Acute cholecystitis in dogs. Cholecystitis in dogs affects the gallbladder

Do you know what internal gland in our body is also the largest? The liver, of course! The list of its functions exceeds more than a dozen positions, and scientists say that the role of the liver is still not fully understood. But everyone knows exactly what normal digestion it is impossible without it, since the bile secreted by the liver is very important in the enzymatic breakdown of food. Not surprisingly, the same cholecystitis in dogs can lead to numerous problems.

Cholecystitis is an inflammation of the gallbladder. Very often it is “combined” with cholecystolithiasis, that is, stones are additionally present in the organ. Due to inflammation of the mucous membrane of the gallbladder, the latter cannot provide normal operation biliary system, often this is accompanied by congestion in it, which is fraught with cholemia or even rupture of the gallbladder. In a word, it's not pleasant. So why does it appear this pathology, what are its signs and how to treat? Read on for all of this!

What causes it?

As with humans, nutrition is the main factor. This is especially well manifested in those dogs that have been eating exclusively dry food throughout their “conscious” life. There is also nothing good in eating "from the master's table." When a doggie (especially for small breeds) is constantly fed with peppered sausage, smoked fish and other delicacies, nothing good happens. Obesity often occurs, even more often it is accompanied by the same cholecystitis. Oddly enough, but many ordinary people and even veterinarians believe that the main cause of the disease is some infectious diseases(both acute and chronic).

Read also: The dog's eyes are swollen: causes and methods of treatment

Once again returning to the topic of infectious etiology of cholecystitis. We emphasize once again that as a result infectious diseases it rarely occurs ... but because of inflammatory phenomena in the intestines, this happens quite often. The reasons are simple: if bile ducts remain open, germs can enter directly into the bubble directly through them. In particular, this arises chronic cholecystitis in dogs. More precisely, in old dogs, which in some cases almost without exception suffer from chronic enteritis.

Read also: Adenovirus in dogs: symptoms and treatments

Finally, we have already talked about stones. If the dog has them, but no treatment has been carried out, then cholecystitis will occur with a probability of almost 100%. The fact is that the edges of neoplasms are rarely smooth. Rolling in the cavity of the organ, they injure its shell. This causes not only wild bouts of pain in dogs, but also leads to the fact that bile simply begins to corrode the damaged mucous membranes. The result is acute cholecystitis in dogs.

Contributing factors

Oddly enough, but diet can be not only the direct cause of the development of the disease, but also the main predisposing factor. It's all about the vitamins. More precisely, in carotene. If the diet is low in this substance, all the mucous membranes in the body (including the gallbladder) can be exposed to degenerative changes, since vitamin A is essential for their timely regeneration.

Clinical signs

What are the symptoms that indicate the development of the disease? In general, they are fairly typical of all liver diseases. First, the dog becomes lethargic, eats little and reluctantly. He drinks well, but he does not feel much joy from this. Urine very often becomes like Orange juice(a lot of bilirubin), but the feces, on the contrary, are pale, since stercobilin simply does not get into it. In addition, there are constant digestive disorders, up to severe profuse diarrhea. By the way, what does dark stool in a dog with cholecystitis? In general, this indicates the preservation of the patency of the bile ducts (which is good), but suggests that the cholecystitis was "initiated" by enteritis, which has now worsened. Simply put, you can suspect the presence of intestinal bleeding (which is very bad). Get to the vet immediately!

One of the most difficult to diagnose and serious diseases of dogs is cholecystitis - inflammatory process walls of the gallbladder and bile ducts.

The gallbladder in dogs is a small pear-shaped organ connected to the liver by bile ducts, through which bile flows into it and is stored there until the food mass enters duodenum. Then there is a contraction of the gallbladder, due to which bile is excreted through the bile ducts into the intestines. Bile is needed to break down fats, speed up the digestion of proteins and carbohydrates, and activate digestive enzymes.

With the development of inflammation motor function of the gallbladder is disturbed, bile stops flowing into the intestines and corrodes the walls of the gallbladder, accumulated undissolved fats cause intoxication of the body. In advanced cases, ulcers appear in the walls of the gallbladder, bile penetrates into abdominal cavity, which is dangerous for the development of peritonitis and the death of the animal.

