Ultrasonographic patterns,clinical findings,and prognostic variables in dogs from Asia with gallbladder mucocele

BackgroundGallbladder mucocele (GBM) is a common biliary disorder in dogs that can be categorized into 6 types, but the value of this classification scheme remains unknown. Cholecystectomy is associated with high death rates and warrants additional interrogation.ObjectivesInvestigate the clinical value of ultrasonographic diagnosis of type of GBM and identify prognostic factors in dogs with GBM undergoing cholecystectomy.AnimalsTwo hundred sixteen dogs.MethodsRetrospective cohort study. Dogs with GBM diagnosed from 2014 to 2019 at 6 veterinary referral hospitals in Asia. Ultrasonogram images were reviewed and a GBM type (ie, types I‐VI) assigned.ResultsDogs with GBM type V as compared to I (OR, 8.6; 95% CI, 2.6‐27.8; P < .001) and III (OR, 10.0; 95% CI, 2.5‐40.8; P = .001), and dogs with type VI compared to I (OR, 10.5; 95% CI, 1.8‐61.2; P = .009) and III (OR, 12.3; 95% CI, 1.8‐83.9; P = .01) were more likely to exhibit signs of biliary tract disease. Independent predictors of death after cholecystectomy included age (OR, 2.81; 95% CI, 1.41‐5.59; P = .003) and intraoperative systolic blood pressure (SBP) nadir. There was an interaction between SBP nadir and gallbladder rupture; SBP nadir in dogs with (OR, 0.92; 95% CI, 0.89‐0.94; P < .001) and without (OR, 0.88; 95% CI, 0.82‐0.93; P < .001) gallbladder rupture.Conclusion and Clinical ImportanceIncreasing developmental stage of GBM could be associated with an increased likelihood of biliary tract related clinical signs. Nadir SBP deserves further investigation as a prognostic or potentially modifiable variable, particularly in the presence of gallbladder rupture.     

COMPARISON BETWEEN ULTRASONOGRAPHIC AND CLINICAL FINDINGS IN 43 DOGS WITH GALLBLADDER MUCOCELES

Cholecystectomy is the current standard recommended treatment for dogs with gallbladder mucoceles. However, medical management with monitoring has also been recommended for asymptomatic dogs. The purpose of this retrospective study was to compare ultrasonographic patterns of gallbladder mucoceles with clinical disease status in a group of dogs. For each included dog, the ultrasonographic pattern of the mucocele was classified into one of six types: type 1, immobile echogenic bile; type 2, incomplete stellate pattern; type 3, typical stellate pattern; type 4, kiwi like pattern and stellate combination; type 5, kiwi like pattern with residual central echogenic bile; and type 6, kiwi like pattern. A total of 43 dogs were included. Twenty‐four dogs, including 11 dogs with gallbladder rupture, were symptomatic. Nineteen dogs were asymptomatic. Cholecystectomy (n = 19), medical therapy (n = 17), or monitoring (n = 6) treatments were applied according to clinical signs and owners’ requests. One dog suspected of having gallbladder rupture was euthanized. Frequencies of gallbladder mucocele patterns were as follows: type 1 = 10 (23%), type 2 = 13 (30%), type 3 = 5 (12%), type 4 = 11 (26%), type 5 = 4 (9%), and type 6 = 0. In dogs with gallbladder rupture, type 2 (8/13) was the most common. No significant correlations were found between ultrasonographic patterns of gallbladder mucoceles and clinical disease status or gallbladder rupture. Findings indicated that ultrasonographic patterns of gallbladder mucoceles may not be valid bases for treatment recommendations in dogs.     

