Ruptured Bile Duct in Dogs

The gallbladder is an organ that sits just below the liver on the right side of the abdomen. The gallbladder collects and stores bile, a digestive fluid produced by the liver. Because of the gallbladder’s function, inflammation of the bile duct (choledochitis) and inflammation of the gallbladder (cholecystitis) are two commonly related conditions. Cholecystitis can be acute or chronic, septic or non-septic, calculus or acalculus, necrotizing or non-necrotizing, and/or emphysematous. Shetland Sheepdogs may be more likely to develop cholecystitis than other breeds of dog. Treatments of cholecystitis attempt to repair the relationship between the intestines, gallbladder, and liver. This can be done by removing the gallbladder and mimicking its’ functions or finding an alternative means of communication between these parts to aid in digestion.

• Pain in the abdomen
• Fever
• Vomiting, whether acute or cyclic
• Jaundice – possible indication of jaundice include yellowing of the skin, eyes, and other tissues. Urine may also become darker.
• Increased liver enzyme activity
• Endotoxic shock – this is categorized by low temperatures, dizziness, little to no urine, restlessness, and rapid heart rate.
• Palpable swelling of gall bladder
• Loss of appetite
• Weight loss

Types

Types of cholecystitis (gallbladder inflammation) include emphysematous cholecystitis/choledochitis, non-necrotizing cholecystitis and necrotizing cholecytitis. Necrosis refers to the death of cells in an organ or tissue, normally caused by disease, injury, or lack of blood supply.

• Non-necrotizing cholecystitis - In this form of cholecystitis, the inflammation may be associated with infection, disease, or neoplasia. Additionally, the condition could be the result of blunt trauma to the abdomen or obstruction of the gallbladder by the cystic duct.
• Necrotizing cholecystitis - This form of cholecystitis typically affects middle-aged and older dogs. Dogs who experience this type of cholecystitis may also experience thromboembolism, blunt trauma to the abdomen, infection, obstruction of the cystic duct, or a gallbladder mucocele. This form of cholecystitis can progress with or without a rupture of the gallbladder or as a chronic condition. This type of cholecystitis requires immediate surgery.
• Emphysematous cholecystitis/choledochitis - This is a less common condition resulting from gas within the wall of the gallbladder. In dogs, this condition is associated with diabetes mellitus, acute cholecystitis, traumatic ischemia, mature gallbladder mucocele formation and neoplasia.

In addition to the three types above, there are a number of characterizations used for cholecystitis. It may be acute or chronic, septic or non-septic and calculus (some obstruction formed, typically from salts, acids, or cholesterol) or acalculus.

While the causes of cholecystitis aren’t well understood, there are a few possible associations that can be made:

• Infection, caused by a variety of infectious agents
• Systemic disease in the animal
• Trauma, particularly a blunt force to the stomach region
• Choleliths, which are stonelike masses in the gallbladder (commonly referred to as gallstones)
• Neoplasia, which is an abnormal growth of new tissue

Though not necessarily causes of cholecystitis, there are some factors that increase the risk of your dog developing this condition:

• Biliary stasis, which is the slowing down or altogether stopping of normal bile flow
• Irritation from biliary sludge and gallstones
• Ascending bacterial infections
• Mucoceles, which are abscesses caused by an inappropriate accumulation of mucus

Shetland Sheepdogs may have a higher vulnerability to the development of cholecystitis than other breeds of dogs.

Diagnostic tests will be used to rule out other possible conditions that could cause the symptoms your pet is presenting. Some of the possible diagnostic tests include:

• A physical exam in which the symptoms are addressed, and a comprehensive examination of the pet is completed.
• Ultrasound, used to detect thickened gallbladder wall or cystic bile duct – this may also lead to pain caused by the pressure of the ultrasound technology in dogs that have cholecystitis.
• Palpation of the gall bladder to determine if there are any masses present or if the area is tender to the touch
• Blood and urinalysis tests
• Abdominal x-rays

The goal of treatment is to restore the status of fluids and electrolytes in the body. This can be achieved in a few different ways:

• Treatment with antibiotics that work against enteric opportunist parasites
• Colloids (a solution with particles ranging between 1 and 1000 nanometers in diameter, remaining equally distributed throughout the solution) and plasma transfusion (in some cases).
• Surgery – in some cases, emergency surgery may be necessary. The surgery of choice is cholecystectomy, in which the gallbladder is completely removed. Biliary diversion procedures may be necessary in some cases. Cholecystoenterostomy is a biliary diversion procedure where the gallbladder and the small intestine are joined. This allows bile to pass from the liver to the intestine when the bile duct is obstructed by something that cannot be moved. Choledochoenterostomy is biliary diversion procedure option that forms a communication between the bile duct and intestine so that bile may pass through as well.
• Samples of bile, gallbladder wall, choleliths and liver tissue may be submitted for aerobic and anaerobic cultures to determine the best treatment options. Based on the results of these cultures and sensitivity of bile and involved tissues, antimicrobial therapy may be used.

Things to be aware of through the recovery process include possible cholecystectomy side effects, such as abdominal pain and diarrhea. Cholecystectomy causes loss of the gallbladder’s functions, so the amount of bile increases. Recurrences of the condition are possible. Your dog should be monitored for fever, lack of appetite, and vomiting. Your veterinarian will likely schedule follow-up visits so that physical exams and any necessary tests can be done to monitor the pet’s condition and avoid recurrence of the condition. In addition, monitoring should be done of rectal temperature in animals with cyclic illness. Most post-treatment illnesses are responsive to antibiotics. For most pets, treatment is highly effective and long-term survival with a good quality of life is expected for cases in which neoplasia is not present.