1. Gallbladder disease and your pet
Tarleton state university
Advanced veterinary medical terminology
Mid-term
Spring 2016
Tiffany Bartlett, lvt

2. What is the gallbladder?
Stores bile from liver
Bile travels from gallbladder to duodenum via cystic duct-common bile duct
Digests fats

3. Cholecystitis caused by cholelithiasis
AKA: Gallbladder inflammation caused by gallbladder stones

4. Causes of choleliths Excess bilirubin in the bile
Excess cholesterol in the bile
Mucocele formation (bile turns gelatinous) preventing adequate emptying
Low bile salt concentration

5. What you (the owner) should look for
Depression
Anorexia (loss of appetite)
Vomiting
Dehydration secondary to vomiting- tacky gums, tented skin
Icteric (yellow) mucous membranes and sclera (gums and whites of eyes)
Abdominal pain
Hunched position, can mimic back pain
Pacing- can’t get comfortable

6. Your trip to the veterinarian
Initial Exam
Bloodwork
Advanced Imaging
Treatments
Discharge

7. Initial exam History of your pet Vitals Examination
Current concern- onset, duration, severity
Pertinent medical history
Vitals
Weight
Temperature
Heart rate/rhythm/sounds
Respiratory rate/lung sounds
Blood pressure
Examination
Head to tail medical assessment

8. Very vague findings-could be several hundred different causes
Initial exam findings
Painful abdomen
Icteric (if severe)
Vomiting
Lethargic
Fever (temperature >102.5°F)
Very vague findings-could be several hundred different causes
Not all patients will have all or any clinical signs

9. Your trip to the veterinarian
Initial Exam
Bloodwork
Advanced Imaging
Treatments
Discharge

10. Bloodwork Complete Blood Count (CBC) Electrolytes
Leukocytosis (elevated white blood cells)
Can be normal
Electrolytes
Imbalanced due to dehydration
Hypokalemia (decreased potassium in the blood)

11. Bloodwork Chemistry panel
Assesses liver, kidney, pancreas, and other vital organs
Varies widely
Elevated hepatic (liver) enzymes; ALT and GGT most commonly- not always seen
Hypercholesterolemia (elevated cholesterol)- not always seen

12. Additional bloodwork Rule out other causes of clinical signs
Canine Pancreatic Lipase (cPL) snap test- pancreatitis can occur conjunctively or be root cause
Bile Acids- elevation is indicative of hepatic or gall bladder disease
Does not distinguish mucocele, stones, rupture, or other causes

13. Your trip to the veterinarian
Initial Exam
Bloodwork
Advanced Imaging
Treatments
Discharge

14. Advanced imaging Radiographs (aka x-rays)
2 or 3 view abdomen ( left and/or right lateral and ventrodorsal)
May not be diagnostic if the gall bladder has ruptured or not fully distended
Ruptured gall bladder causes peritonitis
A radiolucent distended gallbladder is seen (arrow) on this ventrodorsal view

15. Ultrasonography Full abdominal ultrasound Best diagnostic tool
Diagnosis and rules out other disease processes
The gall bladder appears Kiwi shaped- gallbladder mucocele
May also see pancreatitis (inflamed pancreas) caused by cholecystitis

16. Your trip to the veterinarian
Initial Exam
Bloodwork
Advanced Imaging
Treatments
Discharge

17. treatments Emergent Non-emergent Icterus is present
Severe clinical signs
Fully distended gallbladder
Gallbladder rupture
Peritoneal effusion
Needs surgery within hours
Minimal to no clinical signs
Finding of choleliths or biliary mucocele was incidental

18. Non-emergent
Surgery is planned- cholecystectomy or cholecystoduodenostomy
Alternatively the gall bladder could be imaged every 6 months but is not recommended
increases chance of non-emergent patients becoming emergent RX
Ursodiol
Bile acid- reduces uptake, synthesis, and production of cholesterol
s-adenosylmethionine (SAMe, Denosyl®)
Nutritional supplement, liver protectant
Omega-3 fatty acid supplementation
Famotidine (Pepcid AC®)
Low-fat diets

19. Surgery Cholecystectomy Cholecystoduodenostomy Gall bladder removal
For choleliths, gall bladder mucocele, or ruptured gall bladder
Relocating the gallbladder from the liver
Creating a new hole directly from the gall bladder to the duodenum
Bypassing the common bile duct
For bile duct stricture, tumor, or pancreatitis leading to obstruction of the bile duct

20. cholecystoduodenostomy
cholecystectomy
Typical
cholecystoduodenostomy

21. Emergency May need plasma transfusion
Depending on bloodwork; hypoproteinemia
Increased anesthetic and post operative complications
Sepsis, coagulopathies (clotting disorders), pancreatitis, hepatitis, dehiscence, cardiac/respiratory collapse
IV fluids, antibiotics, and pain medication- hospitalized for several days

22. Emergency
If ruptured gallbladder, may need abdominal drains placed
This condition has a decreased change of survival
Mortality rates are between 20–39% for this disease- early surgical intervention may significantly reduce mortality rates
All questions regarding your specific pets prognosis should be discussed with the surgeon.

