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

Exam 3 - Biliary Disease Flashcards

(71 cards)

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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
how is ultrasound used for diagnosing a dog with cholecystitis/cholangitis?
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
26
how is surgery used to diagnose a dog with cholecystitis/cholangitis?
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
27
you do cytology of a cholecystocentesis from a dog with suspected cholecystitis/cholangitis and see this - what do you think?
septic bile
28
when is surgery indicated for cholecystitis/cholangitis in a dog?
cholecystectomy in addition to medical management indicated when there is bile peritonitis, questionable GB wall integrity, or recurrent cases
29
what is the medical management used for a dog with cholecystitis/cholangitis?
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
what are some common causes of extrahepatic bile duct obstructions in dogs?
1. pancreatitis 2. neoplasia of the biliary tract or pancreas 3. obstructive gallbladder mucocele
31
what are some less common causes of extrahepatic bile duct obstructions in dogs?
1. stricture of the bile duct 2. diaphragmatic hernia 3. obstructive cholelithiasis 4. intestinal foreign body
32
what consequences are seen in dogs with an extrahepatic bile duct obstruction?
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
how are extrahepatic bile duct obstructions diagnosed?
usually ALP >> 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
what are you looking for on ultrasound in a dog you think has an extrahepatic bile duct obstruction?
distension of the biliary tree & gallbladder
35
what pathology is seen in this dog?
dilated common bile duct
36
what is the only condition that causes extrahepatic bile duct obstruction in dogs that you can appropriately manage medically?
pancreatitis
37
what conditions causing extrahepatic bile duct obstructions in dogs require surgical management?
obstructive gallbladder mucocele stricture diaphragmatic hernia obstructive cholelithiasis intestinal foreign body
38
how is bile peritonitis in dogs diagnosed?
exudate sometimes has bile crystals effusion bilirubin >>>>>> serum bilirubin ^ it can be 1:1 ratio in dogs & still be a ruptured gallbladder
39
if you see gas present in the gallbladder, will you still poke it for a culture? why?
no!!!!! emphysematous cystitis, very bad no poke
40
if you diagnose a dog with bile peritonitis, what are you going to do in a very urgent manner?
surgery - especially if the bile is septic
41
what are some common biliary disorders seen in cats?
1. feline cholangitis syndrome - neutrophilic, lymphocytic, & fluke-associated 2. cholelithiasis 3. cholecystitis 4. ductal plate abnormalities - biliary cystadenomas & polycystic liver disease
42
is this a normal gallbladder in a cat?
yup - bilobed gallbladder
43
how is a dog definitively diagnosed with cholecystitis/cholangitis?
histopathology of the liver & gallbladder - done during surgery or other way I guess
44
what trematodes are involved in causing fluke-associated feline cholangitis? where do cats get them?
metorchis conjuctus & parametorhis complexus cats get them from secondary hosts (reptiles & fish)
45
T/F: some cats with fluke-associated feline cholangitis may have no clinical signs
true
46
what is seen on this liver biopsy of a cat?
fluke!!!
47
what clinical signs may be seen in a cat with fluke-associated feline cholangitis?
weight loss, anorexia, vomiting, diarrhea, & icterus
48
how is fluke-associated feline cholangitis diagnosed?
fecals are hard because shedding of eggs is sporadic diagnose on bile cytology or histology of the liver
49
how is fluke-associated feline cholangitis treated?
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
when is a cholecystectomy indicated for a cat with cholecystitis?
bile peritonitis, question gallbladder wall integrity, or recurrent cases
51
T/F: clinical signs, diagnosis, & treatment for cholecystitis are similar to those for neutrophilic cholangitis
true
52
T/F: cholecystitis can be seen in conjunction with neutrophilic cholangitis or in isolation
true
53
what is seen on ultrasound in a cat with cholecystitis?
thickened gallbladder wall
54
what is the treatment of choice for biliary cystadenomas? what is it?
surgical excision initially thought to be a benign growth - know we think of it more as a developmental/hereditary disease disease
55
are biliary cystoadenomas an incidental finding?
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
why surgically remove biliary cystadenomas?
they can cause blockage of intrahepatic ducts
57
this is seen on an abdominal ultrasound of an older cat - what is this?
biliary cystadenoma
58
what cat breed is associated with the pictured pathology? what is it?
persians - polycystic liver disease dilated common bile duct in a cat with extrahepatic bile duct obstruction
59
T/F: polycystic kidney disease is more common than polycystic liver disease in cats
true - sometimes the liver is infected in isolation or in conjunction with other organs
60
what is the range of clinical signs seen with polycystic liver disease in cats?
variable severity mild lesions may not cause any signs severe lesions - severe hepatomegaly, portal hypertension, & acquired shunts
61
why is percutaneous drainage not too useful for a cat with polycystic liver disease?
you can use it in severe cases but the fluid will come back
62
what pathology is seen on this dog's gallbladder?
severe cholecystitis
63
T/F: surgery may be an option for clinically affected cats with polycystic liver disease
true
64
what are the goals of surgery of the biliary tract? what are the disadvantages of these surgeries?
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
what is a cholecystectomy?
removing the gallbladder
66
what is likely the most common surgery performed on the biliary tract?
cholecystectomy
67
when is a choledochotomy used?
performed to remove a stone
68
what is the purpose of a cholecystotomy tube?
percutaneous drainage to provide temporary decompression - rarely done
69
what is a choledochoduodenostomy?
reattachment of the bile duct to a new location in the duodenum
70
what is a biliary-enteric anastomosis?
attaching the gallbladder to the small intestine for permanent drainage
71
what is the purpose of choledochal stenting?
provides temporary decompression for the gallbladder

SA DX & TX II (62 decks)

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