CANINE MEDICINE
Tabel 1 : Common Diagnostic Test Results in Dogs with Gallbladder Mucoceles Diagnostic Test
Result Complete blood count Normal results or neutrophilic leukocytosis or non-regenerative anemia
Serum chemistry profile Elevated alkaline phosphatase , alanine transaminase , and gamma-glutamyltransferase activities ; increased total bilirubin concentration
Urinalysis
Normal results or bilirubinuria Abdominal radiography Normal findings or cranial abdominal mass effect
Abdominal ultrasonography Enlarged gallbladder ; increased gallbladder volume ; distended common bile duct ; immobile or echogenic bile , striated or stellate biliary pattern ; normal , thick , or disrupted gallbladder wall
a substantial ( about 40 %) reduction in gallbladder volume will be evident . 23
cholecystocentesis may be performed , as well as aerobic and anaerobic bacterial cultures of the bile . Anywhere from 9 % to 43 % of patients with mucocoeles may have biliary bacterial infections , and bacterial populations are often mixed .
The most common isolates are Escherichia coli and Enterobacter , Enterococcus , and Clostridium species . 24 The bacterial infections are thought to ascend from the intestines but may also be hematogenous in origin .
Histopathology A true mucocele has hyperplastic mucus-secreting glands and may also demonstrate inflammatory infiltrates . 17 In one study , gallbladder wall necrosis was diagnosed in 80 % of patients with mucocoeles , and hepatic pathology was often present . 17 The most common hepatic changes include cholestasis , neutrophilic inflammation , and bacterial infection . 20 Treatment Options
Emergency surgery is necessary if the gallbladder has ruptured or a patient has septic peritonitis . Surgery is also indicated if a dog is clinically compromised or has evidence of extrahepatic biliary duct obstruction , but the patient may need to be stabilised with fluids , intravenous antibiotics ( Table 2 ), antiemetics , and analgesics before anesthesia . 21 Time to stabilisation will vary greatly for each patient and may require one to three days . If the patient has biochemical changes but is asymptomatic or has only mild clinical signs , medical management appears to be an appropriate choice . 1
Surgical Management Preoperative diagnostic tests , including a complete blood count , serum chemistry profile , urinalysis , and coagulation panel , are indicated . Treat all patients with appropriate intravenous fluids , and any electrolyte derangements must be addressed before surgery . Vitamin K 1 therapy is also recommended ( Table 2 ) in all dogs , even if the results of preoperative coagulation panels are normal . 21 Start subcutaneous vitamin
K 1 therapy 24 hours before surgery to allow adequate time for the production of vitamin K-dependent co-
Table 2 : Drugs Commonly Used in the Perioperative and Medical Management of Dogs with Gallbladder Mucoceles |
Drug |
|
Dosage and Frequency |
Route |
Comment |
Ampicillin |
sodium-sulbactam |
20-30mg / kg every 8 hours |
IV |
Broad-spectrum IV antibiotic |
sodium ( Unasyn - Pfizer )* |
Metronidazole 15 mg / kg every 12 hours or 7.5 mg / kg every 12 hours if hepatic insufficiency is present
PO , IV Antibiotic - effective against anaerobes ; antiprotozoal
Enrofloxacin |
|
5-20 mg / kg every 24 hours |
PO , IV |
Broad-spectrum antibiotic-effective against gram-negative organisms |
Amoxicillin |
trihydrateclavulanate |
15-22 mg / kg every 12 hours |
PO |
Broad-spectrum oral antibiotic |
potassium |
|
|
|
Vitamin K 1 |
0.5 mg / kg every 12 hours |
SQ |
Counteracts Vitamin K deficiency |
Ursodiol
7.5 mg / kg every 12 hours or 10-15 mg / kg every 24 hours
PO Choleretic , hepatoprotectant , antioxidant , anti-inflammatory
Silymarin |
20-50 mg / kg every 24 hours |
PO |
Choleretic , hepatoprotectant , |
|
|
|
antioxidant , anti-inflammatory |
S-adenosylmethionine |
20 mg / kg every 24 hours |
PO |
Antioxidant |
* Reference : Plumb DC . Plumb ' s Veterinary Drug handbook . 6th ed . Ames , Iowa : Blackwell Publishing , 2008 ; 60-62 .
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Issue 03 | JUNE 2016 | 30