Liver Disease 2 Flashcards
briefly explain the pathophys of a gallbladder mucocele
the bile physically changes in composition and becomes hard and firm (semi solid to solid), can also include some mucus filled cysts, and mucinous hyperplasia. as it grows it can cause necrosis and rupture=bile peritonitis
_______ makes you 29x more likely to get a gallbladder mucocele
cushings
how does a gallbladder mucocele usually present?
often no clinical signs while it is forming, and there are no real clinical changes until it ruptures
what is “gold standard” diagnosis of a GB mucocele?
ultrasound
on bloodwork, ALP will be higher than ALT
describe the difference between an immature mucocele and a mature mucocele
immature: sludge is accumulating, not gravity dependent, no real organization yet
mature: organized, kiwi or tomato lookin, sludge central and immobile
how is sludge different than a mucocele?
sludge is gravity dependent, non shadowing material, and it does not mean there is hepatobiliary disease!
if you have sludge present in a dog at risk of a mucocele…
consider medical tx first
you have a dog with a GB mucocele but it hasn’t ruptured yet, what treatment option is best?
surgery avoids bile peritonitis, is likely less expensive in the long run, but does carry surgery risks
medical therapy: could potentially reduce or eliminate the mucocele BUT there is still a risk of rupture!
most people choose surgery
Serge says the best option for a mucocele is prophylactic surgery. when should you do this?
can do it at the time of ultrasound diagnosis
can do it when/if medical therapy fails
if there are continued worsening liver enzymes
Describe medical management of a mucocele
Ursodiol: the hope is to change bile acid composition and stimulate gallbladder flow. it decreases mucin secretion and reduces GB crystals
SAMe: a hepatoprotectant and anti-oxidant
what’s the best way to monitor a mucocele?
can repeat ultrasound every 3-6 months
can do labwork and monitor ALP/ALT
monitor clinical signs
plan for a surgery (best option)
Rufus McWooferson presents to the ER with fever, vomiting, tachycardia, icteric sclera and mucus membranes, abdominal pain, and lethargy. On POCUS you see a kiwi gallbladder and free fluid at the subxiphoid site. What are your differentials?
hemoabdomen, uroabdomen, bile peritonitis(mucocele), septic abdomen, neoplasia
after you do an abdominocentesis on Rufus McWooferson, you see bile crystals. If you had not seen bile in the free fluid, does this mean it is not a bile peritonitis?
no! sometimes you dont see bile until you spin down the sample and then look again
you can also compare abominal fluid bilirubin with serum bilirubin (it will be higher in the free fluid)
why is abdominocentesis the BEST diagnostic for bile peritonitis?
ultrasound is not sensitive for detecting the actual tear/rupture of the gallbladder(although it is specific)
rads are not useful at detecting it
is Rufus McWooferson ready to go to surgery right away? what will you to to stabilize him first?
NOOOOO
first: fluid bolus, broad spec antibiotics (bile duct is really close to GI), pain management
