ABSTRACT OF THE WEEK

Journal of the American Veterinary Medical Association
Volume 246 | Issue 9 (May 2015)

Characterization, treatment, and outcome of bacterial cholecystitis and bactibilia in dogs.

J Am Vet Med Assoc. May 2015;246(9):982-9.

Yuri A Lawrence¹, Craig G Ruaux, Sarah Nemanic, Milan Milovancev

¹ Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331.

Abstract

Objective-To characterize historical, clinicopathologic, ultrasonographic, microbiological, surgical, and histopathologic features of bacterial cholecystitis and bactibilia in dogs and evaluate response to treatment and outcomes in these patients.

Design-Retrospective case-control study.

Animals-40 client-owned dogs (10 with bacterial cholecystitis on histologic analysis or bactibilia on cytologic examination [case dogs] and 30 without bactibilia [controls]) evaluated at a veterinary teaching hospital between 2010 and 2014.

Procedures-Signalment, history, clinicopathologic findings, ultrasonographic features, microbiological results, surgical findings, histopathologic changes, treatments, and outcomes of case dogs were derived from medical records and summarized. Demographic and clinicopathologic data and ultrasonographic findings were compared between case and control dogs. Relationships among prior antimicrobial treatment, sediment formation in the gallbladder, presence of immobile biliary sludge, and presence of bactibilia or bacterial cholecystitis were assessed.

Results-No finding was pathognomonic for bactibilia or bacterial cholecystitis in dogs. Case dogs were significantly more likely to have immobile biliary sludge and had a greater degree of biliary sediment formation than did control dogs. All case dogs for which gallbladders were examined histologically (6/6) had bacterial cholecystitis. Five of 10 case dogs were Dachshunds. Medical or surgical treatment resulted in good outcomes.

Conclusions and Clinical Relevance-Bactibilia and bacterial cholecystitis were important differential diagnoses in dogs with signs referable to biliary tract disease. Dachshunds were overrepresented, which may suggest a breed predisposition. Cytologic evaluation of bile should be considered in the routine assessment of dogs with hepatobiliary disease if immobile biliary sludge is present. (J Am Vet Med Assoc 2015;246:982-989).

Companion Notes

Retrospective case-control study on bacterial cholecystitis or bactibilia in 10 dogs

Introduction on bacterial cholecystitis in the dog

- hepatobiliary infections in dogs subclassified as follows

- cholangitis, cholangiohepatitis, or both

- cholecystitis

- choledochitis

- focal suppurative lesions

- multiple hepatic microabscesses

- bile culture from dogs with bacterial cholecystitis has yielded:

- Klebsiella spp

- Clostridia spp

- Corynebacterium spp

- Bacteroides spp

- Streptococcus faecalis

- Peptostreptococcus anaerobius

- Escherichia coli

Study design

- study population: dogs seen at Oregon State University from 1/1/10-2/15/14

- 40 dogs that underwent cholecystocentesis for apparent hepatobiliary disease

- 10 case dogs diagnosed in 1 of 2 ways

- bacterial cholecystitis on histologic analysis

- bactibilia on cytology

- 30 control dogs without bactibilia

- procedure: records retrospectively reviewed

Results

- no pathognomonic finding found for bactibilia or bacterial cholecystitis

- parameters significantly more likely to be found in case dogs than in controls

- immobile biliary sludge

- greater degree of biliary sediment formation

- among the 6 case dogs having their gallbladders examined histologically

- all 6 had bacterial cholecystitis

- 4 also had full-thickness small intestinal biopsies

- evidence of IBD in 3

- history & signalment of case dogs

(age and weight not significantly different between groups)

- median age: 11 years of age with a range of 6-15 years

- median weight: 16.8 kg with a range of 5.6-36.9 kg

- dachshund, 5 of the 10 case dogs

- 2.76% of canine visits during study period were doxies

(dachshunds, dachshund crosses, and long-haired dachshunds)

- history and physical examination findings of case dogs

(7 dogs had ≥ 1 clinical sign)

- asymptomatic, 1 dog with elevated liver enzymes detected

- hyporexia, 6

- vomiting, 5

- lethargy, 4

- signs of abdominal pain, 1

- diarrhea, 1

- icterus, 1

- pigmenturia, 1

- CBC and biochemistry of case dogs

- abnormalities found in ≥ 5 dogs

- increased alanine transaminase

- increased alkaline phosphatase

- increased γ-glutamyltransferase

- hyperbilirubinemia

- culture and susceptibility of case dogs

- Enterobacter spp, 1

- Enterococcus spp, 5 (all were multidrug resistant)

- Escherichia coli, 6

- anaerobic bacterial isolates

- Bacteroides fragilis, 1

- Clostridium perfringens, 1

- medical or surgical treatment provided good outcomes

- medical therapy chosen due to client wishes or financial constraints, 4 cases

- ursodeoxycholic acid, 10-15 mg/kg PO q24h

- antimicrobial treatment for 6-8 weeks based on bacterial culture

- sequential cholecystocentesis performed until bile culture was negative

- median time to completion of treatment: 5 months

- ALP, ALT and total bilirubin improved or normalized in all cases

- surgical therapy (chosen in 2 cases because medical management failed), 6

- ante-grade and retrograde flushing of common bile duct

- cholecystectomy, 5

- surgical decompression via cholecystotomy, 1

- outcome

- surgical therapy

- death due to of sepsis 7 days postop, 1

- median survival time of other 5 dogs: 3 years

- medical therapy: no deaths with follow-ups of 4-12 months

"Previous antimicrobial administration was associated with significantly increased odds of bactibilia, and all 5 dogs with multidrug-resistant bacterial isolates had previously received antimicrobial treatment."

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