When cholecystitis becomes severe, gallbladder necrosis and rupture may occur, with subsequent biliary peritonitis. Ultrasonography
identifies increased gallbladder wall thickness and echogenicity; dilated, tortuous bile ducts; and concurrent cholelithiasis.
Table 2: Bile acid/ultrasonographic findings associated with biliary tract disease.
Antimicrobial therapy based on bacterial culture and sensitivity test results is the optimal treatment for cholecystitis.
Severe cases of cholecystitis, such as emphysematous or necrotic cholecystitis, may be treated surgically with cholecystectomy.
Choleliths are uncommon in older dogs as well. Choleliths are usually composed of cholesterol, bile acids, pigments, calcium
and protein. Diet and cholecystitis are predisposing causes for cholelith formation.
The clinical signs and diagnostic approach to cholelithiasis are similar to that used for cholecystitis. Treatment of cholelithiasis
may be either surgical or medical. Seldom is surgery needed because of the presence of choleliths; however, cholecystectomy
can be performed for cholelithiasis, which will prevent recurrence.
Medical therapy may include antimicrobial agents and commercial canine diet formulated for liver disease.
Dr. Hoskins is owner of DocuTech Services in Baton Rouge, La. He can be reached at (225) 955-3252; fax, (214) 242-2200.