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VSPN AOW : Cholelithiasis in the Dog...
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Cholelithiasis in the Dog: Prevalence, Clinical Presentation, and Outcome.J Am Anim Hosp Assoc. 2020 May/Jun;56(3):152.1 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.; 2 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.; 3 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.; 4 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.; 5 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.; 6 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.; 7 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.; 8 From Small Animal Hospital (P.M.W., K.B., G.H., S.B., M.C., G.N., A.E.R.) and Weipers Centre Equine Hospital (T.P.), University of Glasgow, Glasgow, United Kingdom.
AbstractCanine cholelithiasis is considered to be an uncommon condition and is frequently cited as being an incidental finding. However, there is a paucity of contemporary literature to support these assertions. The aim of this retrospective cross-sectional study was to report the prevalence, clinical presentation, and long-term follow-up of cholelithiasis in dogs. The electronic database at the Small Animal Hospital, University of Glasgow was searched to identify dogs that were diagnosed with cholelithiasis on ultrasound between 2010 and 2018. Sixty-eight dogs were identified, giving an overall prevalence of cholelithiasis in our hospital of 0.97% (confidence interval 0.76-1.22%). Medical records of 61 dogs were available for review. Cholelithiasis was classified as an incidental finding in 53 (86.9%) dogs, with 8 (13.1%) dogs being classified as symptomatic, having complications of cholelithiasis that included biliary duct obstruction, biliary peritonitis, emphysematous cholecystitis, and acute cholecystitis. Follow-up was available for 39 dogs, with only 3 dogs (7.7%) developing complications attributed to cholelithiasis, including biliary duct obstruction and acute cholecystitis, within the subsequent 2 yr. Cholelithiasis is an uncommon but frequently incidental finding in dogs. Within the follow-up period, few of the dogs with incidental cholelithiasis went on to be become symptomatic.
Companion NotesRetrospective, case-controlled, cross-sectional report on cholelithiasis in 61 dogs (incidental finding in 53 of the 61)
Introduction on the cholelith or gallstone - “stone-like mass or calculus formed from bile precipitates in the gallbladder” - less frequently in the intrahepatic or extrahepatic ductal system - in human medicine - reported to affect up to 25% of people in Western world - 90% are asymptomatic at diagnosis - usually detected as an incidental finding - ultrasonography is primary imaging modality of choice with sensitivity of 94% - complications of cholelithiasis - acute cholecystitis/cholangitis - acute pancreatitis - biliary duct obstruction - gallbladder perforation - gallstone ileus - in canine medicine: - overall prevalence of cholelithiasis estimated at 0.03-15%
Study design - study population: dogs seen at University of Glasgow - 68 dogs diagnosed with cholelithiasis on ultrasound - 61 had medical records available - procedure: records between 1/1/10-6/30/18 retrospectively reviewed - dogs were classified as symptomatic for cholelith if the following was present - clinical signs associated with cholelithiasis - vomiting - abdominal pain - fever - lethargy - anorexia - icterus - gallbladder abnormal on ultrasound - biochemical evidence of biliary disease - increases in the following: - bilirubin (hyperbilirubiemia) - alkaline phosphatase (increased alkaline phosphatase) - gamma-glutamyltransferase (increased γ-glutamyltransferase) - cholesterol (hypercholesterolemia) - classified as asymptomatic if biliary tract was otherwise normal in appearance
