Bile peritonitis associated with gastric dilation-volvulus in a dog (original) (raw)
Related papers
Canine Gallbladder Infarction: 12 Cases (1993-2003)
Veterinary Pathology, 2004
A cohort of 12 dogs with severe transmural gallbladder necrosis is described. All dogs had cholecystectomies performed. In six dogs, perforation of the gallbladder was noted at surgery. Eight dogs survived the immediate postoperative period, and four dogs died. Histologically, inflammation was absent or minimal in all cases, suggesting that cholecystitis was not the cause of necrosis. Thrombi (n ϭ 2) and atheromatous vascular changes (n ϭ 1) represent possible vascular causes of this condition. The findings of coagulative necrosis in these 12 dogs are compatible with ''gallbladder infarction,'' and the authors propose this term to describe the histopathologic appearance of the gallbladder.
Unusual Case of Biliary Peritonitis in a Dog Secondary to a Gastric Perforation
Veterinary Sciences
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 p...
Journal of the American Veterinary Medical Association, 2009
Scientific Reports 359 SMALL ANIMALS C anine gallbladder disease is reported in association with choleliths, mucoceles, bacterial infection, neoplasia, and some hepatic diseases. 1-4 The pathogenesis of canine gallbladder disease has been associated with disorders causing biliary stasis (eg, extrahepatic biliary obstruction or cholelithiasis) that may increase susceptibility to bacterial infection. 1,5-8 Clinical signs associated with gallbladder disease in dogs are often vague and include nonspecific abdominal signs. 1,2,5,7 Ultrasonographic imaging of the intra-and extrahepatic biliary system can assist in the recognition of biliary obstruction as well as abnormal biliary contents in the gallbladder or bile duct (eg, gallbladder mucoceles, choleliths, and masses). 5-7 Ultrasonographic identification of gallbladder rupture has been reported in dogs, but there is limited information on evaluation of ultrasonography for identification of gallbladder rupture, and to our knowledge, no attempt has been made to systematically identify imaging characteristics that can be used to predict rupture or the need for surgical intervention in a population of dogs with histologically confirmed gallbladder disease.
Gallbladder diseases in dogs and cats
2013
The biliary system consists of the gallbladder (GB), cystic duct, common bile duct (CBD), hepatic ducts, interlobular ducts, intralobular ducts, bile ductules, and hepatic canaliculi. The GB is a teardrop-shaped organ located in the cranioventral abdomen, attached to the liver to the right of midline within a fossa between the right medial and quadrate liver lobes. The GB acts as a reservoir where bile is stored, modified, and eventually expelled. First, bile is formed in the hepatocytes and is actively secreted into the bile canaliculi. From there, bile flows through the intrahepatic bile duct system (bile ductules-intralobular ducts-interlobular ducts) leaving the liver in the hepatic ducts that finally merge into the CBD after branching off the cystic duct that travels toward the GB. The cystic duct is an important landmark in that it distinguishes the otherwise continuous hepatic ducts from the CBD. At the junction with the intestines, the communication of the CBD and duodenum is anatomically distinct in the dog and cat. After contraction of the GB, bile is released into the CBD and enters the duodenum through the sphincter of Oddi. In the dog, the CBD joins the minor pancreatic duct at the major duodenal papilla. In the cat, the CBD fuses with the major pancreatic duct just before entering the duodenal papilla a few cm caudal to the pylorus. The GB wall of dogs and cats is typically thin-walled (up to 1.5 mm) and the GB volume is approximately 1 mL / kg BW. Its contractions are primarily initiated by cholecystokinin, a peptide hormone secreted in the duodenum in response to fats and proteins entering the small intestine. Bile is primarily composed of cholesterol, lecithin, phospholipids, and bile salts. Bile emulsifies fat and neutralizes acid in partially digested food. The synthesis and secretion of bile acids provides an important method for the excretion of cholesterol. In fact the conversion of cholesterol into bile acids represents the main catabolic escape pathway for cholesterol from the body. This illustrates why hypercholesterolemia is typically seen in cholestatic disease processes. CHOLECYSTITIS The term cholecystitis denotes inflammatory conditions of the GB and encompasses a variety of acute and chronic diseases with or without bacterial infections. Whereas cholecystitis in people is usually seen in the context of cystic duct obstruction, the etiology of cholecystitis has not been well characterized in dogs and cats. Most cases of cholecystitis are associated with conditions leading to prolonged bile stasis with subsequent accumulation of cytotoxic bile acids. The GB epithelium, although normally a robust tissue, is continuously exposed to one of the most noxious agents in the body: a concentrated solution of bile acids detergents. In health, the GB empties the concentrated bile several times a day and is replenished with dilute and less noxious hepatic bile. With prolonged stasis concentrated bile stagnates in the GB lumen. In addition the GB epithelium has relatively high metabolic energy requirements, as it continuously reabsorbs electrolytes and water from the bile. Therefore, in a debilitated, anorectic patient chemical injury to the GB wall may occur. This is why GB mucoceles and cholelithiasis/choledocholithiasis, and rarely biliary neoplasia are known predisposing factors in dogs and cats. Ascending bacterial infection is possible and more commonly found in cases of an advanced extrahepatic