Page 387 - Cote clinical veterinary advisor dogs and cats 4th

Cholecystitis 165.e3

Acute General Treatment Recommended Monitoring Client Education
• Immediate surgical intervention in cases with • Intensive monitoring in a critical care setting • Recurrence is possible if cholecystectomy is
VetBooks.ir • Patients that are systemically ill must be patients (e.g., necrotizing cholecystitis, bile • Early intervention likely improves outcome. Diseases and Disorders
not performed.
gallbladder wall rupture and/or concurrent
is indicated in markedly compromised
bile peritonitis
peritonitis).
aggressively supported before surgical man-
agement (e.g., fluids, antibiotics, colloids). • Serial serum biochemistry profiles and serial SUGGESTED READING
abdominal ultrasound exams as indicated
Tamborini A, et al: Bacterial cholangitis, cholecystitis,
• Monitoring coagulation profiles and vitamin or both in dogs. J Vet Intern Med 30:1046-1055,
Chronic Treatment K supplementation (0.5 mg/kg IM q 12h 2016.
• Select cases of cholecystitis can be managed until relief of obstruction) is indicated in
without surgical intervention, provided 1) patients with complete EHBO. ADDITIONAL SUGGESTED
there are no signs of systemic illness such READINGS
as severe lethargy, vomiting, or anorexia; 2) PROGNOSIS & OUTCOME Church EM, et al: Surgical treatment of 23 dogs
there is no evidence of EHBO or compromise with necrotizing cholecystitis. J Am Anim Hosp
of the gallbladder’s integrity; and 3) serum • Mortality rates of 25%-39% with canine Assoc 24:305-310, 1988.
biochemical values (liver enzymes and necrotizing cholecystitis Harrison JL, et al: Cholangitis and cholangiohepatitis
bilirubin) are decreasing over time or have • Overall mortality rates of 50% with canine in dogs: a descriptive study of 54 cases based on
normalized. bile peritonitis (73% with septic effusions) histopathologic diagnosis (2004-2014). J Vet Intern
• Treatments that may be used in conservative • Septic peritonitis, preoperative elevated Med 32:172-180, 2018.
(nonsurgical) management of these select creatinine concentration, and immediate Ludwig LL, et al: Surgical treatment of bile peritonitis
in 24 dogs and 2 cats: a retrospective study (1987-
cases include long-term antibiotic therapy postoperative hypotension are associated 1994). Vet Surg 26:90-98, 1997.
(e.g., amoxicilliin 20 mg/kg PO q 8h or with a poor clinical outcome. Mehler SJ, et al: Variables associated with outcome
amoxicillin-clavulanic acid 15-20 mg/kg PO • Cholecystectomy may decrease risk of mortal- in dogs undergoing extrahepatic biliary surgery: 60
q 12h until culture and sensitivity results are ity for cholangitis and cholangiohepatitis. cases (1988-2002). Vet Surg 33:644-649, 2004.
available), choleretics (ursodiol 15 mg/kg PO
q 24h), and treatment of any underlying PEARLS & CONSIDERATIONS RELATED CLIENT EDUCATION
disease (e.g., pancreatitis, diabetes mellitus).
Comments SHEETS
Possible Complications • Only selected cases can be managed medically. Cholangitis Complex of Cats
• Gallbladder rupture and bile peritonitis • Surgical management is indicated in all cases Consent to Perform Abdominal Ultrasound
(septic vs. nonseptic) involving gallbladder wall compromise, bile
• Recurrence of cholecystitis with inappropriate peritonitis, or EHBO (excluding select cases AUTHOR: Fredrick S. Pike, DVM, DACVS
treatment of pancreatitis). EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
• EHBO
• Complications associated with cholecys- Technician Tips
tocentesis are uncommon (<4% of cases) Early enteral nutrition is very important for
and include GB wall edema, intraluminal a positive outcome. In severely debilitated
GB hemorrhage and extraluminal leakage patients, esophagostomy or nasogastric feeding
of bile. should be implemented postoperatively.

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