Cholecystitis

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Multiple small choleliths extracted from a Keeshond with cholelithiasis and cholecystitis[1]

Cholecystitis is a disease of the canine gallbladder characterized by infections, idiopathic inflammation or urolith obstruction.

In many cases, infections are of intestinal origin and ascend the common bile duct or arise from hematogenous spread. Cholecystitis can also spread to the surrounding bile ducts and liver parenchyma, resulting in bacterial cholangitis and cholangiohepatitis.

Causes of cholecystitis include:

- predisposition in the Shetland Sheepdog[2], associated with concurrent pancreatitis, hyperlipidemia, corticosteroid excess, hypothyroidism, protein-losing nephropathy, diabetes mellitus, cholelithiasis and gallbladder dysmotility
- Metorchis bilis, Parametorchis complexus, Clonorchis sinensis, Opisthorchis spp, Metagonimus yokogawai
- Escherichia coli, Enterococcus spp, Bacteroides spp, Streptococcus spp and Clostridium spp[4]
- Leptospira spp[5]

In dogs, the infection can remain within the gallbladder, resulting in either necrotizing or emphysematous cholecystitis. With necrotizing cholecystitis, the wall of the gallbladder is damaged, and bile leaks into the abdomen causing a severe septic peritonitis, which can be lethal. If the bile that leaks is inspissated, then peritonitis will be local.

Clinical signs in affected dogs include anorexia, abdominal pain, icterus, fever, and vomiting. Secondary bile peritonitis may be diagnosed on ultrasonography.

Radiographic evidence of gas in the area of the gallbladder is consistent with emphysematous cholecystitis.

The hematological abnormalities are inconsistent and may include mild to moderate leukocytosis with a left shift or a nonregenerative anemia, increases in ALT, AST, delayed clotting times and hyperbilirubinemia[8].

Diagnosis can be confirmed by biopsy for both aerobic and anaerobic cultures and for histopathology. Prognosis is favorable if appropriate antibiotic therapy is initiated early.

Treatment usually consists of antimicrobial agents such as cephalosporins, ampicillin or enrofloxacin as they achieve high concentrations in the bile[9].

Cytoprotective agents such as ursodeoxycholic acid, S-adenosylmethionine, N-acetylcysteine, silymarin and vitamin E may assist recovery[10].

Stabilizing the animal, cholecystectomy, appropriate antibiotic therapy, and management for peritonitis are necessary for treatment. Prognosis is poor, unless diagnosis and treatment are early in the disease.

References

  1. Ward R (2006) Obstructive cholelithiasis and cholecystitis in a keeshond. Can Vet J 47(11):1119-1121
  2. Aguirre AL et al (2007) Gallbladder disease in Shetland Sheepdogs: 38 cases (1995-2005). J Am Vet Med Assoc 231(1):79-88
  3. O'Neill EJ et al (2003) Bacterial cholangitis/cholangiohepatitis with or without concurrent cholecystitis in four dogs. J Small Anim Pract 47(6):325-335
  4. Wagner KA et al (2007) Bacterial culture results from liver, gallbladder, or bile in 248 dogs and cats evaluated for hepatobiliary disease: 1998-2003. J Vet Intern Med 21(3):417-424
  5. Gallagher A (2011) Leptospirosis in a dog with uveitis and presumed cholecystitis. J Am Anim Hosp Assoc 47(6):e162-167
  6. Corfield GS et al (2007) Gall bladder torsion and rupture in a dog. Aust Vet J 85(6):226-231
  7. Hewitt SA et al (2005) Bile peritonitis associated with gastric dilation-volvulus in a dog. Can Vet J 46(3):260-262
  8. Church EM & Matthiesen DT (1988) Surgical treatment of 23 dogs with necrotizing cholecystitis. J Am Anim Hosp Assoc 24:305–310
  9. Kirpensteijn J et al (1993) Cholelithiasis in dogs: 29 cases. J Am Vet Med Assoc 202:1137–1142
  10. Webster CR & Cooper J (2009) Therapeutic use of cytoprotective agents in canine and feline hepatobiliary disease. Vet Clin North Am Small Anim Pract 39(3):631-652