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 mucocele in dogs: 30 cases (2000-2002)

OBJECTIVE: To determine long-term outcome of dogs with gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 30 dogs with gallbladder mucocele, including 23 that underwent cholecystectomy. PROCEDURE: Medical records were reviewed for signalment, history, and clinical, ultrasonographic, and surgical findings. Follow-up information was obtained for all dogs that survived the perioperative hospitalization period. RESULTS: 23 dogs had signs of systemic illness; 7 had no clinical signs. Median values for serum activities of alanine aminotransferase and alkaline phosphatase, serum total bilirubin concentration, and total WBC count were significantly higher among dogs with gallbladder rupture than among dogs without rupture. Sensitivity of sonography for detection of rupture was 85.7%. Overall perioperative mortality rate for dogs that underwent cholecystectomy was 21.7%; mortality rate was not significantly greater for dogs with rupture. Aerobic bacteria were isolated from the bile or gallbladder wall in 8.7% of dogs. All 18 dogs discharged from the hospital had complete resolution of clinical signs. In dogs that underwent in-hospital reexamination, serum liver enzyme activities were significantly decreased, compared with preoperative activities. Persistent increases in serum activities of 1 or more liver enzymes were detected in 9 of 12 dogs; 6 of 12 dogs had persistent abnormalities in hepatic echogenicity. Mean follow-up period was 13.9 months. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cholecystectomy is an effective treatment for gallbladder mucocele. Although perioperative mortality rate is high, prognosis after discharge from the hospital is excellent. Rupture of the gallbladder warrants emergency surgical intervention but does not preclude a positive outcome.     

Factors affecting survival in 516 dogs that underwent cholecystectomy for the treatment of gallbladder mucocele

Gallbladder mucocele (GBM) is a commonly diagnosed disease process in dogs that is associated with high morbidity and mortality if not recognized and appropriately managed. Although the exact mechanism of this disease process is not completely understood, previous studies in smaller populations of dogs have identified multiple factors that predispose to the development of GBM and affect survival. The purpose of this cross-sectional, retrospective study was to evaluate the effects of age, breed category, sex, preoperative antibiotic administration, gallbladder rupture, and a positive biliary culture in dogs that had a cholecystectomy performed for the treatment of GBM. The age (median: 11 years) and percentage of dogs that died within 14 days of cholecystectomy (16.7%) are similar to what have been reported in other studies. Gallbladder rupture and a positive biliary culture occurred in 20.4% and 12.5% of dogs, respectively. Dogs with a gallbladder rupture and positive biliary culture were 2.74 and 3.10 times more likely to die within 14 days of cholecystectomy, respectively. This contradicts a recent study that failed to find a significant association between survival and biliary culture result. Interestingly, younger age was associated with an increased occurrence of gallbladder rupture in that population. Because of the potential effect of gallbladder rupture and a biliary tract infection, abdominal imaging, biliary culture, and empirical preoperative antimicrobial therapy are recommended in dogs undergoing cholecystectomy for the treatment of GBM.     

Left atrial deformation and phasic function determined by two-dimensional speckle-tracking echocardiography in dogs with myxomatous mitral valve disease

Introduction

Left atrial (LA) function can provide useful information in dogs with myxomatous mitral valve disease (MMVD). Recently, we have demonstrated the feasibility of measuring LA longitudinal deformation using speckle-tracking echocardiography (STE) to estimate LA function in healthy dogs. Whether LA strain and strain rate variables provide additional information about LA function and clinical cardiac status in dogs with MMVD remains unexplored.

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 Seroprevalence of Canine Influenza Virus H3N8 in Dogs Participating in a Flyball Tournament in Pennsylvania in 2010: A Follow‐Up Study

Background

Canine influenza virus (CIV) H3N8 infection is thought to be highly contagious and potentially deadly. Low seroprevalence in dogs participating in the sport of flyball in 2009 was reported. It remains unknown if prevalence is changing in dogs at risk.

Objective

To determine seroprevalence of antibodies to CIV H3N8 in a population of pet dogs that participated in an indoor flyball tournament in Pennsylvania in November 2010.

Animals

Dogs participating in a flyball tournament.

Methods

Medical, travel, and activity histories for previous 10.5 months were obtained from consenting owners and serum samples were collected from dogs. Antibodies to CIV H3N8 were measured using hemagglutination inhibition.

