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SA DX & TX II > Exam 3 - Biliary Disease > Flashcards

Exam 3 - Biliary Disease Flashcards

1
Q

what are the functions of bile?

A

bile acids are essential for digestion/absorption of fats

elimination of lipophilic metabolic products & xenobiotics

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2
Q

what makes up the flow of bile through the biliary tract?

A

hepatocytes secrete bile & this drains into bile ductules/caniculi

intralobular ducts

interlobular ducts

hepatic ducts

common bile ducts

cystic duct

gallbladder

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3
Q

what is the function of the gallbladder?

A

stores & concentrates bile

bile is released after a meal in response to CCK, motilin, & vagal stimulation

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4
Q

what is the main anatomical difference in the biliary system between dogs & cats?

A

cats - major bile duct is a combo of the pancreatic duct & bile duct into the duodenum

dogs - separate openings for bile duct & pancreatic duct

cats more at risk for biliary tract infections/triaditis/etc

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5
Q

where are bile acids excreted from?

A

excreted in the bile

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6
Q

what is the cycle of bile acids?

A

bile acids are excreted in the bile - go through bacterial degradation & secondary bile acids

bile acids are reabsorbed from the ileum & enter portal circulation

bile acids are extracted by the liver for storage into the gallbladder & then re-excreted

cholesterol is used in hepatic bile acid synthesis in the liver where it is conjugated by the liver & then stored in the gallbladder

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7
Q

what are some common biliary disorders seen in dogs?

A
  1. gallbladder mucocele
  2. cholecystitis/cholangitis
  3. extrahepatic bile duct obstruction
  4. bile peritonitis
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8
Q

what is the common signalment of dogs affected by gallbladder mucoceles?

A

middle aged to older dogs

breeds - shelties, cocker spaniels, mini schnauzers, & border terriers

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9
Q

what are some risk factors for gallbladder mucocele formation in dogs?

A

hypothyroidism, hyperadrenocorticism

hyperlipidemia

gallbladder inflammation & hypomotility

imidacloprid?

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10
Q

what is the pathogenesis of gallbladder mucoceles?

A

cystic mucosal hyperplasia

progressive accumulation of mucus containing bile

post-hepatic icterus may occur if the mucocele extends into the common bile duct

secondary bacterial infections

distension of the gallbladder can lead to ischemic necrosis

GB rupture & bile peritonitis can occur

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11
Q

what biliary disease is this breed known for?

A

gallbladder mucocele - shelties

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12
Q

what clinical signs are associated with gallbladder mucoceles in dogs?

A

inconsistent clinical signs - some dogs may have none

anorexia, lethargy, vomiting, icterus, & some present acutely due to GB rupture

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13
Q

what is seen on serum biochemistry that is supportive of a gallbladder mucocele in a dog?

A

often increased ALP/ALT

sometimes increased bilirubin

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14
Q

how are gallbladder mucoceles diagnosed?

A

serum biochemistry

abdominal ultrasound - stellate pattern with non-gravity dependent bile, gallbladder wall thickening

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15
Q

T/F: an abdominal ultrasound is sensitive for detecting a ruptured gallbladder in a dog

A

false - not sensitive

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16
Q

you’re doing an abdominal ultrasound on an older dog with non-specific clinical signs and see this - what are you diagnosing?

A

gallbladder mucocele

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17
Q

when is medical management appropriate to use for a dog with a gallbladder mucocele?

A

dogs with no clinical signs or concerning lab/imaging findings

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18
Q

how is medical management used for a dog with a gallbladder mucocele?

A

treat any underlying disorders

low-fat diet

ursodeoxycholic acid & SAMe for cholestasis

+/- abx

repeat ultrasound every 1-3 months - may need to treat patient for months

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19
Q

T/F: surgical outcomes for gallbladder mucoceles are better for elective/prophylactic surgery than emergent surgery

A

true

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20
Q

what is the surgical correction used for gallbladder mucoceles? what should be done during this surgery?

A

cholecystectomy

ensure the patency of the biliary system by cannulating the duodenal papilla & flush it

histopathology of the liver & gallbladder

culture the bile, GB, & liver

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21
Q

T/F: cholecystitis/cholangitis is less common in dogs than cats

A

true

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22
Q

why may we see cholecystitis/cholangitis in a dog?

