Snow Leopard

Snow Leopard
Snow Leopard cub (7 mos old) - Cape May County Zoo

Tuesday, May 3, 2011

Happy Anniversary to ME

On the one year anniversary of MY gallbladder surgery, I thought it would be appropriate to tell you that we DO see gallbladder (GB) disease in pets too. 


I couldn't find a good normal dog gallbladder photo but this drawing gives you the idea of what  normal is supposed to look like.




First, let me tell you (and I'll date myself here) when I was in veterinary school, we didn't really discuss the topic I am about to get into: GB mucoceles. I even went back into my medicine AND surgery notes and there is NOTHING on this.  It may have been mentioned in passing in a class, but certainly not anything to really "make sure I remember." 


I think there are several reasons for it: we were JUST starting to use ultrasonography as a diagnostic modality AND we didn't "know" what it was at that time. We weren't "looking" for it.


So what IS it? It's an accumulation of mucous within the GB that is caused by dysfunctional and proliferating mucous producing cells. We don't know WHY it happens. In people, it happens for a different reason - usually due to an obstruction of the bile duct. In dogs, this is not the case. 


We just don't see stones, or choleliths, in dogs and cats, like we do in people. I won't say NEVER but I've seen them maybe once or twice and it was on an xray I took for a TOTALLY different reason.  


The dogs that have these come in with vague signs of illness or NDR (not doing right). These include mild inappetance to complete anorexia, lethargy, vomiting, and diarrhea. These signs can be chronic and even waxing/waning (the dog gets better, then worse, then better, etc). 


Of course, those signs can mean about 3,000 things (ok, I didn't REALLY count but you get the idea). So we start with blood work and maybe an xray (depending on history and physical exam findings). In many cases, we will find abnormalities in liver values and white blood cell counts (not all the time of course!) 


All dogs with the above findings will not get an ultrasound. First of all, as stated before, there can be many causes to the above signs and lab findings. If there is abdominal pain we are more apt to pursue further diagnostics. If there are certain things in the patient's history we also may go down that road. In many cases, there is a financial constraint. And since there is often response to "generic" therapy used for "gastroenteritis" type signs, most people don't wish to go further..unless we have a relapse. 


When an ultrasound is done, what is found is what is  described as looking like a "kiwi." You can see that it does!


Admittedly they don't ALL look this classic. But there is a definite difference for the trained ultrasonographer versus a nice normal gallbladder. 


Most of these DO respond to medical therapy that includes antibiotics, antiemetics (to stop vomiting), liver support supplements and diet. 


There is always a danger of GB rupture however and in those cases, the patient can go south very quickly. Certainly some cases, especially those that don't respond (again, BEST monitored with a recheck ultrasound) will require surgical removal of the GB. 


This is what they look like when removed:




Just for fun, and since I'm sharing part of ME with all of YOU in this blog, here's what a normal human gallbladder does NOT look like (despite what a whole bunch of docs and normal tests say!):


Yep, MY gallbladder...we parted ways 1 year ago today.  I don't  miss it!
FYI it's not supposed to be big and white!


Thanks to my wonderful surgeon, Dr. Peter Rovito, for : respecting the fact that 1) I have a brain (one of the few docs that didn't treat me with disdain when they found out I was a veterinarian) and actually KNOW and understand anatomy, physiology and disease processes  2) I know my body and also for knowing that 3) Normal tests do NOT equal NO disease and 4) Exploratory surgery has immense value!! 



2 comments:

  1. OMG!!!! You had some gall! Glad you got rid of it.

    ReplyDelete
  2. :) LOL..yeah I did huh? ME too..I don't miss it one bit!

    ReplyDelete