Gallbladder Mucocele: Variables Associated with Outcome and the Utility of Ultrasonography to Identify Gallbladder Rupture in 219 Dogs (2007–2016)

Background

Gallbladder mucocele (GBM) is an increasingly recognized extrahepatic biliary disease in dogs.

Objectives

To investigate cases of GBM and identify variables associated with survival and the sensitivity and specificity of ultrasonography to identify gallbladder rupture.

Animals

Two hundred and nineteen client‐owned dogs with GBM.

Methods

Multicenter, retrospective study of dogs with GBM, presented from January 2007 to November 2016 to 6 academic veterinary hospitals in the United States. Interrogation of hospital databases identified all cases with the inclusion criteria of a gross and histopathologic diagnosis of GBM after cholecystectomy and intraoperative bacteriologic cultures of at least 1 of the following: gallbladder wall, gallbladder contents, or abdominal effusion.

Results

Two hundred and nineteen dogs fulfilled the inclusion criteria. Dogs with GBM and gallbladder rupture with bile peritonitis at the time of surgery were 2.7 times more likely to die than dogs without gallbladder rupture and bile peritonitis (P = 0.001; 95% confidence interval [CI], 1.50–4.68; n = 41). No significant associations were identified between survival and positive bacteriologic cultures, antibiotic administration, or time (days) from ultrasonographic identification of GBM to the time of surgery. The sensitivity, specificity, positive, and negative likelihood ratios for ultrasonographic identification of gallbladder rupture were 56.1% (95% CI, 39.9–71.2), 91.7% (95% CI, 85.3–95.6), 6.74, and 0.44, respectively.

Conclusion and Clinical Importance

Dogs in our study with GBM and intraoperative evidence of gallbladder rupture and bile peritonitis had a significantly higher risk of death. Additionally, abdominal ultrasonography had low sensitivity for identification of gallbladder rupture.     

Association of Gallbladder Mucocele Histologic Diagnosis with Selected Drug Use in Dogs: A Matched Case‐Control Study

Background

The cause of gallbladder mucocele (GBM) formation in dogs currently is unknown. Many available drugs represent a newer generation of xenobiotics that may predispose dogs to GBM formation.

Objective

To determine if there is an association between the histologic diagnosis of GBM in dogs and administration of selected drugs.

Animals

Eighty‐one dogs with a histologic diagnosis of GBM and 162 breed, age, and admission date‐matched control dogs from a single referral institution.

Methods

Medical records of dogs with GBM and control dogs from 2001 to 2011 were reviewed. Owner verification of drug history was sought by a standard questionnaire. Reported use of heartworm, flea, and tick preventatives as well as nonsteroidal anti‐inflammatory drugs, analgesics, corticosteroids, or medications for treatment of osteoarthritis was recorded.

Results

Dogs with GBM were 2.2 times as likely to have had reported use of thyroxine (as a proxy for the diagnosis of hypothyroidism) as control dogs (95% confidence interval [CI], 0.949–5.051), 3.6 times as likely to have had reported treatment for Cushing''s disease (95% CI, 1.228–10.612), and 2.3 times as likely to have had reported use of products containing imidacloprid (95% CI, 1.094–4.723). Analysis of a data subset containing only Shetland sheepdogs (23 GBM and 46 control) indicated that Shetland sheepdogs with GBM formation were 9.3 times as likely to have had reported use of imidacloprid as were control Shetland sheepdogs (95% CI, 1.103–78.239).

Conclusions and Clinical Importance

This study provides evidence for an association between selected drug use and GBM formation in dogs. A larger epidemiologic study of Shetland sheepdogs with GBM formation and exposure to imidacloprid is warranted.     

The Cow in Endocrine Focus Before and After Calving

During the period 1 month before and 1 month after parturition in the cow, several events take place. The dam has to be prepared for the impending parturition and the uterus and ovaries must return to a certain stage to be prepared for a new pregnancy. Most of these processes are due to or reflected in endocrine changes. A special interest is of course the status of the foetus --"foetal well being". The processes could either be considered as normal in a clinical perspective or as impaired (dystocia, small calves, stillbirth, retained foetal membranes, etc.). The main question for this presentation is if normal and impaired performance could be mirrored in endocrine parameters. Many studies have been performed to follow endocrine changes during the periparturient period in the cow. The following parameters have been shown to be the most important and seem to be the most suitable for an endocrine supervision: Endocrine parameter: progesterone; parameter of: corpus luteum, maternal adrenals, placenta. Endocrine parameter: prostaglandin (PG) metabolite; parameter of: placenta, uterus, inflammation. Endocrine parameter: cortisol; parameter of: regulator of prostaglandin synthesis, stress. Endocrine parameter: free oestrogens; parameter of: placenta, ovaries. Endocrine parameter: oestrone sulphate; parameter of: placenta, calf weight. Endocrine parameter: pregnancy-associated glycoproteins (PAG); parameter of: placenta.     