A

may be due to ascending bacteria from the gi tract

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23
Q

what clinical signs are seen in a dog with cholecystitis/cholangitis?

A

similar clinical signs to cats with neutrophilic cholangitis - often acute onset, icterus, & vomiting

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24
Q

what may be seen on lab findings of a dog with cholecystitis/cholangitis?

A

ALP/ALT commonly increased

bilirubin may be increased

+/- inflammatory leukogram

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25
Q

how is ultrasound used for diagnosing a dog with cholecystitis/cholangitis?

A

rule out physical obstruction of the biliary tract - from mucocele or pancreatitis

consider a cholecystocentesis for cytology & culture - risk of bile peritonitis if you do this

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26
Q

how is surgery used to diagnose a dog with cholecystitis/cholangitis?

A

abdominal exploratory - consider a cholecystectomy

check patency of the biliary tract

histopathology of the liver & gallbladder - required for definitive diagnosis!!!!

culture of liver, GB, bile, & any cholecystoliths

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27
Q

you do cytology of a cholecystocentesis from a dog with suspected cholecystitis/cholangitis and see this - what do you think?

A

septic bile

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28
Q

when is surgery indicated for cholecystitis/cholangitis in a dog?

A

cholecystectomy in addition to medical management

indicated when there is bile peritonitis, questionable GB wall integrity, or recurrent cases

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29
Q

what is the medical management used for a dog with cholecystitis/cholangitis?

A

4-6 weeks of antibiotics ideally based on c/s - amoxi/clav is a reasonable empiric choice

ursodeoxycholic acid

hard to clear a bacterial infection of the GB with antibiotics alone!!!

30
Q

what are some common causes of extrahepatic bile duct obstructions in dogs?

A
  1. pancreatitis
  2. neoplasia of the biliary tract or pancreas
  3. obstructive gallbladder mucocele
31
Q

what are some less common causes of extrahepatic bile duct obstructions in dogs?

A
  1. stricture of the bile duct
  2. diaphragmatic hernia
  3. obstructive cholelithiasis
  4. intestinal foreign body
32
Q

what consequences are seen in dogs with an extrahepatic bile duct obstruction?

A

hydrophobic bile acids damage hepatocytes & cholangiocytes

progressive distension of the bile ducts

fat malabsorption - vitamin K deficiency

secondary infections

after 6 weeks or more, biliary cirrhosis may develop - portal hypertension & acquired portosystemic shunts

33
Q

how are extrahepatic bile duct obstructions diagnosed?

A

usually ALP&raquo_space; ALT with GGT often increased

cholesterol & bilirubin increased

abdominal ultrasound - distension of biliary tree & gallbladder, may need to be repeated

surgical explore may be needed for confirmation

34
Q

what are you looking for on ultrasound in a dog you think has an extrahepatic bile duct obstruction?

A

distension of the biliary tree & gallbladder

35
Q

what pathology is seen in this dog?

A

dilated common bile duct

36
Q

what is the only condition that causes extrahepatic bile duct obstruction in dogs that you can appropriately manage medically?

A

pancreatitis

37
Q

what conditions causing extrahepatic bile duct obstructions in dogs require surgical management?

A

obstructive gallbladder mucocele

stricture

diaphragmatic hernia

obstructive cholelithiasis

intestinal foreign body

38
Q

how is bile peritonitis in dogs diagnosed?

A

exudate sometimes has bile crystals

effusion bilirubin&raquo_space;»» serum bilirubin

^ it can be 1:1 ratio in dogs & still be a ruptured gallbladder

39
Q

if you see gas present in the gallbladder, will you still poke it for a culture? why?

A

no!!!!! emphysematous cystitis, very bad no poke

40
Q

if you diagnose a dog with bile peritonitis, what are you going to do in a very urgent manner?

A

surgery - especially if the bile is septic

41
Q

what are some common biliary disorders seen in cats?

A
  1. feline cholangitis syndrome - neutrophilic, lymphocytic, & fluke-associated
  2. cholelithiasis
  3. cholecystitis
  4. ductal plate abnormalities - biliary cystadenomas & polycystic liver disease
42
Q

is this a normal gallbladder in a cat?

