Biliary Diseases Flashcards
How does the gallbladder in cats differ from dogs?
Cats have 1 entry into duodenum, CBD joins pancreatic duct prior to the major duodenal papilla
What enzymes on biochemistry are most indicative of cholestasis?
- Increased ALKP > ALT
- Increased GGT in cats
What are causes of intrahepatic cholestasis?
- Hepatocellular swelling (Ex: Hepatic lipidosis, corticosteroid hepatopathy in dogs)
- Inflammation or neoplasia around portal area and biliary tree
- Solid tumors
- Fibrosis around biliary tree
- Bile sludge
What are causes of extrahepatic cholestasis?
- Tumors in pancreas, duodenum, biliary tract
- Pancreatitis
- Choleliths
- Parasites
- Mucocoeles
How does cholestasis affect absorption from the GI tract?
- Causes malabsorption of fat-soluble vitamins (A,D,E,K)
- Malabsorption of Vitamin K leads to decreased Factor II, VII, IX, X, Protein C and S)
- Risk of prolonged PT and coagulopathies
List clinical signs of extra hepatic cholestasis
- Jaundice
- Anorexia
- Vomiting
- Abdominal pain
- White acholic feces or lack of urine pigment
What diseases have an increased incidence in patients with gall bladder mucocoele?
- Hyperadrenocorticism
- HypoT
- Hyperlipidemia
What is the treatment of choice for gall bladder mucoceles?
- Cholecystectomy has best long term results
- Medical management is a reasonable alternative
- Emergency sx if gall bladder rupture!
How can a gall bladder mucocele be medically managed?
- Low fat diet
- Ursodiol
- Antibiotics ONLY IF evidence of infection
- Treat underlying cause
- Monitor ultrasounds
What is the doctor term for a bacterial infection of bile?
Cholecystitis
What bloodwork changes can be seen with cholecystitis?
- Increased ALP, GGT, ALT, and Bilirubin + inflammatory leukogram with or without left shift
(bacterial infection of bile)
How is cholecystitis diagnosed?
Cholecystocentesis (bile sample)
Contraindicated if gall bladder mucocele!!
When is a Cholecystocentesis (bile FNA sample) contraindicated?
Contraindicated if gall bladder mucocele!!
What is the most common cause of cholecystitis?
- Haematogenous > ascending bacterial infection
- E. coli, Enterococcus, Bacteroides, Clostridium
What is the treatment protocol for cholecystitis?
Antibiotics for 4-6 weeks based on C&S from FNA
How do patients with cholecystitis typically present?
- Sometimes asymptomatic or intermittent signs, difficult to diagnose
- V/D, anorexia, ABD discomfort, jaundice, pyrexic if severe
List risk factors for cholecystitis
- Choleliths
- Extra hepatic biliary obstructions
- Hepatic neoplasia
- Congenital abnormalities
- Pancreatitis and IBD esp in cats
- Pre existing hepatitis
What are secondary consequences to cholecystoliths?
- Bile obstruction
- Rupture
- Inflammation
- Infection
What is the recommended treatment protocol for patients with cholecystoliths?
- Most require surgical removal
- Ursodiol if non-obstructive small stones
- Antibiotics
What is cholangitis vs cholecystits?
- Cholangitis is inflammation of the bile ducts
- Cholecystitis is inflammation of the gallbladder
What are the different forms of cholangitis seen in cats?
- Neutrophilic (most common)
- Lymphocytic
- Sclerosing, associated with liver flukes
What is the most common cause of neutrophilic cholangitis in cats?
- Ascending bacT infection within bile ducts (e. coli, enterococcus, clostridium, etc)
- Rarely protozoal infections (toxoplasma, coccidiosis)
How do cats with neutrophilic cholangitis typically present?
- Acute CS most commonly
- Only 30-40% are pyrexic
- V/D
- Jaundice
- ABD pain
- Hepatomegaly
- Ptyalism
- Often concurrent pancreatitis and/or IBD (triaditis)
(Presents like acute extrahepatic cholestasis)
How is feline neutrophilic cholangitis diagnosed?
- Cholecystocentesis (FNA gall bladder) to ID bacteria
- Biopsy for definitive diagnosis, but only recommended if FNA culture comes back negative
(Can see false negatives with FNA)
