Page 448 - Problem-Based Feline Medicine

440 PART 7 SICK CAT WITH SPECIFIC SIGNS

● Sonography shows a distended/tortuous common
CHOLECYSTITIS
bile duct, large gall bladder and distended intrahep-
atic biliary ducts. These findings may be observed
Classical signs
as early as 5–7 days post-obstruction when viewed
by an experienced sonographer. ● Abdominal pain, fever, vomiting.
● +/- jaundice.
● Palpable right cranial abdominal mass.
Differential diagnosis
The historical, clinical and laboratory features of extra-
Clinical signs
hepatic biliary obstruction may be indistinguishable
from other severe cholestatic hepatopathies. Abdominal pain, fever, vomiting and jaundice.
Abdominal ultrasonography is the quickest and least A mass lesion may be palpable in the cranial abdomen.
invasive means to confirm extrahepatic biliary obstruc-
Animals may present in endotoxic shock with gall blad-
tion.
der rupture.
Treatment Pathogenesis

First stabilize the patient with fluid and electrolyte therapy. Inflammation of the gall bladder is uncommon.
Perform a laparotomy for inspection/correction of the Inflammation may occur from occlusion of the cystic
biliary tract obstructive lesion. duct, with resultant gall bladder inflammation resulting
● Prompt correction of complete obstruction via per- from bile stasis. Occlusion may occur due to extralu-
formance of cholecystoduodenostomy or cholecysto- minal compression (e.g., mass, adhesion) or intralumi-
jejunostomy is recommended. nal obstruction as seen with cholelithiasis.
● Broad-spectrum antibiotics are indicated if biliary- Emphysematous cholecystitis is most commonly
enteric anastomosis is performed. observed in association with diabetes mellitus, acute
Extrahepatic biliary obstruction caused by pancreatitis cholecystitis with/without cholelithiasis, and traumatic
may be amenable to medical therapy (dietary modifica- ischemia of the gall bladder.
tion, IV fluids, antiemetics, etc.). E. coli bacteria are most commonly cultured from the
● Biliary decompression is recommended in pan- biliary tree of affected cats.
creatitis patients with rising hype bilirubinemia or
sonographic evidence of worsening gall bladder
Diagnosis
distention.
Specific therapy for hepatocellular inflammation (con- Most animals have a variable leukocytosis.
firmed by biopsy) and intrahepatic cholestasis may be Hepatic biochemical parameters (total bilirubin, ALT
required. and ALP) are modestly increased.
● Use ursodeoxycholic acid (10 mg/kg PO q 12 h) for
5–7 days post-operatively to reduce cholestatic Ultrasonography or laparotomy is usually necessary for
injury. a diagnosis.
● Gas accumulation within the biliary tree/gall blad-
der indicates cholecystitis.
Prognosis ● Choleliths may be an uncommonly recognized inci-
dental finding.
Guarded to good depending upon the underlying cause.
● Cranial abdominal fluid accumulation indicates bil-
Biochemical abnormalities associated with extraheptic iary rupture and peritoneal inflammation. Analysis of
biliary obstruction subside quickly following success- peritoneal effusion reveals the presence of inflamma-
ful surgery. tory cells (e.g., neutrophils, macrophages) and biliru-
bin crystals in a turbid golden-brown or green fluid.