Types of cholecystitis depending on the cause:

obstructive. It develops as a result of compression of the bile ducts in tumors of the liver and intestines, cholelithiasis, an increase in the pancreas and mechanical injuries Oh.

The main reasons for the development of cholecystitis are:

Symptoms

Most often, cholecystitis in dogs is asymptomatic, and in veterinary clinic animals come with running stage illness. Owners are advised to show their pet to a specialist when the following symptoms diseases:

Belching after every meal and frequent vomiting with undigested food particles, mucus, and sometimes bile;
Diarrhea, flatulence, bloating, constipation, light stools;
Increase in body temperature;
Deterioration of the quality of wool, its loss, dry skin;
Decreased appetite and weight loss;
Weakness, apathy, drowsiness;
Painful reaction to touch on right side;
Eye proteins, nasal mucosa and oral cavity yellow color;
Urine orange.

The nature of the course can be acute and chronic.

The acute course is characterized by jaundice, intoxication, fever caused by blockage of the bile ducts and the cessation of bile flow into the duodenum. The consequence of these processes may be a rupture of the gallbladder with the development of peritonitis. To save the pet in these cases, urgent surgical intervention.

The chronic form is hidden, this form of the disease is characterized by: lethargy after feeding, vomiting, diarrhea or constipation, weight loss. With these symptoms, the owners are advised to show the animal to a specialist.

Diagnostics

For staging accurate diagnosis the doctor examines the animal, notes signs of exhaustion, pain on palpation of the abdominal cavity, yellowness of the mucous membranes, dry skin, a slight increase in body temperature.

In the diagnosis of cholecystitis in a dog, laboratory tests are mandatory:

general and biochemical analyzes blood, the disease is characterized by leukocytosis and changes in liver parameters;
fecal analysis - are detected fatty acid and undigested fiber
urinalysis - noted increased content bilirubin;
analysis of bile - the pathogen is detected.

To clarify the diagnosis and find out the cause, radiography and ultrasound of the animal's abdominal cavity, as well as a liver biopsy with cytological examination biopsy.

Treatment

Methods of treatment depend on the nature of the course and neglect of the disease. Under conditions not life threatening pet, apply drug therapy, with suspicion of rupture of the gallbladder and the development of peritonitis, it is indicated surgery.

First of all, the dog is assigned special diet. The animal is kept on a 12-hour starvation diet, followed by medical nutrition. The dog's diet should consist of carrots, pumpkin, lean beef, poultry, rice, buckwheat, low-fat cottage cheese, eggs and dairy products. The pet should be fed often, in small portions, the food should be mashed.

Mandatory symptomatic therapy using anti-inflammatory, antispasmodic, analgesic, choleretic, hormonal, vitamin preparations and hepatoprotectors.

At severe intoxication and dehydration, the animal is prescribed intravenous infusions saline solutions.

For removal inflammatory edema and reduce soreness, thermal procedures are used.

Prevention

Most often, you can prevent the development of cholecystitis by adhering to simple preventive measures:

Cholecystitis in dogs can and should be treated. At the first symptoms of an intestinal disorder, a change in the color of feces or urine, it is advisable to show the pet to a doctor. Proper nutrition healthy feed and active walks can prevent dangerous diseases and prolong the life of your four-legged friend.

Primary diseases of the biliary system have recently been recognized as more common than previously thought. However, reports of them are still rare.

Diseases of the gallbladder (calculous and non-calculous cholecystitis, mucocele, cholelithiasis, neoplasia, etc.) is quite difficult to diagnose in dogs and cats on early stages, since the symptoms are nonspecific and often associated with obstruction and / or inflammation of the common bile duct, inflammatory liver diseases, etc. Therefore, they were previously detected in an advanced form and were confirmed during surgery and / or autopsy.

In addition to the progressive deterioration of the animal's condition, severe cholecystitis can lead to gallbladder rupture and subsequent biliary peritonitis. All this requires a more thorough diagnosis in patients with symptoms suggestive of cholecystitis, and individual approach when choosing a treatment.

Cholecystitis is an inflammation of the gallbladder. According to the etiology, there are three categories of gallbladder injuries: obstructive, non-obstructive, and ruptures of the bladder and / or bile ducts, as well as acute and chronic forms of the course of the disease.

