Int. J. Agric.Sc & Vet.Med. 2014 K Satish Kumar and D Srikala, 2014 Research Paper ISSN 2320-3730 www.ijasvm.com Vol. 2, No. 3, August 2014 2014 www.ijasvm.com. All Rights Reserved DIAGNOSIS AND MANAGEMENT OF CHOLECYSTITIS IN DOGS K Satish Kumar 1* and D Srikala 2 *Corresponding Author: K Satish Kumar, drsatish.ksk@gmail.com A male Labrador retriever of 8 years presented with the signs anorexia, persistent vomiting since a couple of weeks and going down in condition was ultrasonographically diagnosed for cholecystitis. Dull and depression with poor physical condition, moderate dehydration, icterus were the significant clinical signs. Leukocytosis with neutrophilia and elevated ALP, serum bilurubin but with normal ALT, BUN and creatinine were the hemato-biochemical findings. Ultrasonographic examination of liver parenchyma showed normal echogenecity, but the gall bladder wall was symmetrically thickened and filled with sludge which appeared as uniform echogenic sediment. Treatment with enrofloxacin, 10 mg/kg, im, bid for 14 days, ursodeoxycholic acid, tricholine citrate and sorbiline, orally for two weeks along with metaclopamide, ranitidine and DNS for 3 days showed complete recovery. Keywords: Cholecystitis, Dog, Diagnosis, Ursodeoxycholic acid INTRODUCTION Cholecystitis is a disease of the gallbladder characterized by infections, idiopathic inflammation or urolith obstruction, which is commonly caused by bacteria ascending from the intestines via the common bile duct or by hematogenous route. Cholecystitis can also spread to the surrounding bile ducts and liver parenchyma, resulting in bacterial cholangitis and cholangiohepatitis. In dogs, the infection can remain within the gallbladder, resulting in either necrotizing or emphysematous cholecystitis. With necrotizing cholecystitis, the wall of the gallbladder is damaged and bile leaks into the abdomen causing a severe septic peritonitis, which can be lethal. If the bile that leaks is inspissated, then peritonitis will be local (Hewitt, 2005). The condition presents few non-specific signs like persistent vomiting, abdomen pain and fever. Though serum chemistry helps to identify gall bladder changes like obstruction, ultrasonographic diagnosis confirms the cholecystitis (Aissi and Slimani, 2009). 1 Veterinary Medicine, Sri Venkateswara Veterinary University, Veterinary Hospital Warangal, Andhra Pradesh, India. 2 Veterinary Medicine, College of Veterinary Science, SVVU, Tirupati, India. 13
Int. J. Agric.Sc & Vet.Med. 2014 K Satish Kumar and D Srikala, 2014 MATERIALS AND METHODS A male Labrador retriever of 8 years was presented to Teaching Veterinary Clinical Complex, Bhoiguda of CVSc Hyderabad with the signalment of loss of appetite, persistent vomiting since a couple of months and going down in condition. The dog has been under treatment at a private clinic but with incomplete recovery. It was also reported that the condition has been recurring once treatment was stopped. After thorough clinical examination, blood was collected and serum separated for hemato-biochemical studies. Further, ultrasonography of abdomen was performed using Ixos Vet Doppler machine a real time scanner with L10-5 linear transducer. RESULTS AND DISCUSSION Close clinical examination revealed dull and depression with poor physical condition, moderate dehydration, icteric mucosa with moderately elevated rectal temperature (103.2-103.8 C) and normal pulse and respiratory rate. Leukocytosis with neutrophilia was the haematological abnormality. Whereas, serum chemistry analysis revealed elevated levels of alkaline phosphatase (412-546 U/L), total bilurubin (5.16-5.98 mg/dl) and direct bilurubin (4.02-4.12 mg/dl) with normal ALT (48-46 U/L), BUN (14.8-15.4 mg/dl) and creatinine (1.10-9.86 mg/dl) on the day of presentation. Sagittal and transverse scans of liver parenchyma showed no abnormality with echogenecity. The gall bladder was oval in shape with symmetrically thickened wall that was hyperechoeic when compared with the surrounding liver tissue. The gall bladder was filled with sludge which appeared as uniform echogenic sediment (Figure 1). Based on these findings the case was diagnosed as cholecystitis. The case was managed with ursodeoxycholic Figure 