Gallbladder disease and your pet - PowerPoint Presentation

Slide1

Gallbladder disease and your pet

Tarleton state university

Advanced veterinary medical terminology

Mid-term

Spring 2016

Tiffany Bartlett,

lvtSlide2

What

is

the gallbladder?

Stores bile from liverBile travels from gallbladder to duodenum via cystic duct-common bile ductDigests fatsSlide3

Cholecystitis caused by cholelithiasis

AKA: Gallbladder inflammation caused by gallbladder stonesSlide4

Causes of choleliths

Excess bilirubin in the bile

Excess cholesterol in the bile

Mucocele formation (bile turns gelatinous) preventing adequate emptyingLow bile salt concentrationSlide5

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 comfortableSlide6

Your trip to the veterinarian

Initial Exam

Bloodwork

Advanced Imaging

Treatments

DischargeSlide7

Initial exam

History of your pet

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 assessmentSlide8

Initial exam findings

Painful abdomen

Icteric (if severe)

VomitingLethargicFever (temperature >102.5°F)

Very vague findings-could be several hundred different causesNot all patients will have all or any clinical signsSlide9

Your trip to the veterinarian

Initial Exam

Bloodwork

Advanced Imaging

Treatments

DischargeSlide10

Bloodwork

Complete Blood Count (CBC)

Leukocytosis (elevated white blood cells)

Can be normalElectrolytesImbalanced due to dehydration

Hypokalemia (decreased potassium in the blood)Slide11

Bloodwork

Chemistry panel

Assesses liver, kidney, pancreas, and other vital organs

Varies widelyElevated hepatic (liver) enzymes; ALT and GGT most commonly- not always seen Hypercholesterolemia (elevated cholesterol)- not always seenSlide12

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 causesSlide13

Your trip to the veterinarian

Initial Exam

Bloodwork

Advanced Imaging

Treatments

DischargeSlide14

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 viewSlide15

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 Slide16

Your trip to the veterinarian

Initial Exam

Bloodwork

Advanced Imaging

Treatments

DischargeSlide17

treatments

Emergent

Icterus is present

Severe clinical signsFully distended gallbladderGallbladder rupturePeritoneal effusion

Needs surgery within hoursNon-emergent

Minimal to no clinical signs

Finding of choleliths or biliary mucocele was incidentalSlide18

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 emergentRX Ursodiol

Bile acid- reduces uptake, synthesis, and production of cholesterols-adenosylmethionine (SAMe, Denosyl®)

Nutritional supplement, liver protectant

Omega-3 fatty acid supplementation

Famotidine (Pepcid AC®)

Low-fat dietsSlide19

Surgery

Cholecystectomy

Gall bladder removal

For choleliths, gall bladder mucocele, or ruptured gall bladder

CholecystoduodenostomyRelocating the gallbladder from the liverCreating 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 ductSlide20

Typical

cholecystectomy

cholecystoduodenostomySlide21

Emergency

May need plasma transfusion

Depending on bloodwork; hypoproteinemia

Increased anesthetic and post operative complicationsSepsis, coagulopathies (clotting disorders), pancreatitis, hepatitis, dehiscence, cardiac/respiratory collapse

IV fluids, antibiotics, and pain medication- hospitalized for several daysSlide22

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.Slide23

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 placedCulture of the gall bladder and biopsies will be sent out for testing

Culture allows for specific antibiotic use instead of an educated guessBiopsies to rule out an underlying causeSlide24

Your trip to the veterinarian

Initial Exam

Bloodwork

Advanced Imaging

Treatments

DischargeSlide25

At home

Confined for 10-14 days

It takes ~2 weeks for the muscle, subcutaneous, and cutaneous layers to heal

Excessive movement puts strain on healing tissues causing dehiscenceLow fat diet for life<10% of fatSlide26

At home

RX

Pain medications

NSAID (non steroidal anti-inflammatory) use will depend on hepatic valuesOpioids- (Tramadol)Antibiotics