Obstructive cholecystitis develops most often due to compression cystic duct and / or choledochus with an altered pancreas (in this case, the disease can be considered secondary), less often - the development of mucocele, thickening of bile, neoplasia of the intestine, liver, biliary tract, diaphragmatic hernia and even less often - the formation of gallstones.

Pneumocholecystitis (emphysematous cholecystitis) is caused by gas producing bacteria such as E. coli or Clostridium perfringens. Often seen in association with acute cholecystitis diabetes and against the background of traumatic ischemia of the gallbladder.

Gallbladder rupture can occur with serious injuries(accident, fall from a height, blows) or as a result of perforation of the altered wall of the gallbladder in chronic inflammatory processes.

According to the WSAVA Liver Standardization Group, gallbladder diseases include neutrophilic, lymphoplasmacellular, follicular cholecystitis, mucocele, and gallbladder infarcts.

Neutrophilic cholecystitis is common in cats and less common in dogs and is generally associated with bacterial infection; can be seen as independent disease or in combination with neutrophilic cholangitis. Damage is characterized by the appearance of neutrophils in the bladder cavity, epithelium and wall of the gallbladder, with chronic course- mixed inflammatory infiltrate containing neutrophils, lymphocytes, plasma cells.

Lymphoplasmacellular and follicular cholecystitis result from the formation of lymphoplasmacytic infiltrate and / or lymphoid follicles in the gallbladder mucosa.

Gallbladder infarction occurs due to occlusion of the cystic artery. Complete or partial gallbladder infarction has been described in dogs. Histological examination shows necrosis of the entire thickness of the gallbladder wall without signs of concomitant cholecystitis and (often) arterial thrombosis.

Clinical symptoms

In most cases, cholecystitis is seen as acute illness. Owners note that the animal has nausea, vomiting, refusal to feed, pain in the abdomen. Jaundice is an optional symptom, especially if the common bile duct is free, and may not appear immediately. Its appearance in this case is explained by the development of nonspecific reactive hepatitis and intrahepatic cholestasis in response to endotoxins from the inflamed gallbladder. Cholecystitis accompanied by bile stasis can lead to acholia and discoloration stool. The appearance against the background of these symptoms of fever, syndrome acute abdomen and signs septic shock (shallow breathing, hypothermia, pale gums and weak but rapid pulse) may indicate rupture of the gallbladder and requires urgent action.

Cholecystitis can be chronic and present with intermittent nausea in the animal, signs of discomfort after eating, loss of appetite, weight loss, diarrhea, or no symptoms at all (and changes in the gallbladder would be an incidental finding on ultrasonography).

Diagnostics

The data of the anamnesis and physical examination only allow us to assume the described pathology in the animal, but do not make it possible to make a diagnosis. Besides clinical picture does not fully reflect the degree of damage to the gallbladder, and therefore does not allow to determine the best way treatment and prognosis of the disease.

At the first stage of diagnosis, clinical and biochemical (as complete as possible) blood tests are required, urine is an optional study. Laboratory tests can detect an increase in alkaline phosphatase, hypercholesterolemia, hyperbilirubinemia without signs hemolytic anemia. Hyperbilirubinemia leads ultimately to bilirubinuria. Level up bile acids, glutamate dehydrogenase, and leukocytosis are very characteristic of this pathology and additionally indicate the need for a study of bile. An increase in transaminases will be detected only if the liver parenchyma is involved in the inflammatory process.

When choosing a method for diagnosing cholecystitis directly, preference is given to visual studies and mainly ultrasound diagnostics. X-ray is less sensitive in this pathology and informative only in the case of calcification of the gallbladder wall or the formation of radiopaque stones (Figures 6 and 7).

Photos 6 and 7.

In this section, we will consider changes in the ultrasound picture of the gallbladder and biliary system observed in cholecystitis, without affecting possible changes pancreas, neoplasia of other organs, etc.