23. Post operative testing
Bloodwork to recheck hepatic values, coagulation times, and other parameters will be periodically monitored
Critical cases will have an arterial catheter placed for constant blood pressure and heart rate monitoring
A central catheter, esophagostomy tube, and urinary catheter may also need to be placed
Culture of the gall bladder and biopsies will be sent out for testing
Culture allows for specific antibiotic use instead of an educated guess
Biopsies to rule out an underlying cause

24. Your trip to the veterinarian
Initial Exam
Bloodwork
Advanced Imaging
Treatments
Discharge

25. At home Confined for 10-14 days Low fat diet for life
It takes ~2 weeks for the muscle, subcutaneous, and cutaneous layers to heal
Excessive movement puts strain on healing tissues causing dehiscence
Low fat diet for life
<10% of fat

26. At home RX Pain medications Antibiotics Famotidine
NSAID (non steroidal anti-inflammatory) use will depend on hepatic values
Opioids- (Tramadol)
Antibiotics
Depending on culture results, can be multiple
Famotidine
Cerenia- antinausea, only if indicated
Ursodiol
Denamarin- liver protectant

27. Rechecks
Typically the surgeon only needs to see your pet 2 weeks after discharge
Unless complications arise
Life time care should be overseen by your regular veterinarian
Prescription refills (Ursodiol and Denamarin)
Annual or biannual blood work (complete blood count, chemistry, and electrolytes)

28. References
American College of Veterinary Surgeons. (2015). Gallbladder Mucocele | ACVS. Retrieved February 28, 2016, from (Slides 5; 8; 15-18)
Animal Surgical Center of Michigan. (2009). Gallbladder Mucocele in Dogs. Retrieved February 28, , from (Slides 25-27)
Cornell. (2016). Biliary System [Digital rendering]. Retrieved from (Slide 2)
Crews, L. J., Feeney, D. A., Jessen, C. R., & Rose, N. D. (2009, February 1). AVMA - Journal of the American Veterinary Medical Association - 234(3):359 - Abstract. Retrieved February 28, 2016, from (Slide 17)

29. References
Degner, D. (2004). Gall bladder disease. Retrieved February 28, 2016, from (Slides 19; 20-23)
DVM 360. (2014, August 1). Female veterinary lab technician [Photograph]. Retrieved from blood-lab-work-female-tech _460x284.jpg (Slide 11)
Heartland Vet Supply. (2016). Ursodiol [Photograph]. Retrieved from (Slide 18)
IDEXX. (n.d.). CPL Snap Test [Photograph]. Retrieved from (Slide 12)
Lyman, R. (2009, August 1). Gallbladder mucoceles: Surgery still recommended due to risk of rupture. Retrieved February 27, 2016, from (Slides 10-11; 14; 21-23; 26)

30. References
Meditoons. (2012, December 2). Acute Cholecystitis (Gallbladder Attack) Meditoons™ [Video file]. Retrieved from (Slide 3)
Medscape. (2016). Radiograph [Radiograph]. Retrieved from tn.jpg (Slide 14)
Pet MD. (2016). Ursodiol - Pet, Dog and Cat Medication and Prescription List | petMD. Retrieved February 26, 2016, from (Slide 18)
Quizlet. (2016). Blood smear [Picture]. Retrieved from (Slide 10)

31. References
Rodriguez, D., & Jasmer, R. (2015, March 26). What Are Gallstones? | Everyday Health. Retrieved February 26, 2016, from (Slide 4)
Romich, Janet Amundson ( ). An Illustrated Guide to Veterinary Medical Terminology (Page 304). Delmar Cengage Learning. Kindle Edition. (Slide 2)
Spielman, B., & Morgan, R. (2015, July 13). Jaundice in Dogs. Retrieved February 26, 2016, from dogs/symptoms/jaundice-in-dogs (Slide 4)
The Awkward Yeti. (2014). Gallbladders' last day [Cartoon]. Retrieved from (Slide 4)
VCA Animal Hospitals. (2016). Serum Bile Acids | VCA Animal Hospitals. Retrieved February 28, 2016, from information/article/animal-health/serum-bile-acids/122 (Slide 12)