Results

Of 251 competing dogs, 103 dogs were tested. Overall, seroprevalence of CIV H3N8 in dogs participating in flyball was 1.9% (95% CI, 0.05–6.8%). Thirty‐five dogs were tested in both 2009 (all titers <8) and 2010 (all titers <8). Ten of 103 dogs had been vaccinated for CIV H3N8. Two dogs had positive titers (>8) and both had been vaccinated twice in the previous month. Titers in remaining 8 vaccinated dogs were undetectable. Seroprevalence in vaccinated dogs was 20% (95% CI, 5.7–50.1%), whereas in unvaccinated dogs it was 0% (95% CI, 0–4.0%). Although 7 dogs had history of respiratory signs, only 1, which was vaccinated, was serologically positive for CIV H3N8.

Conclusions

Consistent with low prevalence of CIV H3N8 exposure previously reported in flyball dogs, unvaccinated dogs had 0% prevalence, suggesting a stable exposure rate. However, low seroprevalence may result in unprotected flyball dogs at risk for developing CIV H3N8.     

Cholangitis and Cholangiohepatitis in Dogs: A Descriptive Study of 54 Cases Based on Histopathologic Diagnosis (2004–2014)

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.     

Idiopathic Canine Laryngeal Paralysis as One Sign of a Diffuse Polyneuropathy: An Observational Study of 90 Cases (2007–2013)

Objective

To determine survival and incidence of complications in dogs with idiopathic laryngeal paralysis (ILP) and concurrent neurologic signs.

Study Design

Observational study.

Animals

Dogs (n = 90) with ILP.

Methods

Medical records (January 2007–June 2013) of dogs with ILP were reviewed. Neurologic comorbidities, including pelvic limb neurologic abnormalities and esophageal abnormalities were identified. Using medical record information and client interviews, the relationship between these comorbidities and postoperative survival (primary outcome measure) and postoperative complications (secondary outcome measure) was identified.

Results

Dogs that had surgical correction of ILP had a 2.6‐fold reduction in the hazard of death throughout the study period (HR = 2.6; 95% CI: 1.34–4.84, P = .006). Owner assessed patient quality of life (10‐point scale) increased by an average of 4.1 ± 1.4 units immediately postoperatively, and 4.9 ± 0.9 units until death or followup compared with preoperative values. Thirty‐five of 72 dogs available for followup had evidence of diffuse neurologic comorbidities. Overall complication rate for dogs with neurologic comorbidities was 74%, compared with 32% for dogs without neurologic comorbidities. Presence of any neurologic comorbidity was associated with a significantly greater odds of any complication (OR = 4.04; 95% CI: 1.25–13.90, P = .019) as well as recurring complications (OR = 8.00; 95% CI: 1.49–54.38; P = .015).

Conclusion

Surgical correction of ILP was positively associated with survival, and dogs with neurologic comorbidities were at greater risk for developing postoperative complications.

     

Epidemiology and clinical significance of canine distichiasis: A retrospective study of 291 cases

Objective

To describe the epidemiological factors and clinical significance of canine distichiasis.

Animals studied

Two hundred and ninety-one client-owned dogs.

Methods

Retrospective study of medical records for canine patients diagnosed with distichiasis between 2010 and 2019 in an ophthalmology specialty practice. The breed, sex, skull conformation, coat type, age at the time of diagnosis, reason for presentation, clinical examination findings, and affected eyelid(s) were reviewed.

Results

The prevalence of distichiasis was 5.5% (95% confidence interval (CI): 4.9–6.1) in the population of dogs presented to an ophthalmology specialty practice. The breeds with the highest prevalence were English bulldogs (35.2%, 95% CI: 26.7–43.7) and American cocker spaniels (19.4%, 95% CI: 8.3–30.5). The prevalence was significantly higher in brachycephalic dogs (11.9%, 95% CI: 9.8–14.0) than in non-brachycephalic dogs (4.6%, 95% CI: 4.0–5.3) and in short-haired dogs (8.2%, 95% CI: 6.8–9.6) than in dogs with other coat types (5.3%, 95% CI: 4.5–6.1). Most dogs were affected bilaterally (63.6%, 95% CI: 58.0–69.1). Among dogs with clinical signs, 39.0% (95% CI: 26.5–51.4) exhibited corneal ulceration, including superficial ulcers (28.8%, 95% CI: 17.3–40.4) and deep stromal ulcers (10.2%, 95% CI: 2.5–17.8). Distichiasis was non-irritating in 85.0% (95% CI: 80.6–89.4) of affected dogs.