The gallbladder wall thickens (thicker than 1 mm in cats and 2-3 mm in dogs), becomes hyperechoic, with jagged edges - a sign of inflammation, edema (portal hypertension, hypoalbuminemia), necrosis, hyperplasia of the bladder mucosa, less often neoplasia (Photo 1) ;
Along with wall thickening, the appearance of a double-contour rim is often noted (especially in more acute period) or diffusely hyperechoic wall, sometimes combined with mineralization (with a chronic process) (Photo 2 and 3);
Thickening of the wall and dilatation of the lumen of the common bile duct, increasing its tortuosity. However, it can be quite difficult to differentiate lumen dilatation against the background of obstruction from dilatation against the background of cholestasis in a chronic inflammatory process. In addition, at chronic disorder outflow, the common bile duct may remain dilated even after the obstruction has been removed (this must be taken into account in the postoperative examination);
Appearance of bile sludge. Physiologically, bile can thicken and be converted into bile sludge(bile dirt). It is a mixture of mucus, calcium bilirubinate and cholesterol crystals. Under pathological conditions, its consistency and accumulation can complicate the evacuation of bile into the extrahepatic bile ducts, leading to obstruction of the latter. characteristic feature bile sludge - a change in its appearance on the scan, depending on the change in the position of the animal's body and the slow achievement of a new horizontal level (the criterion of mobility of the sludge makes it possible to distinguish it from a biliary mucocele). General rule is the absence of a distal acoustic shadow. The echogenicity of sludge can vary. Sometimes the sludge fills the whole gallbladder, making it difficult to differentiate between liver tissue and gallbladder. This situation is called "hepatization of the gallbladder" (Photos 4 and 5);
Gallbladder mucocele (mucinous hyperplasia of the gallbladder) - characterized by hyperplasia of the epithelium and papillary growths, excessive accumulation mucus that stretches the gallbladder. The disease is rare, usually in dogs of small and medium breeds ( average age- 9 years). It is one of the reasons for the development of obstruction of the extrahepatic bile ducts and, as a result, cholecystitis. As the mucocele develops, a stellate contour first appears on the scan, then the transverse section of the gallbladder acquires a kiwi (fruit) pattern in cross section.

Photo 1 and 2.

Photos 3 and 4.

Photo 5.

With any change in the gallbladder or the appearance of bile heterogeneity on ultrasound, a fine-needle biopsy should be performed to aspirate bile for cytological and bacteriological research. Number 22-25 needles can be used for this, and during this procedure as much bile as possible must be removed to prevent bile from seeping through the puncture hole. The probability of such a complication is extremely small, we have not seen this in our practice, but in the presence of an undiagnosed obstruction of the extrahepatic biliary tracts, the risk increases. We also recommend taking liver parenchyma material for histological examination(The procedure for taking a biopsy for histological examination is not much more complicated than a fine-needle liver biopsy, but the result is many times more informative).

One of the modern informative methods is a radionuclide scan of the gallbladder (scintigraphy), which allows you to evaluate the work of the gallbladder, determine the location of the obstruction of the duct. Unfortunately, this method is not yet available in our practice.

If biliary peritonitis is suspected, diagnostic laparoscopy or laparotomy.

Treatment

The choice between therapy and surgical method treatment for this disease is based on integrated assessment the condition of the animal, the presence of concomitant diseases in history, the presence of diseases that provoked the development of cholecystitis and, of course, the severity and duration this disease, the effectiveness of previous treatment, if any, and the occurrence of relapses.

There's no point in doing conservative treatment and wait for an improvement in the picture of the disease in the animal in critical condition, following the lead of its owners, seeking to preserve the organ. Without an inflamed gallbladder, the animal will be able to live perfectly. At the same time, if circumstances permit, it is possible and necessary to carry out intensive drug therapy, which in many situations is successful.

So, if we are approached by the owner of a cat or dog that has the above symptoms and the condition of the animal is satisfactory, there is no fever, cachexia and uncontrolled vomiting, blood tests indicate an inflammatory process, and ultrasound reveals non-obstructive cholecystitis, possibly with a small amount of bile sludge in the cavity, then we carry out the following actions:

prescribe a diet. It is convenient to use industrial feed for liver diseases, since at home it is quite difficult to prepare mechanically and chemically non-irritating food.
we carry out adequate antibiotic therapy (after taking bile for bakposev). If the sowing turns out to be sterile, this will be an excellent prevention. secondary infection. Bacterial, including emphysematous, cholecystitis requires long-term use of antibiotics:
amoxicillin/ampicillin (10–22 mg/kg every 8–12 hours, IM) or cephalosporin drugs (cefoperazone 50 mg/kg every 12 hours, iv or IM; 4th generation cephalosporins with cefkin ( Cobactan, MSD AnimalHealth) - 0.5 ml / 5 kg body weight once a day IM) and / or metronidazole (15-25 mg / kg every 12 hours, iv) for gram-positive flora and anaerobes (C. perfringens ) for 14-21 days and fluoroquinolones for gram-negative bacteria (E. coli and others). For example, enrofloxacin 5-20 mg/kg per day, s.c., for 10-14 days.
According to the results of the antibiogram after sowing, treatment must be adjusted.

daily dose

if necessary, treatment of the primary or concomitant disease, infusion therapy, antispasmodics are prescribed.

In the event that the animal is in a critical condition due to acutely developed cholecystitis, or we are dealing with recurrent cholecystitis, or we have every reason to assume obstructive cholecystitis and/or rupture of the gallbladder and/or choledochus, we perform surgical treatment. Choice of method surgical correction depends on the alleged pathology, the capabilities of the clinic and the experience of the doctor performing the manipulation. AT recent times cholecystectomy in our clinic is performed exclusively laparoscopically, which allows to reduce the invasiveness of the operation, minimize complications and speed up recovery period. At the same time, we necessarily carry out contrasting of the gallbladder to make sure the patency biliary tract, and carry out the washing of the choledochus. Unfortunately, in view of anatomical features in cats and dogs today it is impossible to use endoscopic retrograde cholangiopancreatography for the same purposes, therefore we use more invasive methods. Of course, in situations associated with rupture of the gallbladder or obstruction of the choledochus, we resort to classical way- laparotomy. There are several options for operations on the gallbladder, and the choice of a surgeon is determined by the condition of the gallbladder, the developed pathology, etc. But this topic requires a separate article, so it will be omitted here.

Before the operation, it is necessary to make sure that there are no violations of the blood coagulation system. This can be facilitated by prolonged stagnation and impaired bile outflow (vitamin K deficiency appears, the level of coagulation factors II, VII, IX and X decreases). Therefore, they carry out additional analysis blood - coagulogram. To prevent possible coagulopathy, konakion (vitamin K1) is additionally administered at a dose of 1-2 mg/kg subcutaneously, this is enough to normalize coagulation within 3-12 hours after administration.

Patients with concomitant jaundice should be aware of their predisposition to hypotension in postoperative period and possible development kidney failure.

The tissues of the removed gallbladder must be sent to the laboratory for histological examination.

It should be noted that there is still controversy about the implementation of choledochotomy in obstructive pathologies. This is again due to the peculiarities of the anatomy of our patients, or rather, the small size of the structures of the biliary tract and a large number the described complications (leaky sutures, stenosis in the postoperative period, high mortality during such operations, etc.). The experience of our clinic and the reports of S. G. Baker, P. D. Mayhew, S. J. Mehler (Journal of Small Animal Practice, Volume 52, Issue 1, pages 32-37, January 2011) suggest a low level of complications in these operations and require further development.

The prognosis of the disease is conditionally favorable, with adequate treatment, the function of the gallbladder will be fully preserved. greatest danger may represent complications associated with rupture of the gallbladder and the occurrence of peritonitis. In the case of its development, even with adequate treatment available fatal outcome. It is also necessary to pay great attention observations of the attending physician, since the clinical dynamics has its own characteristics in each case.

Dogs, unfortunately, are susceptible to many human diseases. One of the most common among them is cholecystitis. The disease is an inflammation of the lining of the gallbladder, may have different etiology and be acute or chronic.

Improper nutrition, heredity and poor ecology affect animals in the same way as people. Therefore, pet owners should be attentive to the health of their wards, properly feed, monitor behavior, mood changes and well-being. Check for cholecystitis in dogs initial stage difficult, so it is important to know the symptoms of the disease and contact the veterinarian at the first deviations from normal behavior.

