Choleretic agents for dogs. Inflammation of the biliary tract or cholecystitis in dogs

Inflammation of the gallbladder in combination with damage to the ducts often develops in dogs against the background poor nutrition. In the absence of proper therapy, the disease takes chronic form, the digestion process and the general condition of the pet worsen.

How to promptly recognize cholecystitis in dogs? Symptoms and treatment of pathology, possible complications, effective measures prevention and others important nuances disclosed in the article.

Causes and predisposing factors

In most cases, cholecystitis in dogs develops against the background of errors in the nutrition of the four-legged pet. Owners often give animals food common table, which negatively affects digestive tract, the functioning of the gallbladder and liver. Difficult-to-digest substances accumulate, rot, and inflammation develops. For poor bile flow and stones pathological process intensifies.

Other negative factors associated with feeding your dog:

• cheap food of low quality;
• overfeeding the dog, development of obesity;
• V free access there is not always water available when receiving dry food, which leads to digestive problems;
• The diet contains few foods containing vitamin A and beta-carotene. Shortage useful substances interferes with the regeneration of liver and gallbladder cells;
• violation of the feeding regime, the dog often goes hungry;
• the animal receives food, threatening for the health of your four-legged pet.

External and internal factors, provoking the development of cholecystitis:

Diet and nutrition correction

Medical nutrition - important element normalization of gallbladder functions. The optimal type of diet is suggested by the veterinarian observing the pet. Many doctors recommend giving your four-legged pet natural food instead of dry food, until the dog recovers or you urgently need to stop cheap granular food, switch to elite items from the medicinal series for dogs with sensitive digestion. Boiled pumpkin and carrots (puree) are useful.

Symptoms and treatment of cholecystitis - information that owners of four-legged pets should study. Gallbladder disease develops in dogs small breeds and larger pets. To reduce the risk of acute and chronic cholecystitis You need to give your pet high-quality food, carry out deworming on time, and fight infections. It is important to remember about preventive measures and regular visits to the veterinarian to monitor the health of the animal.

Cholecystitis in dogs is a disease characterized by the occurrence inflammatory process in the gallbladder. You can learn more from the next video useful information about the causes and symptoms of the disease, as well as how treatment is carried out:

J. Braid Case, DVM, MS, Diplomate of the American College of Veterinary Surgeons. College of Veterinary Medicine, Florida State University, Gainesville, USA.

Indications for laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is one of the most commonly performed laparoscopic procedures. surgical operations in people. Although initial fears and prejudices prevented her wide application and delayed it, currently more than 90% of cholecystectomies are performed laparoscopically. One of the most common indications for laparoscopic cholecystectomy in humans is symptomatic cholelithiasis. However, in dogs, so-called symptomatic cholelithiasis is much less common. Additionally, the most common extrahepatic biliary disorder in dogs is gallbladder mucocele with/without obstruction. bile ducts or with cholecystitis.
A veterinary surgeon contemplating laparoscopic cholecystectomy is faced with two main questions: is there bile duct obstruction and can resection be done safely?
Bile duct obstruction can usually be ruled out by ultrasound examination abdominal cavity and monitoring serum bilirubin. However, many factors influence the ability to safely remove the gallbladder. To date, the exact indications for HL in dogs have not yet been determined. This is due to the lack of experience and clinical data on HL in dogs. However, uncomplicated gallbladder mucocele appears to be the primary indication for HL, as few clinical reports have demonstrated the safety and effectiveness of surgery in the presence of this condition.
Recognized on this moment contraindications are coagulopathy, biliary peritonitis, rupture/obstruction of the bile ducts, small size patient (< 4 кг) и факторы, ограничивающие стабильность пациента под анестезией 1-3. Данная публикация может служить в качестве инструкции для принятия решения и выбора собак, пригодных для лапароскопической холецистэктомии, а также в качестве руководства по выполнению процедуры.

