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Biliary Tract Disorders in Dogs/cats
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Cholecystitis may be much more common than many people realize. Dogs that have evidence of antibiotic responsive hepatobiliary tract disease may have a bacterial cholecystitis. Typically, both the ALT and SAP are increased, and icterus is common. Most dogs with cholecystitis do not have dis cernable gall stones. Many (maybe most) gall stones found in dogs and cats are clinically insignificant and only serve to confuse veterinarians. Ultrasound findings in dogs with bacterial cholecystitis are non-specific: finding "sludge" in the gall bladder can also occur in clinically normal dogs. However, aspirating bile via percutaneous puncture with a 22-25 gauge needle may be very helpful. Rarely, such aspiration technique will cause a vagal response that will cause extreme bradycardia; however, if this happens all that is usually needed is an injection of a parasympatholytic such as glycopyrrolate. Finding WBCs and/or bacteria in the bile seems to be very specific, but we are not really sure how sensitive this test is for cholecystitis. Therapy usually involves chronic (i.e., > 6-8 weeks) antibiotic therapy. If I cannot culture bacteria, I prefer to use a combination of amoxicillin and enrofloxacin. If that approach is unsuccessful, then cholecystectomy is usually the next step. Do not do a cholecystotomy or an incisional biopsy of gall bladder wall; dehiscence appears to be a major cause of morbidity and mortality after such surgery. Rather, remove the entire gall bladder and submit it for histopathology and microbiology. Be sure that you do not ligate or transect the common bile duct, or you may kill the dogs. Remember that cholecystectomy may be required to cure a patient with cholecystitis. […]
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