystitis dangerous in dogs? Who knows what the largest and heaviest gland in a dog’s body is? Of course the liver! We can say that this is the body’s internal kitchen in which the process of preparing food for digestion occurs - special enzymes break down the incoming product and send it for further processing to the intestines.
Cholecystitis in dogs can often pass without any signs, but there are symptoms that should make a loving owner be wary:
Of course the data signs may indicate other diseases, and therefore you must definitely contact a veterinarian who can diagnose accurate diagnosis after taking biomaterials for analysis. In particular, the doctor may suggest taking blood and urine tests to obtain more specific information. You should not self-medicate suspecting cholecystitis in your pet. This disease can be diagnosed and treated exclusively with the help of a veterinarian.
At the final stage of treatment general well-being is significantly improved by thermal physiotherapeutic procedures, the purpose of which is to resolve exudate, improve blood circulation, reduce discomfort. Treat cholecystitis in dogs, only a specialist should administer prescribed medications.
To prevent your pet from finding out what kind of disease it is, you need to try carefully, but the results are worth it: shiny wool, active behavior, joyful sparkles in the eyes will certainly pay off your work. First of all, you need to do the following:
The veterinary center "YA-VET" friendlyly opened its doors to numerous visitors, because this is one of the few places where you can get help when diagnosing cholecystitis in dogs. Treatment must be professional, using all currently possible techniques. As a rule, the doctor uses several diagnostic methods in order to establish the cause of the disease and the diagnosis itself:
Remember that in 90% of cases of cholecystitis the owners are to blame, and therefore it is recommended to carefully follow the diet prescribed by the doctor. For example, if the dog is on a natural diet, and the treated dogs are prescribed chicken or selected fresh meat, do not think that they are joking with you, that they are scamming you for money. Cholecystitis in dogs cannot be completely cured, but you can maintain health if you meticulously follow all personal prescriptions and doctor’s recommendations.
Currently, veterinary medicine is developing at a rapid pace and what previously seemed fantastic is now quite feasible. Cholecystitis in dogs can be treated at home as follows:
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