Endocrine tumors.

Because of the diverse nature of endocrine organs, and their vast range of physiologic functions, endocrine tumors encompass a wide range of origination sites and disease entities. The clinical picture of affected individuals is highly dependent on the tissue of origin, and the presence or absence of functional hormone secretions. Identification, localization, and therapeutic strategies, as well as prognosis can vary greatly. Many endocrine tumors have been described in human as well as veterinary patients. This article focuses on endocrine tumors of dogs and cats. Various tumors affecting the pancreas, thyroid, parathyroid, adrenal and pituitary glands are described, including insulinoma, gastrinoma, glucagonoma, and thyroid carcinoma, as well as parathyroid hormone- and growth hormone-secreting tumors. The syndrome of multiple endocrine neoplasia is also described.     

环境内分泌干扰物对睾丸间质细胞功能的影响

近年来,环境内分泌干扰物(environmental endocrine disrupting chemicals,EDCs)对雄性动物的生殖毒性引起了广泛的关注。大量资料显示EDCs可引起雄性生殖发育障碍,如隐睾、尿道下裂、睾丸癌、精液品质不良等。作者就几种典型的EDCs对睾丸间质细胞分泌睾酮的影响机制作一综述。     

Gallbladder aspirate from a dog

A 7-year-old, male, castrated, Labrador Retriever with a history of pancreatitis and inflammatory bowel disease presented for vomiting and anorexia. Serum biochemistry findings were indicative of cholestasis, hepatocellular insult, and decreased hepatic function. Ultrasound examination showed sediment and gas within the gallbladder, and a diagnosis of emphysematous cholecystitis was made. Emergency gallbladder resection was performed. Cytologic examination of bile fluid collected at surgery showed a mixed population of bacteria (bactibilia) together with fungal organisms consistent with Cyniclomyces guttulatus (previously known as Saccharomycopsis guttulatus). Similar fungal organisms were seen on a fecal smear. Bacteria cultured were normal gastrointestinal flora, supporting ascending infection; the fungal organisms were interpreted as incidental. Histopathology of the gallbladder indicated active (suppurative) and chronic (lymphocytic) cholecystitis and sections of liver tissue had evidence of chronic liver disease. A positive liver culture indicated concurrent bacterial hepatitis or cholangiohepatitis. Despite supportive care, the dog continued to decline and was euthanized 30 days later. Necropsy results confirmed end stage liver disease, but an initiating cause was not found. This case highlights the role of bactibilia in the development of acute cholecystitis and the unique cytologic appearance of C guttulatus as an incidental finding in bile fluid.     

Laparoscopic Cholecystectomy for Management of Uncomplicated Gall Bladder Mucocele in Six Dogs

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=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.     

Gallbladder motility in sheep: effects of cholecystokinin and related peptides

Gallbladder motility was recorded as tonic and small amplitude (rhythmic) contractions in conscious sheep fitted with miniaturized strain-gauge force transducers located in the corpus and fundus. Nichrome wire electrodes were chronically implanted in the gastroduodenal area. Both tonic and superimposed rhythmic gallbladder contractions were increased during feeding. They decreased during the periodic phases of antroduodenal quiescence. The excitatory effects on gallbladder and antroduodenal motility were mimicked by pilocarpine and blocked by atropine. Cholecystokinin (CCK-OP) and caerulein elicited motor responses of the gallbladder in a dose-related manner without antroduodenal stimulation. In contrast, pentagastrin induced gallbladder motor responses with concomitant stimulation of the antroduodenal area. The results suggest that feeding may act to trigger gallbladder motor activity through a mechanism related to the increased antroduodenal activity. Direct effects of CCK-OP and caerulein confirm that gallbladder motor function is also mediated through specific receptor sites.     

Endocrine disorders and laminitis

Two common endocrine disorders, pituitary pars intermedia dysfunction and equine metabolic syndrome, predispose horses and ponies to laminitis and may even induce the condition. The exact mechanisms involved in endocrinopathic laminitis have not been elucidated but hyperinsulinaemia and insulin resistance are currently being investigated. Obesity and regional adiposity may also contribute to laminitis susceptibility through the release of inflammatory cytokines and adipokines. In the case of pituitary pars intermedia dysfunction, glucocorticoid excess is likely to weaken hoof structures, alter vascular dynamics within the foot and induce or exacerbate insulin resistance. This review will summarise current theories regarding the pathophysiology of endocrinopathic laminitis and provide recommendations for the diagnosis and management of these common equine endocrine disorders.     

Gallbladder agenesis in a Maltese dog

This report describes the diagnostic evaluation of a 7-month-old, female Maltese dog with elevated liver enzymes. Marked elevations of alanine transferase were the significant clinical findings. A diagnosis of gallbladder agenesis was made, based on lack of a gallbladder on ultrasonography and on surgical exploration. Gallbladder agenesis is a rare condition described in humans but not previously reported in dogs.