Cholecystitis. Why do dogs get sick

The gallbladder is internal organ, which is a kind of reservoir for bile. The concentration of this secret of liver cells is increased 10 times in comparison with the same characteristics of bile when produced by the liver. healthy dogs produce approximately 1 ml of bile per 1 kg of their weight. More than half of the fluid enters the duodenum through the bile ducts, where it affects the process of digestion. The rest of the volume is stored in the gallbladder, gradually concentrating to the desired density.

Any violation of the walls of the gallbladder, which entailed an inflammatory process, is called cholecystitis. This disease is less common in dogs than in cats, but last years veterinarians note an increase in the percentage of acute cholecystitis in them. The main causes of cholecystitis:

Infection, unvaccinated animals get sick more often, receiving inflammation as a complication after plague, enteritis or other disease of bacterial etiology.
Improper feeding, for example, low-quality cheap dry food, leads to stones in the liver and gallbladder, causing acute cholecystitis.
Worm infestation, which occurs mainly during feeding raw meat(giardia, liver fluke, etc.), worms settle in the liver, causing stagnation of bile and severe intoxication of the body.
Heredity, chronic form disease can be passed on genetically.
Anomalies in the development of the gallbladder, may be intrauterine or after trauma.

Incorrect treatment or complete absence lead to rupture of the gallbladder, the penetration of the secret into the abdominal cavity, the development of peritonitis and the death of the animal.

Signs and symptoms of cholecystitis in dogs

The first symptom of a dog's illness is always behavior change. Lethargy, drowsiness, the animal stops playing, is interested in what is happening, all this should already alert the owner. The pet's coat grows dull, its abundant loss can be observed, as during molting. When stroking, fingerprints remain on the wool, it loses its firmness and elasticity. it general symptoms for any animal ailment, but there are also special signs of dog cholecystitis.

Refusal to feed, vomiting of bile, heat and rapid weight loss are the main symptoms of this particular disease. The dog lies with its back arched, mainly on its stomach, with its paws tucked under it. In the future, yellowness of the sclera and abdomen appears, on final stages the stool becomes discolored. On external examination, pressing fingers into the area of the liver causes anxiety or severe pain in the animal.

The course of the disease can be either sharp, or chronic. In the latter case, the symptoms may be nonspecific. Anemia, pale gums and sclera, lowering body temperature. At acute course the disease develops very quickly, and without urgent medical intervention, it can result in gallbladder rupture, peritonitis and, as a result, death.

The chronic form of cholecystitis can go unnoticed for a long time. The disease is often discovered incidentally scheduled inspection at the doctor's. Sometimes in chronic type cholecystitis can go into its acute form if the pet is not cured.

Diagnosis and treatment of cholecystitis in dogs

The final diagnosis of cholecystitis in animals is made on the basis of an external examination of the animal, ultrasound of the gallbladder and liver, general and biochemical blood tests and urinalysis. Sometimes stones in the bile ducts can only be detected with an X-ray.

Treatment of the disease depends on its form, neglect and nature. AT emergency situations the animal undergoes a laparotomy, but in most cases therapeutic intervention is sufficient. It is impossible to self-medicate when diagnosing cholecystitis in dogs, the appointment must be prescribed by a doctor. Throughout the course of treatment, the animal must be periodically brought to the clinic for examination.

Diet and disease prevention

One of the most important factors in the treatment of cholecystitis in both animals and humans is a properly selected diet. First of all, you should exclude from the diet all homemade food. The dog, in principle, should not receive food that family members eat, and with inflammation of the gallbladder, such feeding can be fatal.

The diet should have a large number of vitamin A, fresh vegetables, in particular, carrots and pumpkins, lean poultry, lean beef or veal, cottage cheese, eggs, kefir, cereals from easily digestible cereals. Nothing fatty, fried, spicy, smoked and salty can not be added to dog food with cholecystitis.

Preventive measures to ensure that the dog does not get sick with this serious illness:

Feeding only fresh food or feed.
no greasy and spicy food even as a treat.
Using natural products pick up right balance protein and plant foods, add the necessary vitamins.
If fed dry food, do not use cheap varieties, as long-term feeding with them can lead to the formation of stones in the liver or gallbladder.
Do not overfeed the dog, monitor its weight, take long daily walks.

Good nutrition directly affects health pet. Therefore, the main attention should be paid to the diet.