1: Oval Shaped Gall Bladder (G) with Hyperechoeic Wall (W) and Sludge (S) acid, 5 mg/kg, bid, tricholine citrate and sorbiline, 5 ml, bid, orally for two weeks along with metaclopamide, 0.5 mg/kg, im and DNS, 250 ml, iv, bid for 3 days. Further, the affected dog was also treated with antibiotic enrofloxacin, 10 mg/ kg, im, bid for 14 days. Following therapy the dog showed clinical improvement such as reduction of vomiting, gradual appetence and improvement in hydration status from day two and complete recovery after ten days. Leukocytosis was initially recorded on day five and hence, the antibiotic was continued for 14 days. After completion of therapy hemato-biochemical parameters returned to near normal to normal. Further, no recurrence was noticed for six months after therapy. Ettinger and Feldman (2000) documented that loss of appetite, vomiting, icterus and abdomen pain along with loss of weight are the striking signs in dogs suffering with gall bladder and hepatobiliary dysfunction. The findings in the present report are in agreement with the above authors. Haematological abnormalities like neutrophilic leukocytosis could be associated with inflammatory condition of the gall bladder and whereas, serum chemistry abnormalities like elevated alkaline phosphatase and serum bilirubin 14
Int. J. Agric.Sc & Vet.Med. 2014 K Satish Kumar and D Srikala, 2014 might be due to obstruction of biliary tract as the inflammatory condition of the bile duct and gall bladder could elicit sufficient inflammatory cells infiltrate and edema that may lead to biliary obstruction (Singh et al., 2008). The hematological abnormalities in gall bladder diseases are inconsistent and may include mild to moderate leukocytosis with a left shift or a nonregenerative anemia, with increase in ALT, AST and serum bilirubin (Ward, 2006). Aguirre (2007), opined that probable cause of cholecystitis in dogs is bacterial infection particularly of E. coli, and Staphylococcus spp. usually manifested by elevated temperature, that could probably ascend to hepatic parenchyma causing cholangiohepatitis suggested by elevated levels of ALT in the present case. Ultrasonographic appearance of the normal gall bladder is anechoeic, round to oval structure with smooth margins located within the liver. The size of the gall bladder varies with fasting or feeding condition of the patient. Normally the gall bladder wall is not visualised or poorly visualised. But when there is inflammation of gall bladder the wall becomes thickened that can be recorded as hyperechoeic thick structure some times as a double rim effect when there is edema (Aissi and Slimani, 2009). In the present study the hepatoprotective agents and specific antibiotic used for respective period could have helped to permanently resolve the complaint. Treatment of cystitis usually consists of antimicrobial agents such as ampicillin or enrofloxacin as they achieve high concentrations in the bile. Cytoprotective agents such as ursodeoxycholic acid, silymarin and sorbital may assist recovery (Webster and Cooper, 2009). CONCLUSION An eight year old male Labrador was ultrsonographycally diagnosed for cholecystitis, that was presented with dull and depression, poor physical condition and jaundice. The gall bladder was oval in shape with thick wall and filled with sludge. Enrofloxacin, ursodeoxycholic acid and other hepatoprotective agents were found effective in treating the case. REFERENCES 1. Aguirre A L (2007), Gallbladder Disease in Shetland Sheepdogs: 38 Cases (1995-2005), J. Am. Vet. Med. Assoc., Vol. 1, pp. 79-88. 2. Aissi and Slimani C (2009), Ultrasound Diagnosis of Cholecystitis in a Dog (A Case Report), Global Vet., Vol. 3, pp. 514-515. 3. Hewitt S A (2005), Bile Peritonitis Associated with Gastric Dilation-Volvulus in a Dog, Can. Vet. J., Vol. 46, pp. 260-262. 4. Singh R S, Chand N and Sindhu S S (2008), Cholecystitis in a Dog, Indian Vet. J., Vol. 85, pp. 77-78. 5. Ward R (2006), Obstructive Cholelithiasis and Cholecystitis in a Keeshond, Can. Vet. J., Vol. 47, pp. 1119-1121. 6. W ebster C R and Cooper J (2009), Therapeutic Use of Cytoprotective Agents in Canine and Feline Hepatobiliary Disease, Vet. Clin. North Am. Small. Anim. Pract., Vol. 39, pp. 631-652. 15