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165.e2 Cholecystitis

Cholecystitis Client Education
Sheet
VetBooks.ir Initial Database
PHYSICAL EXAM FINDINGS
BASIC INFORMATION
• Nonspecific findings may include tachycardia, • CBC: variable depending on severity and
Definition tachypnea, fever, dehydration, and cranial cause. Inflammatory leukogram (e.g.,
Inflammation of the gallbladder wall; can abdominal pain. neutrophilic leukocytosis) is common.
be acute, chronic, necrotizing, and/or • Icterus often is present when there is concur- • Serum biochemistry profile: commonly,
emphysematous rent extrahepatic biliary obstruction (EHBO elevated liver enzyme activities (especially
[p. 118]). alkaline phosphatase [ALP] and gamma-glu-
Epidemiology tamyltransferase [GGT]), hyperbilirubinemia,
SPECIES, AGE, SEX Etiology and Pathophysiology and hypercholesterolemia. Hypoglycemia
• Necrotizing and emphysematous forms of • Necrotizing cholecystitis (type I) (septic peritonitis) or hyperglycemia (diabetes
cholecystitis occur infrequently in dogs and ○ Secondary to infection with subsequent mellitus and emphysematous cholecystitis)
are extremely rare in cats. loss of viability of the gallbladder wall possible
• Acute cholecystitis may occur in cats second- ○ Gallbladder perforation does not occur • Abdominal radiographs may show air or
ary to bacterial cholangitis/cholangiohepatitis despite wall necrosis. calculi in gallbladder. Loss of cranial abdomi-
(p. 160). ○ Antibiotic resistance is an emerging feature nal detail (peritonitis) may be apparent.
• Mean age: 9.5 years for aerobic isolates. • Abdominal ultrasound is highly reliable for
• Male dogs are at increased risk. • Acute (type II) and chronic (type III) the identification of gallbladder rupture
cholecystitis (86% sensitivity), although it is operator
GENETICS, BREED PREDISPOSITION ○ Cause is poorly defined. dependent.
Older, female, small-breed dogs are at increased ○ Bacterial infection (ascending from the ○ Loss of gallbladder wall continuity,
risk for cholelithiasis. Shetland sheepdogs appear common bile duct or by hematogenous hyperechoic fat in the cranial portion of
to be predisposed. spread) suspected the abdomen, and free abdominal fluid
○ Type II cholecystitis results in gallbladder are possible findings. Choleliths may be
RISK FACTORS perforation and peritonitis. seen, as may evidence of mucocele.
Age (increased risk with age), history of pre- ○ Type III cholecystitis results in cholecystic ○ Contrast-enhanced ultrasound is extremely
vious cholecystitis, and concurrent systemic adhesions (omental and hepatic adhesions) specific for gallbladder edema, necrosis,
disease are associated with increased risk of and/or fistulation. and rupture.
cholecystitis. • Emphysematous cholecystitis
○ Invasion of the wall with gas-forming Advanced or Confirmatory Testing
ASSOCIATED DISORDERS bacteria • Definitive diagnosis requires surgical biopsy
• Cholangitis (inflammation of the bile ducts), ○ Tympanic cholecystitis is the result of gas and histopathologic evaluation of a specimen
choledochitis (inflammation of the common distention of the lumen of the gallbladder of the gallbladder wall.
bile duct), and cholangiohepatitis (inflamma- by gas-forming bacteria. • Cultures of bile and/or gallbladder mucosa:
tion of the biliary tree and periportal hepatic ○ Severe tympanic cholecystitis can be Escherichia coli, Klebsiella spp, Enterococcus
parenchyma) associated with emphysematous cholecys- spp, and Clostridium spp are common;
• Cholelithiasis, gallbladder rupture/perfora- titis (gas dissection into the gallbladder aerobic and anaerobic cultures are warranted.
tion, and subsequent bile peritonitis (septic wall). • Laparoscopic evaluation and liver biopsy
or sterile) can be sequelae to cholecystitis. may prove useful. Conversion to an open
• Can occur as the result of gallbladder DIAGNOSIS procedure and cholecystectomy should be
mucocele presumably due to ischemia of anticipated.
the gallbladder wall (p. 374) Diagnostic Overview • Ultrasound-guided, percutaneous cholecys-
• Diabetes mellitus and cystic duct obstruc- • Cholecystitis should be a differential for any tocentesis: bile cytology and bacterial culture
tion: emphysematous cholecystitis (weak patient with cranial abdominal pain and and sensitivity. The reported incidence of
association) elevated serum hepatic enzyme activities or complications after cholecystocentesis is
total bilirubin concentration. Cholecystitis 3.4%.
Clinical Presentation should be the primary differential for a • Cholangiography: radiographic imaging of
DISEASE FORMS/SUBTYPES patient with bile peritonitis without a history the biliary system; rarely performed
• Chronic and emphysematous forms may of trauma. • Abdominal paracentesis or diagnostic
be incidental findings noted on abdominal • A definitive diagnosis is based on surgical peritoneal lavage: if free fluid identified or
ultrasound or abdominal radiographs findings, histopathologic analysis, and culture ultrasound is not available to rule out rupture
(emphysematous: gas within gallbladder). results. (pp. 1056 and 1343)
• Acute and necrotizing forms generally result • Recent literature suggests biliary tract rupture • Scintigraphy: accurate indicator of canine
in systemic illness. occurs in 33% of cases of cholangitis or EHBO but is rarely performed
• Severe transmural gallbladder necrosis, called cholecystitis. Death occurs in 50% of cases
gallbladder infarction, is considered a subtype with biliary tract rupture. TREATMENT
of acute cholecystitis.
Differential Diagnosis Treatment Overview
HISTORY, CHIEF COMPLAINT • Other hepatobiliary disease (gallbladder Surgical removal of a severely compromised
• Presenting complaints are generally vague, mucocele, bile duct obstruction, choleli- or perforated gallbladder and relief of
but may include vomiting, diarrhea, depres- thiasis, intrahepatic diseases) EHBO are essential. Nonsurgical manage-
sion, lethargy, weight loss, abdominal pain. • Pancreatitis ment may be appropriate in select cases
• Profound weakness or collapse can occur • Proximal small bowel disease without compromise of the gallbladder wall’s
with gallbladder perforation and peritonitis. • Causes of icterus (p. 528) integrity.

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