biliary stasis. An important and often overlooked factor is GB wall ischemia. Having only a single source of perfusion (i.e. left branch of the hepatic artery) makes the GB also uniquely susceptible to ischemic necrosis following states of splanchnic vasoconstriction (hypovolemic or distributive shock) or blunt abdominal trauma. Studies in humans showed that capillaries barely filled in acalculous cholecystitis, suggesting that altered microcirculation plays an important role in its pathogenesis. A ruptured necrotic GB should be suspected in dogs with a history of (hypovolemic) shock and abdominal effusion with elevated (above serum) bilirubin concentrations. Emphysematous cholecystitis is a rare variant of cholecystitis in dogs and cats and may be seen as a biliary complication in diabetic patients. Prolonged hyperglycemia, lowered resistance to ascending bacterial infections due to hypomotility of the sphincter of Oddi, and delayed GB emptying may contribute to the increased risk of emphysematous cholecystitis in diabetic patients. In addition, infarction and hematogenous spread of bacteria may be involved in septic patients or patients with a distant primary infectious focus. Another well-recognized risk factor for development of acute cholecystitis in humans is the use of total parenteral nutrition (TPN) in critically-ill patients due to complete disuse of gastrointestinal tract and resulting bile stasis. Because cholecystitis is very difficult to diagnose in our patients with multisystemic disease, the relevance of this complication while using TPN has yet to be determined in veterinary medicine. CLINICAL SIGNS Cholecystitis may be either acute or chronic in nature. Mild cases are very likely often asymptomatic. Clinical signs can be vague and unspecific and solely consist of intermittent inappetence and occasional vomiting, which is why the diagnosis usually requires a high index of clinical suspicion. More severe cases of acute cholecystitis present with anorexia, weakness, vomiting, abdominal pain and fever. The presence of icterus is variable. Patients that present with acute cholecystitis as a consequence of splanchnic hypoperfusion may solely exhibit classical shock signs, such as tachycardia, tachypnea, prolonged capillary refill time, and weak pulses. Chronic cholecystitis is much more difficult to diagnose. Clinical signs may include intermittent anorexia, vomiting, and postprandial discomfort (i.e. lip smacking, tachypnea, tense abdomen). Pain is likely present but is not always readily detected on examination.
Journal of Small Animal Practice, 2017
To report prevalence, risk factors and clinical outcomes for presumptive gastric dilation-volvulus diagnosed among an emergency-care population of UK dogs. Methods: Cross-sectional study design using emergency-care veterinary clinical records from the VetCompass TM Programme spanning September 1 st , 2012 to February 28 th , 2014. Risk factor analysis using multivariable logistic regression modelling. Results: The study population comprised 77,088 dogs attending 50 Vets Now clinics. Overall, 492 dogs had presumptive gastric dilation-volvulus diagnoses giving a prevalence of 0.64% (95%CI: 0.58%-0.70%). Compared with crossbred dogs, breeds with the highest odds ratios for diagnosis of presumptive gastric dilation-volvulus were the great Dane (OR: 114.3, 95% CI 55.1-237.1, P < 0.001), akita (OR: 84.4, 95% CI 33.6-211.9, P < 0.001) and dogue de Bordeaux (OR: 82.9, 95% CI 39.0-176.3, P < 0.001). Odds increased as dogs aged up to years and neutered male dogs had 1.3 (95% CI 1.0-1.8, P = 0.041) times the odds compared with entire females. Of presumptive gastric dilation-volvulus cases that presented alive, 49.7% survived to discharge but 79.3% of surgical cases survived to discharge. Clinical importance: Approximately 80% of surgically managed cases survived to discharge. Certain large breeds were highly predisposed.
Journal of the American Veterinary Medical Association, 2011
Objective—To identify risk factors for failure to survive and development of septic peritonitis following full-thickness gastrointestinal incision in dogs. Design—Retrospective cohort study. Animals—Dogs that underwent gastrointestinal surgery from 1998 through 2007 at the University of Georgia Veterinary Teaching Hospital. Procedures—Medical records of dogs undergoing a full-thickness gastrointestinal incision were reviewed, and information regarding dog history, clinicopathologic findings, surgery characteristics, and outcome was collected. Results—Records for 197 dogs (225 surgeries) were evaluated. In 35 (16%) surgeries, the dogs died prior to hospital discharge. After 28 (12%) surgeries, dogs developed septic peritonitis. For 45 (20%) surgeries, dogs had preoperative septic peritonitis; of those, approximately a third resulted in continued septic peritonitis (17/45; 38%) or death (15/45; 33%). Of the 180 surgeries performed in dogs lacking preoperative septic peritonitis, 11 (6...
Journal of the American Animal Hospital Association
Fifteen dogs with extrahepatic biliary tract disease underwent cholecystoenterostomy. Long-term survivors were significantly older at presentation (mean age 140.5 months) than dogs that survived the first 20 days after surgery but subsequently died from causes related to the surgery or hepatobiliary disease (mean age 72 months). Dogs that died during the first 20 days had significantly more complications in the hospital than dogs that survived this period. The type of underlying hepatobiliary disease (i.e., benign or malignant) was not associated with either short-term outcome or long-term survival. Eight dogs died from causes related to surgery or hepatobiliary disease. Long-term complications included hepatic abscesses, acquired portosystemic shunts, pancreatitis, and vomiting.
