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Created page with "Also known as: '''''Biliary calculi — Gallstones — Choleliths''''' ==Introduction== Cholelithiasis are rare but occur in '''all animals'''. They may be of '''minute size'''..."
Also known as: '''''Biliary calculi — Gallstones — Choleliths'''''
==Introduction==
Cholelithiasis are rare but occur in '''all animals'''.
They may be of '''minute size''', like grains of sand, or they may be '''large and solitary'''.
In dogs and cats, most stones consist of '''calcium salts and bilirubinate''' (pigment stones).
Stones vary in weight and fragility depending upon their composition. They are sometimes concentrically laminated and often faceted. They are composed of a varying mixtures of materials to include salts of bilirubin, calcium carbonate, calcium phosphate and glycoproteins.
When stones occur in the gallbladder this is called '''cholecystolithiasis''', and when they occur in the bile duct it is called '''choledocholithiasis'''.
==Pathogenesis==
Potential causes include:
:'''bile stasis'''
:'''cholecystitis'''
:'''change in bile composition'''
Stones can form in the absence of infection, but clinical disease usually results when the biliary system containing stones becomes infected or obstructed.
Dogs with pigment gallstones suffer from '''gallbladder inflammation and mucus hypersecretion''' from soluble factors in the bile that inflame the gallbladder wall.
==Clinical Signs==
Cholelithiasis is '''often asymptomatic'''.
Clinical disease presents as: '''jaundice, vomiting, anorexia, weight loss and dehydration'''.
Signs may be mild, transitory or recurrent.
'''Acholic faeces''' indicate complete bile duct obstruction, which can lead to persistent abdominal pain.
==Diagnosis==
Cholelithiasis should be considered as a possible diagnosis if obstructive icterus is present.
'''Radiography''': will detect radioopaque calculi (50% at most)
'''Ultrasonography''': will detect radiolucent calculi and enables examination of the liver parenchyma.
'''Haematology and biochemistry''' reveal extrahepatic biliary tract obstruction: raised AST and ALP, increased bilirubin.
==Treatment==
Animals may need no treatment if they are asymptomatic.
'''Surgical removal''' is the treatment of choice for clinical cases.
'''Cholecystotomy or choledochotomy''' enable stone removal, but bile duct patency must be checked and is vital for a successful surgical outcome.
The treatment of choice is '''cholecystectomy''', as secondary changes of inflammation, fibrosis and necrosis of the gallbladder are common, and removing the gallbladder elimiates a potential source of disease and a reservoir for subsequent stone formation.
Bile should be '''cultured and antibiotic sensitivity testing''' should be performed to ensure adequate antimicrobial cover.
{{Learning
|flashcards = [[Small Animal Soft Tissue Surgery Q&A 18]]
}}
==References==
Pasquini, C. (1999) '''Tschauner's Guide to Small Animal Clinics''' ''Sudz Publishing''
Slatter, D. (2002) '''Textbook of small animal surgery''' ''Elsevier Health Sciences''
Carlyle, T. (1997) '''Veterinary pathology''' ''Wiley-Blackwell''
Merck and Co (2008) '''Merck Veterinary Manual''' ''Merial''
[[Category:To Do - Helen]]
[[Category:To Do - Review]]
==Introduction==
Cholelithiasis are rare but occur in '''all animals'''.
They may be of '''minute size''', like grains of sand, or they may be '''large and solitary'''.
In dogs and cats, most stones consist of '''calcium salts and bilirubinate''' (pigment stones).
Stones vary in weight and fragility depending upon their composition. They are sometimes concentrically laminated and often faceted. They are composed of a varying mixtures of materials to include salts of bilirubin, calcium carbonate, calcium phosphate and glycoproteins.
When stones occur in the gallbladder this is called '''cholecystolithiasis''', and when they occur in the bile duct it is called '''choledocholithiasis'''.
==Pathogenesis==
Potential causes include:
:'''bile stasis'''
:'''cholecystitis'''
:'''change in bile composition'''
Stones can form in the absence of infection, but clinical disease usually results when the biliary system containing stones becomes infected or obstructed.
Dogs with pigment gallstones suffer from '''gallbladder inflammation and mucus hypersecretion''' from soluble factors in the bile that inflame the gallbladder wall.
==Clinical Signs==
Cholelithiasis is '''often asymptomatic'''.
Clinical disease presents as: '''jaundice, vomiting, anorexia, weight loss and dehydration'''.
Signs may be mild, transitory or recurrent.
'''Acholic faeces''' indicate complete bile duct obstruction, which can lead to persistent abdominal pain.
==Diagnosis==
Cholelithiasis should be considered as a possible diagnosis if obstructive icterus is present.
'''Radiography''': will detect radioopaque calculi (50% at most)
'''Ultrasonography''': will detect radiolucent calculi and enables examination of the liver parenchyma.
'''Haematology and biochemistry''' reveal extrahepatic biliary tract obstruction: raised AST and ALP, increased bilirubin.
==Treatment==
Animals may need no treatment if they are asymptomatic.
'''Surgical removal''' is the treatment of choice for clinical cases.
'''Cholecystotomy or choledochotomy''' enable stone removal, but bile duct patency must be checked and is vital for a successful surgical outcome.
The treatment of choice is '''cholecystectomy''', as secondary changes of inflammation, fibrosis and necrosis of the gallbladder are common, and removing the gallbladder elimiates a potential source of disease and a reservoir for subsequent stone formation.
Bile should be '''cultured and antibiotic sensitivity testing''' should be performed to ensure adequate antimicrobial cover.
{{Learning
|flashcards = [[Small Animal Soft Tissue Surgery Q&A 18]]
}}
==References==
Pasquini, C. (1999) '''Tschauner's Guide to Small Animal Clinics''' ''Sudz Publishing''
Slatter, D. (2002) '''Textbook of small animal surgery''' ''Elsevier Health Sciences''
Carlyle, T. (1997) '''Veterinary pathology''' ''Wiley-Blackwell''
Merck and Co (2008) '''Merck Veterinary Manual''' ''Merial''
[[Category:To Do - Helen]]
[[Category:To Do - Review]]