Conclusion

This study reports the largest cohort of canine distichiasis to date. In a large proportion of dogs, distichiasis was a non-irritating condition. However, brachycephalic breeds, especially English bulldogs, were the most frequently and severely affected.     

Ultrasonography and surgery of canine biliary diseases

Findings of hepatic and gallbladder ultrasonography were analyzed in 12 dogs with gallbladder and/or extrahepatic biliary tract obstruction and compared with the results of exploratory laparotomy. Hepatic ultrasonography demonstrated normal liver in 2 dogs and hepatic abnormalities in 10 animals. The following ultrasonographic diagnoses were established compared to surgical findings: gallbladder obstruction caused by bile sludge (correct/incorrect: 1/2, surgical diagnosis: choleliths in one case), gallbladder obstruction caused by neoplasm (0/1, surgical diagnosis: mucocele), gallbladder and extrahepatic biliary tract obstruction due to choleliths (3/3), extrahepatic biliary tract obstruction caused by pancreatic mass (1/1) and small intestinal volvulus (1/1). Bile peritonitis caused by gallbladder rupture (4/4) was correctly diagnosed by ultrasound, aided with ultrasonographically-guided abdominocentesis and peritoneal fluid analysis. Rupture of the gallbladder should be suspected in the presence of a small, echogenic gallbladder or in the absence of the organ together with free abdominal fluid during ultrasonography. Laparotomy was correctly indicated by ultrasonography in all cases. However, the direct cause of obstruction could not be determined in 2 of the 12 dogs by ultrasonography alone.     

EVALUATION OF CONTRAST‐ENHANCED ULTRASONOGRAPHY AS A METHOD FOR DETECTING GALLBLADDER NECROSIS OR RUPTURE IN DOGS

Gall bladder necrosis and rupture are life‐threatening conditions in dogs requiring surgical intervention and early diagnosis is essential. Human patients with suspected gall bladder necrosis/rupture are commonly evaluated with contrast‐enhanced ultrasonography (CEUS), however this procedure has not been described in dogs with suspected gall bladder necrosis/rupture. In a prospective diagnostic cohort study, CEUS (using SonoVue contrast medium) was performed in 93 dogs with gallbladder lesions identified by abdominal conventional ultrasonography. Necrosis/rupture was identified by CEUS as a focal lack of enhancement of the gallbladder wall. Dogs with positive CEUS finding for necrosis/rupture (complete lack of regional wall enhancement) underwent immediate surgery as did dogs with other biliary disorders requiring surgery. Dogs with negative CEUS findings or those not requiring surgery were managed medically. In cases undergoing surgery, necrosis/rupture was confirmed intraoperatively (and via histopathology). Absence of necrosis/rupture was confirmed either intraoperatively (via histopathology) or was assumed to be absent by complete recovery with medical management. Forty‐nine dogs underwent surgery and cholecystectomy: 24 had necrosis/rupture. CEUS was more accurate (100% sensitive and specific) in diagnosing gallbladder wall necrosis/rupture than conventional ultrasonography (75% sensitive and 81% specific) (P < 0.03). In conclusion, CEUS provides accurate characterization of gallbladder wall integrity that can impact decisions regarding clinical management, either surgical or medical.     