Veterinary Surgery, 2004
Objective-To report clinical findings and define clinical variables associated with outcome in dogs undergoing extrahepatic biliary surgery. Study Design-Retrospective study. Animals-Sixty dogs that had extrahepatic biliary tract surgery. Results-Primary diagnoses included necrotizing cholecystitis (36 dogs, 60%), pancreatitis (12 dogs, 20%), neoplasia (5 dogs, 8%), trauma (4 dogs, 7%), and gallbladder rupture from cholelithiasis without necrotizing cholecystitis (3 dogs, 5%). Bile peritonitis occurred in 19 (53%) dogs with necrotizing cholecystitis, 4 dogs with trauma, and 3 dogs with cholelithiasis without evidence of necrotizing cholecystitis. Cholecystectomy (37 dogs, 62%) and cholecystoduodenostomy (14 dogs, 23%) were the 2 most commonly performed procedures. Median hospitalization for survivors was 5 days (range, 1-15 days). There were 43 surviving dogs (72%) and 17 nonsurvivors (28%, 4 died, 13 euthanatized). Presence of septic bile peritonitis (P ¼ .038), elevation in serum creatinine concentration (P ¼ .003), prolonged partial thromboplastin times (PTTs; P ¼ .003), and lower postoperative mean arterial pressures (P ¼ .0001) were significantly associated with mortality. Conclusions-Extrahepatic biliary surgery is associated with high mortality and a relatively long hospitalization time for survivors. Cholecystectomy and cholecystoduodenostomy were the most common surgical procedures to treat the 4 major biliary problems (necrotizing cholecystitis, pancreatitis, neoplasia, and trauma) observed in this cohort of dogs. The relatively high mortality rate likely reflects the underlying diseases and their effects on the animal (septic bile peritonitis, higher serum creatinine, prolonged PTT, and lower postoperative mean arterial pressure) rather than complications of surgery. Clinical Relevance-Septic bile peritonitis, preoperative elevated creatinine concentration, and immediate postoperative hypotension in dogs undergoing extrahepatic biliary tract surgery are associated with a poor clinical outcome. Adequate supportive care and monitoring in the perioperative period is critical to improve survival of dogs with extrahepatic biliary disease. r
Laparoscopic Cholecystectomy for Management of Uncomplicated Gall Bladder Mucocele in Six Dogs
Veterinary Surgery, 2008
Objectives-To describe a technique for, and outcome after, laparoscopic cholecystectomy (LC) for management of uncomplicated gall bladder mucocele (GBM) in dogs. Study Design-Case series. Animals-Dogs (n ¼ 6) with uncomplicated GBM. Methods-Dogs with ultrasonographic evidence of GBM but without imaging or laboratory signs of gall bladder rupture, peritonitis, or extra-hepatic biliary tract rupture that had LC were included. A 4 portal technique was used. A fan retractor was used to retract the gall bladder to allow dissection around the cystic duct with 5 or 10 mm right-angle dissecting forceps. The cystic duct was ligated using extracorporeally tied ligatures supplemented sometimes with hemostatic clips. A harmonic scalpel was used to dissect the gall bladder from its fossa. The gall bladder was placed into a specimen retrieval bag and after bile aspiration the bag was withdrawn through the 11 mm portal incision. Results-Five dogs had mild intermittent clinical signs including vomiting, inappetence, and lethargy. All dogs had successful LC without conversion to an open approach. All dogs with clinical signs had improvement or resolution of signs postoperatively. No important perioperative complications occurred and all dogs were alive at a median of 8 months postoperatively (range, 3-14 months). Conclusions-LC can be accomplished safely and effectively in dogs with uncomplicated GBM. Clinical Relevance-A minimally invasive approach for cholecystectomy can be used for the treatment of GBM in dogs. r
Gastric Dilation and Volvulus Syndrome in Dog
Gastric dilatation and volvulus syndrome (GDV) in dogs is an abnormal accumulation of gastric gas (dilatation), which may be complicated by rotation of the stomach (volvulus) about its mesentric axis. A number of factors, both environmental and host have been implicated in GDV. This syndrome has a variety of effects on the cardiovascular, respiratory, gastrointestinal, metabolic, haemolymphatic-immune, renal and central nervous systems. Clinical signs include distended, painful, tympanic abdomen, retching, unproductive vomiting, hypersalivation, respiratory distress accompanied by varying degrees of shock. Treatment of GDV includes medical and fluid therapy at shock dosages to initially stabilize the patient followed by gastric decompression. Surgical procedure comprises of gastric derotation followed by partial gastrectomy or spleenectomy depending upon gastric or spleenic viability and lastly, permanent right sided gastropexy. Post surgical considerations include frequent small meals instead of one large meal, avoiding vigorous activity immediately after meals and not allowing animal to gorge on water after meals or activities.