A

yup - bilobed gallbladder

43
Q

how is a dog definitively diagnosed with cholecystitis/cholangitis?

A

histopathology of the liver & gallbladder - done during surgery or other way I guess

44
Q

what trematodes are involved in causing fluke-associated feline cholangitis? where do cats get them?

A

metorchis conjuctus & parametorhis complexus

cats get them from secondary hosts (reptiles & fish)

45
Q

T/F: some cats with fluke-associated feline cholangitis may have no clinical signs

A

true

46
Q

what is seen on this liver biopsy of a cat?

A

fluke!!!

47
Q

what clinical signs may be seen in a cat with fluke-associated feline cholangitis?

A

weight loss, anorexia, vomiting, diarrhea, & icterus

48
Q

how is fluke-associated feline cholangitis diagnosed?

A

fecals are hard because shedding of eggs is sporadic

diagnose on bile cytology or histology of the liver

49
Q

how is fluke-associated feline cholangitis treated?

A

trial treatment with praziquantel (20 mg/kg PO every 8 hours for 3-5 days)

supportive care - short course of prednisolone, +/- ursodeoxycholic acid & prophylactic abx

50
Q

when is a cholecystectomy indicated for a cat with cholecystitis?

A

bile peritonitis, question gallbladder wall integrity, or recurrent cases

51
Q

T/F: clinical signs, diagnosis, & treatment for cholecystitis are similar to those for neutrophilic cholangitis

A

true

52
Q

T/F: cholecystitis can be seen in conjunction with neutrophilic cholangitis or in isolation

A

true

53
Q

what is seen on ultrasound in a cat with cholecystitis?

A

thickened gallbladder wall

54
Q

what is the treatment of choice for biliary cystadenomas? what is it?

A

surgical excision

initially thought to be a benign growth - know we think of it more as a developmental/hereditary disease disease

55
Q

are biliary cystoadenomas an incidental finding?

A

may be an incidental ultrasound finding in older cats - usually no clinical findings or lab changes

but you may notice a mass effect on abdominal palpation

56
Q

why surgically remove biliary cystadenomas?

A

they can cause blockage of intrahepatic ducts

57
Q

this is seen on an abdominal ultrasound of an older cat - what is this?

A

biliary cystadenoma

58
Q

what cat breed is associated with the pictured pathology? what is it?

A

persians - polycystic liver disease

dilated common bile duct in a cat with extrahepatic bile duct obstruction

59
Q

T/F: polycystic kidney disease is more common than polycystic liver disease in cats

A

true - sometimes the liver is infected in isolation or in conjunction with other organs

60
Q

what is the range of clinical signs seen with polycystic liver disease in cats?

A

variable severity

mild lesions may not cause any signs

severe lesions - severe hepatomegaly, portal hypertension, & acquired shunts

61
Q

why is percutaneous drainage not too useful for a cat with polycystic liver disease?

A

you can use it in severe cases but the fluid will come back

62
Q

what pathology is seen on this dog’s gallbladder?

A

severe cholecystitis

63
Q

T/F: surgery may be an option for clinically affected cats with polycystic liver disease

A

true

64
Q

what are the goals of surgery of the biliary tract? what are the disadvantages of these surgeries?

A
  1. confirm the underlying disease process
  2. establish a patent biliary system
  3. minimize perioperative complications

relatively high morbidity/mortality rates - complex surgeries, so usually have to be referred

65
Q

what is a cholecystectomy?

A

removing the gallbladder

66
Q

what is likely the most common surgery performed on the biliary tract?

A

cholecystectomy

67
Q

when is a choledochotomy used?

A

performed to remove a stone

68
Q

what is the purpose of a cholecystotomy tube?

A

percutaneous drainage to provide temporary decompression - rarely done

69
Q

what is a choledochoduodenostomy?

A

reattachment of the bile duct to a new location in the duodenum

70
Q

what is a biliary-enteric anastomosis?

A

attaching the gallbladder to the small intestine for permanent drainage

71
Q

what is the purpose of choledochal stenting?

A

provides temporary decompression for the gallbladder

SA DX & TX II (62 decks)

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