ULTRASONOGRAPHIC APPEARANCE AND CLINICAL FINDINGS IN 14 DOGS WITH GALLBLADDER MUCOCELE

Fourteen dogs with enlarged gallbladders and immobile stellate or finely striated bile patterns on ultrasound are described. Smaller breeds and older dogs were overrepresented, with 4/14 Cocker Spaniels. Most dogs presented for nonspecific clinical signs such as vomiting, anorexia and lethargy. Abdominal pain, icterus and hyperthermia were the most common findings on physical examination. All dogs except one had serum elevation of total bilirubin and/or alkaline phosphatase, alanine aminotransferase and gamma glutamyl transferase. All dogs were diagnosed with a gallbladder mucocele upon histologic and/or macroscopic evaluation. Ultrasonographically, mucoceles are characterized by the appearance of the stellate or finely striated bile patterns and differ from biliary sludge by the absence of gravity dependent bile movement. On ultrasound, gallbladder wall thickness and wall appearance were variable and nonspecific. The cystic or common bile duct were normal sized in 5 dogs although all 5 had evidence of biliary obstruction at surgery or necropsy. Loss of gallbladder wall integrity and/or gallbladder rupture were present in 50% of the dogs, all located in the fundus. Gallbladder wall discontinuity on ultrasound indicated rupture whereas neither bile patterns predicted the likelihood of gallbladder rupture. Pericholecystic hyperechoic fat or fluid were suggestive of but not diagnostic for a gallbladder rupture. Cholecystectomy appears to be an appropriate treatment for mucoceles, if not to treat a gallbladder rupture, at least in most dogs to prevent it since gallbladder wall necrosis was identified by histology in 9 of 10 dogs. Mucosal hyperplasia was present in all gallbladders examined histologically. Positive aerobic bacterial culture was obtained from bile in 6 of 9 dogs. Cholecystitis was diagnosed histologically in 5 dogs and 4 dogs had signs of gallbladder infection solely upon bacterial bile culture. Gallbladder infection was not present with all the mucoceles suggesting that biliary stasis and mucosal hyperplasia may be the primary factors involved in mucocele formation. Based on the results of our study, we suggest two alternate courses of action in the presence of a distended gallbladder with an immobile ultrasonographic stellate or finely striated bile pattern: a cholecystectomy when clinical or biochemical signs of hepatobiliary disease are present or a medical treatment (antibiotics and choleretics) and patient monitoring by follow-up ultrasound examinations when the patient does not have clinical or biochemical abnormalities. An aerobic bile culture should be obtained in all patients, by ultrasound-guided fine needle aspirate or at surgery.     

Gallbladder perforation associated with cholelithiasis and cholecystitis in a dog

A four-year-old female Japanese akita was admitted with icterus, ascites and chronically elevated serum bilirubin and liver enzymes. Abdominal ultrasonography revealed a diffusely thickened, hyperechoic gallbladder wall with a focal defect, hepatic lymphadenopathy and a large volume of anechoic fluid within the peritoneal space. Diagnosis of biliary tract rupture with bile peritonitis was based on the findings of bile and suppurative exudate in peritoneal aspirates. A perforated gallbladder and cholelithiasis were found on exploratory celiotomy, while histopathology revealed chronic suppurative cholecystitis. The dog recovered uneventfully after cholecystectomy. Although rare, the triad of cholelithiasis, cholecystitis and gallbladder perforation should be considered after detection of one of these conditions.     

Prevalence of and Risk Factors for Degenerative Mitral Valve Disease in Dogs Attending Primary‐care Veterinary Practices in England

Background

To date, epidemiological studies on degenerative mitral valve disease (DMVD) in dogs have largely reported referral caseloads or been limited to predisposed breeds. Analysis of primary‐care data to identify factors associated with DMVD would help clinicians identify high‐risk individuals and improve understanding.

Objectives

To estimate the prevalence of and identify risk factors for DMVD in dogs attending primary‐care veterinary practices in England.

Animals

Cases were identified within the electronic patient records of 111,967 dogs attending 93 practices. Four hundred and 5 dogs were diagnosed with DMVD (diagnosed cases) and a further 3,557 dogs had a heart murmur (HM) consistent with DMVD (possible cases).

Methods

Retrospective cross‐sectional study design. Prevalence was adjusted for the sampling approach. Mixed effects logistic regression models identified factors associated with DMVD.

