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ACVIM Specialty 2023 > Gallbladder disease > Flashcards

Gallbladder disease Flashcards

1
Q

What two liver lobes is the gallbladder located between?

A

The right medial and quadrate lobes

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2
Q

What duct connects the intrahepatic bile ducts to the gallbladder?

A

The cystic duct

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3
Q

Name 4 components of bile

A

Cholesterol, lecithin, phospholipids, and bile salts

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4
Q

What dog breeds are predisposed to choleliths?

A

Miniature Schnauzer, Miniature Poodle

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5
Q

What are most canine choleliths comprised of? Why are calcium based choleliths very rare in dogs?

A
  • Bilirubin, cholesterol, or a mix of both
  • The canine gallbladder can absorb free calcium in the bile
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6
Q

What are choledocholiths? Where can they form?

A
  • Stones in the common bile duct
  • Primary stones develop in the common bile duct
  • Secondary stones develop in the GB - more common
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7
Q

After a complete obstruction, when does dilation of the extrahepatic bile ducts develop? The intrahepatic bile ducts?

A
  • Extrahepatic: dilation evident within 24-48 hours
  • Intrahepatic: dilation evidence within 5-7 days
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8
Q

In a case of bile peritonitis, the bilirubin concentration in the peritoneal effusion will be how many times greater than the serum?

A

At least 2x higher

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9
Q

In cats, a GB wall thickness greater than what accurately predicts GB disease?

A

> 1mm

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10
Q

Bacterial cultures of the bile are positive in what percent of patients with cholecystitis?

A

62%

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11
Q

What is emphysematous cholecystitis?

A

Acute cholecystitis with gas producing organisms. Gas may accumulate in the lumen, wall, or pericholecystic tissues

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12
Q

Name 3 ultrasonographic findings with biliary rupture?

A

Pericholecystic fluid, general peritoneal effusion, omental adhesions to the GB

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13
Q

How is emphysematous cholecystitis treated?

A

Cholecystectomy recommended due to high risk of GB rupture and septic peritonitis

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14
Q

What bacteria are most commonly isolated in cases of emphysematous cholecystitis?

A

E coli and Clostridium perfringens

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15
Q

What chronic infection may contribute to the development of cholangiocarcinomas in the cat?

A

Parasitic infections with liver flukes (Platynosomum)

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16
Q

How does a mucocele lead to GB rupture and bile peritonitis?

A

Expansion of the semisolid to immobile mucocele stretches the GB wall and disrupts blood flow, leading to pressure necrosis of the wall and rupture

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17
Q

What are predisposing factors that contribute to mucocele formation?

A

Dyslipidemia, dysmotility of the GB, endocrine disease, exogenous steroids

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18
Q

What breeds are predisposed to mucocele formation?

A

Shetland Sheepdogs, Cocker Spaniels, Miniature Schnauzers

19
Q

How is hyperadrenocorticism or steroid administration thought to result in mucocele formation?

A
  • Steroids lead to higher levels of unconjugated bile acids in the extrahepatic biliary tree.
  • Unconjugated bile acids are hydrophobic and lead to injury to the biliary epithelium
  • The injured epithelium secretes more mucin => mucinous hyperplasia => mucocele formation
20
Q

How is hypothyroidism thought to result in mucocele formation?

A

Hypothyroidism impairs relaxation of the sphincter of Oddi, leading to decreased bile excretion. Liver cholesterol metabolism is also altered. Mucin then solidified and organizes

21
Q

How do acute and chronic pancreatitis differ histhopathologically?

A

Acute: neutrophilic inflammation, interstitial edema, necrosis of mesenteric fat
Chronic: lymphocytic inflammation, fibrosis, acing atrophy

22
Q

What percent of feline cholangitis cases are associated with extrahepatic bile duct obstruction?

A

64% in one study
40% of acute cases and 76% of chronic cases in another study

23
Q

In cats with liver disease, how did the time to maximum serum concentration and the half life of mirtazepine differ from healthy cats?