Results - history & signalment - overall prevalence at that hospital: 0.97% (confidence interval 0.76-1.22%) - median at identification: 9 years of age with a range of 0.25-17 years - breeds represented by 4 or more cases - mixed-breed dog, 11 cases - Labrador retriever, 7 - border collie, 5 - Cavalier King Charles spaniel, 4 (2 were symptomatic) - cocker spaniel, 4 - survey abdominal radiography, available for 27 dogs - mineralized radiopacities, region of hepatic silhouette, 16 dogs (59%) (anatomically consistent with the biliary tree) - clinical signs - asymptomatic (incidental finding), 53 (86.9%) dogs - median age 9 years of age with a range of 0.33-17 - 22 had neoplasia as the final diagnoses - symptomatic, 8 (median age: 6 years of age with a range of 2-9) - these had complications of cholelithiasis including: - biliary duct obstruction - biliary peritonitis - emphysematous cholecystitis - acute cholecystitis - symptomatic dogs had significantly higher levels of the following: - aspartate transaminase with reference at 0-35 unit/L - median in symptomatic dogs: 170 with a range of 42-634 - median in asymptomatic dogs: 43 with a range of 10-2056 - alanine aminotransferase with reference at 0-90 unit/L - median in symptomatic dogs: 1000 with a range of 45-3988 - median in asymptomatic dogs: 150 with a range of 13-2456 - gamma-glutamyltransferase with reference at 0-20 unit/L - median in symptomatic dogs: 64 with a range of 8-250 - median in asymptomatic dogs: 6 with a range of 0-250 - bilirubin with reference at 0-0.58 mg/dL - median in symptomatic dogs: 1.52 with a range of 0-9.42 - median in asymptomatic dogs: 0.18 with a range of 0-5.32 - cholesterol with reference at 77.22-270.27 mg/dL - median in symptomatic dogs: 456 with reference at 245.2-776.1 - median in asymptomatic dogs: 281.9 with a range of 141.3-521.2 - 4-year-old sex:M dog - presenting with the following: - vomiting - icterus - fever - abdominal ultrasonography - single choledocholithasis - dilated cystic bile duct, 14 mm - distended gallbladder - gallbladder sludge - diagnosis: obstructive choledocholithiasis - treatment: cholecystoduodenostomy - 8-year-old neutered sex:F dog - presenting with the following: - vomiting - icterus - pain on abdominal palpation - abdominal ultrasonography - single cholecystolith - distended gallbladder - thickened gallbladder wall - echogenic peritoneal effusion - diagnosis: biliary rupture septic peritonitis - treatment: cholecystectomy - 7-year-old sex:M dog - presenting with the following: - fever - vomiting - hemorrhagic diarrhea - abdominal ultrasonography - single cholecystolith - small volume peritoneal effusion next to gallbladder - severe increased echogenicity of mesentery - diagnosis: biliary rupture septic peritonitis - treatment not performed - 7-year-old neutered sex:M dog - presenting with the following: - fever - vomiting - abdominal ultrasonography - multiple cholecystoliths - thickened gallbladder wall, 3.7 mm - gas within gallbladder wall - common bile duct, 3.8 mm - diagnosis: emphysematous cholecystitis - treatment: cholecystectomy - 10-year-old neutered sex:M dog - presenting with the following: - collapse - vomiting - abdominal ultrasonography - multiple cholecystoliths - thickened gallbladder wall - dilated extrahepatic bile duct, 4.8 mm - gas within gallbladder wall - diagnosis: acute cholecystitis - treatment: medical management - 2-year-old neutered sex:F dog - presenting with the following: - fever - abdominal ultrasonography - multiple cholecystoliths - dilated common bile duct, 5 mm - thickened gallbladder wall - gas within gallbladder wall - diagnosis: acute cholecystitis - treatment: medical management - 4-year-old neutered sex:F dog - presenting with the following: - anorexia - icterus - abdominal ultrasonography - single cholecystolith - thickened gallbladder wall, 4.6 mm - lamination of gallbladder wall - gallbladder sludge - diagnosis: acute cholecystitis - treatment: medical management - 5-year-old neutered sex:M dog - presenting with the following: - anorexia - vomiting - pain on abdominal palpation - abdominal ultrasonography - single choledocholith - dilated common bile duct, 9 mm - gallbladder sludge - diagnosis: obstructive choledocholithasis - treatment spontaneously passed - outcome with followup for subsequent 2 years available for 39 dogs - 3 dogs (7.7%) developing complications attributed to cholelithiasis - biliary duct obstruction - acute cholecystitis
“In human medicine, more subtle clinical signs of cholelithiasis might include transient localized abdominal pain, known as "biliary colic," which may be difficult to fully appreciate in veterinary patients….”
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VSPN AOW : Cholelithiasis in the Dog...
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