BILIARY MUCOCOELE: A SURGICAL LIVER DISEASE OF DOGS
It all starts with a sick, usually middle-aged or older dog. He is listless, not eating, maybe having vomiting and/or diarrhea, fever. These are symptoms that could mean any number of things but usually when he reaches the veterinarian’s examination table he has jaundice (yellow pigmentation visible in the whites of his eyes and possibly on his skin and gums). Hospitalization is recommended to rehydrate him and provide supportive care and blood tests point to a liver problem. Medications are administered to minimize the liver’s workload but soon ultrasound is being discussed to image the liver and costs may be rising quickly.
In a survey of dogs with hepatobiliary mucocoeles, the following symptoms were observed:
Vomiting – 77%
The alphabet soup of blood tests can be confusing and it can be tempting to wait a few days and see how medical support works out before imaging. While this may be a fair choice depending on the patient, there is an important reason to image the liver quickly and this reason is the possibility that surgery is needed urgently.
If the patient has a surgical disease,
The sooner the surgical patient is identified, the better the chance of survival.
WHY DO WE NEED ULTRASOUND IF WE ALREADY KNOW THE PROBLEM IS LIVER DISEASE?
Dr. Jon Perlis of DVMSound at our hospital performing ultrasound exam.
(original graphic by marvistavet.com)
While blood testing can point to the liver, the fact is that there are numerous diseases that can affect the liver. The liver can have an infection or cancer or scarring (cirrhosis) or any number of conditions and the more specific our diagnosis gets, the more specific treatment can be.
Ultrasound represents a non-invasive way to evaluate the internal texture of the liver and gall bladder. By looking at the liver’s texture it is possible to see a tumor and determine if removing it is possible or if it has invaded too far. Ultrasound can evaluate scarring and abscessation. Through ultrasound it is possible to guide a biopsy needle to an exact area to sample tissue should this be deemed necessary.
Ultrasound evaluates the gall bladder and bile ducts. One of the more important diseases to rule out promptly is the biliary mucocoele because it commonly represents a surgical emergency. If one waits a few days to see how the patient responds to general liver support, it may be too late. Further, ultrasound allows for evaluation of the integrity of the gall bladder for if the mucocoele ruptures and spills bile into the belly, not only will the surgeon need to know that but additional treatment for this complication is needed. Ultrasound also evaluates concurrent abdominal conditions that might bear on recovery, including pancreatitis which can present with very similar symptoms or might be present along with a biliary mucocoele.
WHAT IS THE GALL BLADDER AND WHAT IS THE BILIARY SYSTEM?
WHAT IS A BILIARY MUCOCOELE?
WHY DOES THIS HAPPEN?
Having Cushing’s Syndrome increases a dog’s risk of developing a biliary mucocoele by 29 times
Oddly, the biliary mucocoele, which is now a fairly common cause of canine liver disease, was only rarely seen before the 1990’s. No one knows why this might be so but it does correspond to the mainstreaming of diagnostic ultrasound into general practice.
The Shetland sheepdog, cocker spaniel, miniature schnauzer and dachshund seem predisposed to developing biliary mucocoeles.
REMOVING THE GALL BLADDER (CHOLECYSTECTOMY)
WHAT IF SURGERY IS NOT AN OPTION?
There is no question that surgery is the best treatment choice but there is more to the story. Biliary mucocoeles can be in an incidental finding in dogs that are not sick or who are sick from something else and are having ultrasound of the belly for some other reason. In the patient that is not experiencing problems with a mucocoele, medication may be able to stave off illness.
As for skipping surgery in a dog that is sick from its mucocoele, this is a risky move but survival is possible.
It is possible to attempt treatment with general liver support medications, low fat diet, and choleretics (medications to help liquefy bile, such as ursodiol) but the problem is that the gall bladder is obstructed with a big wad of goop. This goop is unlikely to liquefy in a timely fashion if at all, no matter what we do. If medical management is attempted, it is important to regularly recheck the gall bladder by ultrasound to watch for any sign of progression that would indicate that surgery should no longer be postponed.
Page posted: 8/12/2012