Results

Prevalence estimates of diagnosed DMVD and HMs consistent with DMVD (both diagnosed and possible cases) were 0.36% (95% confidence interval [CI]: 0.29–0.45) and 3.54% (95% CI: 3.26–3.84) respectively. In the multivariable analysis, males had higher odds of diagnosed DMVD than did females (odds ratio [OR] 1.40, 95% CI: 1.12–1.74). Insured dogs had increased odds of DMVD compared with noninsured dogs (OR 3.56, 95% CI: 2.79–4.55) and dogs ≥20 kg had approximately half the odds of DMVD diagnosis compared with dogs <20 kg (OR 0.51, 95% CI: 0.36–0.74). Strong associations between a DMVD diagnosis and individual breeds and age were identified.

Conclusions and Clinical Importance

Degenerative mitral valve disease was a common disorder in practice‐attending dogs. Knowledge of identified risk factors for DMVD could improve clinical diagnosis and direct future research.     

Influence of signalment on developing cranial cruciate rupture in dogs in the UK

Objectives : To investigate risk factors associated with cranial cruciate ligament rupture in dogs. Methods : Retrospective case‐control study: medical records of a first‐opinion veterinary practice were searched for dogs diagnosed with cranial cruciate ligament rupture (1995 to 2007). For each case, six unaffected dogs were randomly selected from all dogs presenting that day for comparison. Multi‐variable binary logistic regression was performed to assess the association of variables on likelihood of cruciate rupture. Results : Frequency of cranial cruciate ligament rupture was 1·19% [95% confidence interval (CI) 1·02 to 1.36%]. West Highland white terriers (n=17), Yorkshire terriers (n=14) and Rottweilers (n=11) were at significantly increased risk of cranial cruciate ligament rupture (P≤0·002). Rottweilers were at five times greater risk compared with other pure breeds (OR 5·12, 95% CI 2·281 to 11·494, P<0·001), obesity quadrupled the risk of cranial cruciate ligament rupture (OR 3·756, 95% CI 1·659 to 8·502, P=0·001) and females were twice as likely to suffer cranial cruciate ligament failure compared to males (OR 2·054, 95% CI 1·467 to 2·877, P<0·001). Dogs less than two years old were statistically less likely to sustain cranial cruciate ligament rupture than dogs older than eight years (OR 0·246, 95% CI 0·127 to 0·477, P<0·001). There was no significant difference in median weights (in kilograms) of neutered dogs, compared to their entire counterparts in either the case group (P=0·994) or in the control group (P=0·630). There was also no significant difference in body condition (‐underweight/normal weight/overweight/obese) of neutered versus entire dogs among the cases (P=0·243), or the controls (P=0·211). Clinical Significance : Cranial cruciate ligament rupture is more likely in Rottweilers and in female dogs, older dogs and obese dogs. Following multi‐variable analysis, it was established that neutering was not associated with increased risk of cranial cruciate ligament rupture.     

Surgical management of gallbladder mucoceles in dogs: 22 cases (1999-2003)

OBJECTIVES: To describe preoperative, surgical, and postoperative findings and determine prognostic indicators and treatment recommendations in dogs treated surgically for gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURES: Medical records of dogs with gallbladder mucoceles that were treated surgically were reviewed. History, clinical signs, results of selected clinicopathologic analyses and abdominal ultrasonography, surgical procedure performed, results of histologic examination of a liver biopsy specimen, and survival time were recorded. Follow-up information was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs were 7 to 15 years of age and had non-specific clinical signs (vomiting, anorexia, and lethargy). Physical examination findings included icterus, signs of depression, and signs of discomfort on palpation of the abdomen. Sixteen dogs had a definitive diagnosis and 6 dogs were strongly suspected of having a gallbladder mucocele on the basis of results of abdominal ultrasonography. Fifteen dogs survived after surgery; 3 of these dogs had bile-induced peritonitis, and 4 had pancreatitis. One dog was euthanatized as a result of severe pancreatitis, and 1 was euthanatized because of acute renal failure; 5 dogs died as a result of pancreatitis, cholecystitis, or bile-induced peritonitis. Hepatic abnormalities were detected histologically in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE: No predictors of survival were identified. No associations between outcome of surgical treatment (survival vs nonsurvival) and preoperative findings, biliary rupture, surgical procedure performed, results of histologic examination of the liver, or development of pancreatitis were found. Cholecystoduodenostomy and cholecystectomy appear to be acceptable treatments for gallbladder mucocele.     