Depending on culture results, can be multipleFamotidineCerenia- antinausea, only if indicatedUrsodiolDenamarin- liver protectantSlide27

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 veterinarianPrescription refills (Ursodiol and Denamarin)Annual or biannual blood work (complete blood count, chemistry, and electrolytes)Slide28

References

American College of Veterinary Surgeons. (2015). Gallbladder Mucocele | ACVS. Retrieved February 28, 2016, from

https://www.acvs.org/small-animal/gallbladder-mucocele

(Slides 5; 8; 15-18)

Animal Surgical Center of Michigan. (2009). Gallbladder Mucocele in Dogs. Retrieved February 28, 2016, from

http://animalsurgicalcenter.com/Library_articles/gi_gallbladder_mucocele

(Slides 25-27)

Cornell. (2016). Biliary System [Digital rendering]. Retrieved from

http://weill.cornell.edu/cms/health_library/images/ei_0054.gif

(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

http://avmajournals.avma.org/doi/abs/10.2460/javma.234.3.359

(Slide 17)Slide29

References

Degner

, D. (2004). Gall bladder disease. Retrieved February 28, 2016, from

http://vetsurgerycentral.com/gallbladder.htm

(Slides 19; 20-23)

DVM 360. (2014, August 1). Female veterinary lab technician [Photograph]. Retrieved from

http://files.dvm360.com/alfresco_images/DVM360/2014/08/01/7fdf6331-0eee-4690-ac75-18660eefc9b4/veterinary-

blood-lab-work-female-tech-485204871_460x284.jpg

(Slide 11)

Heartland Vet Supply. (2016). Ursodiol [Photograph]. Retrieved from

http://www.heartlandvetsupply.com/popup.aspx?src=images/Product/large/2930100.jpg

(Slide 18)

IDEXX. (

n.d.

). CPL Snap Test [Photograph]. Retrieved from

http://www.idexx.co.uk/images/en_gb/smallanimal/snap/png/cpl-interpreting-results.png

(Slide 12)

Lyman, R. (2009, August 1). Gallbladder

mucoceles

: Surgery still recommended due to risk of rupture. Retrieved February 27, 2016, from

http://veterinarynews.dvm360.com/gallbladder-mucoceles-surgery-still-recommended-due-risk-rupture

(Slides 10-11; 14; 21-23; 26)Slide30

References

Meditoons

. (2012, December 2).

Acute Cholecystitis (Gallbladder Attack) Meditoons™ [Video file]. Retrieved from https://www.youtube.com/watch?v=Ih2mEsh46Ug

(Slide 3)Medscape. (2016). Radiograph [Radiograph]. Retrieved from http://img.medscape.com/pi/emed/ckb/gastroenterology/169972-1340257-173885- 1927876tn.jpg (Slide 14)Pet MD. (2016). Ursodiol - Pet, Dog and Cat Medication and Prescription List |

petMD

. Retrieved February 26, 2016, from

http://www.petmd.com/pet-medication/ursodiol

(Slide 18)

Quizlet. (2016). Blood smear [Picture]. Retrieved from

http://o.quizlet.com/i/9Dq7FNvLpC3a5fPr7LENIw_m.jpg

(Slide 10)Slide31

References

Rodriguez, D., &

Jasmer

, R. (2015, March 26). What Are Gallstones? | Everyday Health. Retrieved February 26, 2016, from http://www.everydayhealth.com/gallbladder/gallstones/ (Slide 4)Romich

, Janet Amundson (2014-04-03). 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 http://www.petplace.com/article/dogs/diseases-conditions-of- dogs/symptoms/jaundice-in-dogs

(Slide 4)

The Awkward Yeti. (2014). Gallbladders' last day [Cartoon]. Retrieved from

http://theawkwardyeti.com/?s=gallbladder

(Slide 4)

VCA Animal Hospitals. (2016). Serum Bile Acids | VCA Animal Hospitals. Retrieved February 28, 2016, from

http://www.vcahospitals.com/main/pet-health- information/article/animal-health/serum-bile-acids/122

(Slide 12)