A
  • Time to maximum concentration was prolonged (4 vs 1 hour)
  • Half life was prolonged (13.8 vs 7.4 hours)
  • Consider reduced frequency of administration
24
Q

In cats with lymphocytic cholangitis treated with prednisone or ursodiol, which group had prolonged survival?

A

Prednisolone survived longer (1 or 2 mg/kg/day)

25
Q

Compared to cat with lymphocytic cholangitis, cats with neutrophilic cholangitis had what clinicopathologic abnormalities?

A

Higher segmental and band neutrophil counts, higher ALT and bilirubin

26
Q

A single bacterial species is cultured from what percent of neutrophilic cholangitis cases? What bacteria are the most common?

A

> 80% of cases, E coli most common

27
Q

Gallbladder agenesis occurs most commonly in what breed?

A

Chihuahua

28
Q

What clinicopathologic abnormalities and histopathology abnormalities are found with gallbladder agenesis?

A

Elevated ALT most common, common bile duct dilation without evidence of obstruction is common, most dogs had ductal plate malformations on liver biopsy

29
Q

In a 2016 study of bacterial cholangitis in dogs, what bacterial were most commonly isolated?

A
  • E. coli (17 cases), Enterococcus (8 cases), Clostridium (5 cases)
  • E coli isolates were resistant to >3 classes of antibiotics in 10/16 cases
30
Q

What is the agreement between cytology and bile culture in identifying bacterial cholangitis?

A

Agreement was 85% (kappa 0.62) for all dogs/cats, but improved to 94% (kappa 0.84) if only including animals that had not received antimicrobials

31
Q

According to a 2017 paper, what is the sensitivity, specificity, and NPV of abnormal gallbladder ultrasound for predicting positive bile culture results in CATS?

A

Sensitivity 96%, specificity 49%
NPV 96% - so cats with a normal gallbladder US are unlikely to have positive bile culture results
Most common abnormality was GB wall thickening

32
Q

According to a 2017 paper, what is the sensitivity, specificity, and NPV of abnormal gallbladder ultrasound for predicting positive bile culture results in DOGS?

A

Sensitivity 81%, specificity 31%, PPV 20%, NPV 88%
Less predictive than in cats

33
Q

What is an alternative to a fecal floatation for the diagnosis of Platynosomum infection?

A

Egg counts on bile obtained by ultrasound guided cholecystocentesis

34
Q

In dogs with extrahepatic bile duct obstruction due to pancreatitis, what was the survival rate? What percent survived with medical management alone?

A

79% survived
Of the survivors, 94% were treated with medical management alone

35
Q

In dogs with extrahepatic bile duct obstruction due to pancreatitis, what was the time from the onset of clinical signs to increase in bilirubin, the peak bilirubin elevation, and initial improvement in bilirubin?

A

7, 8, and 15 days respectively

36
Q

What is the difference in mortality rate between dogs that undergo elective and non-elective cholecystectomy?

A

2% mortality in the elective group vs 20% in the non-elective group

37
Q

In cats undergoing choledochal stenting for EHBO, what percent survived to discharge? What was the MST?

A

78%, MST 931 days

38
Q

In cats undergoing choledochal stenting for EHBO, what percent had a recurrence of EBHO in the future?

A

39% - due to cholelithiasis

39
Q

What hormone was higher in dogs with mucoceles vs healthy dogs?

A

Leptin

40
Q

The odds of identifying a mucocele in Border Terriers was how many times higher than all other breeds?

A

85x higher

41
Q

What is the sensitivity and specificity of ultrasound for identifying GB rupture?

A

Sensitivity 56%, specificity 91.7%

42
Q

Dogs with a mucocele and gallbladder rupture/bile peritonitis were how many more times likely to die post-operatively than dogs with a mucocele and no rupture?

A

2.7 times more likely to die

43
Q

What is the survival time for dogs with mucoceles that survived at least 14 days after diagnosis?

A

Surgically managed: 1802 days
Medically managed: 1340 days
Medically managed, then needed surgery: 203 days

44
Q

What percent of dogs with mucoceles are hyper coagulable on TEG?

A

83%

ACVIM Specialty 2023 (38 decks)

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