Microbiologic Evaluation of Gallbladder Bile of Healthy Dogs and Dogs with Iatrogenic Hypercortisolism: A Pilot Study

Background: In people, hypercortisolism (HC) has been associated with acalculous cholecystitis and biliary dyskinesia, which may potentiate ascending biliary infections. In dogs, an association between HC and gallbladder disease recently has been documented, although the role of bacteria remains controversial. Furthermore, there is no information on the gallbladder bile microbial flora in healthy dogs.
Objectives: To investigate the microbial flora in gallbladder bile in healthy dogs, the relationship between iatrogenic hyperadrenocorticism and bactibilia and possible changes in biliary microbial flora after cortisol withdrawal in dogs.
Animals: Six control dogs and 6 dogs treated with hydrocortisone.
Methods: Gallbladder bile obtained by percutaneous ultrasound-guided cholecystocentesis was cultured aerobically and anaerobically and examined cytologically before (d0), during (d28, d56, d84), and after (d28p, d56p, d84p) administration of hydrocortisone (8 mg/kg PO q12h).
Results: In the control group, 2/42 bile cultures yielded bacterial growth ( Enterococcus sp.; Escherichia coli on d0) and 1/42 bile smears had cytological evidence of bacteria (d28). In the HC group, 2/42 bile cultures yielded bacterial growth ( Enterococcus sp. on d28; Bacillus sp. on d28p) and 3/42 bile smears had cytological evidence of bacteria (d84, d84, d28p). All dogs remained healthy throughout the study period (168d).
Conclusions and Clinical Importance: Based on the results of conventional bacterial culture techniques, gallbladder bile of healthy dogs periodically may harbor bacteria, which do not appear to be clinically relevant. A 3-month period of iatrogenic HC was not associated with bactibilia. A higher prevalence of bactibilia may be detected with micromolecular techniques.     

Gallbladder disease in Shetland Sheepdogs: 38 cases (1995-2005)

OBJECTIVE: To determine risk, clinical features, and treatment responses for gallbladder disorders in Shetland Sheepdogs. DESIGN: Retrospective case-control study. ANIMALS: 38 Shetland Sheepdogs with gallbladder disease. PROCEDURES: Medical records were reviewed for signalment, history, physical findings, laboratory results, imaging features, coexistent illnesses, histologic findings, treatments, and survival rates. RESULTS: Mature dogs with gastrointestinal signs were predisposed (odds ratio, 7.2) to gallbladder disorders. Gallbladder mucocele was confirmed in 25 dogs. Concurrent problems included pancreatitis, hyperlipidemia, corticosteroid excess, hypothyroidism, protein-losing nephropathy, diabetes mellitus, cholelithiasis, and gallbladder dysmotility. Mortality rate was 68% with and 32% without bile peritonitis. Nonsurvivors had high WBC and neutrophil count and low potassium concentration. Although preprandial hypercholesterolemia, hypertriglyceridemia, and high serum liver enzyme activities were common, gallbladder disease was serendipitously discovered in 11 of 38 dogs. Histologic examination (n=20 dogs) revealed gallbladder cystic mucosal hyperplasia in 20 dogs, cholecystitis in 16, periportal hepatitis in 9, and vacuolar hepatopathy in 7. Surgery included cholecystectomy (n=17) and cholecystoenterostomy (4). In 1 hyperlipidemic dog without clinical signs, gallbladder mucocele resolved 6 months after beginning use of a fat-restricted diet and ursodeoxycholic acid. CONCLUSIONS AND CLINICAL RELEVANCE: Shetland Sheepdogs are predisposed to gallbladder disorders, with mucoceles and concurrent dyslipidemia or dysmotility in many affected dogs. Most dogs were without clinical signs during mucocele development. Low survival rate after cholecystectomy in clinically affected dogs suggested that preemptive surgical interventions may be a more appropriate treatment strategy.