Patient preparation/selection

In dogs clinical picture mucocele of the gallbladder usually includes symptoms of gastrointestinal intestinal tract, such as anorexia/hyporexia, vomiting and diarrhea. Patients are recommended to undergo a thorough physical examination, perioperative treatment with fluids and antiemetics, and perioperative antibiotic prophylaxis. Despite the limited access required for HL, extensive shaving is recommended due to the use of multiple lateral abdominal ports and the potentially high rate of conversion to laparotomy with this procedure (0–35%)1-3. Cranially, the shaved area should extend approximately 5–10 cm cephalad to the xiphoid process, and caudally should extend beyond the pubic bone. The lateral edges should be approximately at the level of the hypaxial muscles.

Special Notes and Tools

Bipolar electrosurgical devices are important for hemostasis during gallbladder resection. In some cases gallbladder may surround omental adhesions, and their dissection is accelerated by the use of these instruments. Dissection of the gallbladder from the hepatic fossa can be accomplished using a bipolar electrode (eg, a Harmonic scalpel), as well as a monopolar J-hook electrosurgical device and/or blunt palpation probes.

Aspiration and irrigation

Typically, during resection of the gallbladder, slight bleeding occurs from the liver parenchyma and/or bladder vessels. Blood in most cases accumulates around the base of the bladder and the common bile duct, which impairs visibility, so irrigation and evacuation of this blood is necessary. There are two main devices available, which, according to the author, are in this case necessary. These are a reusable suction/irrigation device with a tubular valve (manufactured by Karl Storz Endoscopy) and a disposable combined suction/irrigation device containing an electrosurgical hook (for example, the Surgiwand device from Medtronic).

Gallbladder retraction

Sufficient and stable retraction of the gallbladder is in many cases a difficult task. The gallbladder is usually large and heavy, and its wall is fragile. Direct grasping with Babcock or DeBakey forceps poses a risk due to the possibility of gallbladder rupture, so grasping the gallbladder with forceps is not recommended. Instead, multiple fan retractors can be used to achieve atraumatic ventral retraction without the need for direct grasping of the gallbladder wall.

Basic tools

For HL, either a 0- or 30-degree endoscope is suitable. A 30-degree endoscope is advantageous in that it allows examination of the cephalad region of the cystic duct, which helps determine a safe dissection plane and guide suture material around the duct. Various ports for LH are described. These include reusable ports with a diameter of 5 and 10 mm and ports for single-incision laparoscopic surgery (SILS) with a diameter of 24 mm, to which separate 5-mm ports are added or not1-3. At least one port must be large enough to accommodate a 10 mm clip applicator and specimen retrieval device.

In general, required laparoscopic instruments include:

• 5 mm laparoscopic Babcock scissors
• auxiliary curved scissors
• Dissector Kelly
• 5mm and 10mm right angle forceps (preferably rotary)
• biopsy forceps and blunt palpation probe

If extracorporeal knot tying is used for cystic duct ligation, a 5-mm knot pusher is also required.

Experience

According to the author, HL is one of the most problematic laparoscopic procedures, so before recommending and performing this procedure, the surgeon must be familiar with the traditional abdominal approach for cholecystectomy and have practical experience its implementation.

Patient placement and port locations

Dogs are placed in the forward or reverse Trendelenburg position (lying on their back) depending on the surgeon's preference. Reverse position The Trendelenburg position provides the advantage of cephalad displacement of the liver and gallbladder lobes, while the direct Trendelenburg position promotes caudal displacement of the internal organs of the gastrointestinal tract. The author finds that both positions can be beneficial during HL, so it is recommended to use an operating table with a “floating” bed or a table that allows the patient to change position during surgery.
All port sites are infiltrated with bupivicaine before the appropriate incision is made. A 5 mm camera/endoscope port is placed in the subumbilical area and an initial laparoscopic examination is performed. The Ternamian threaded cannula is preferred because these ports minimize slippage into and out of the peritoneal cavity.
Once the endoscope has been positioned and completed initial examination, a second threaded cannula with a diameter of 5 mm is placed 5–8 cm lateral and 3–5 cm cephalad to the subumbilical port on the left cranial part of the abdomen, and the other two ports are placed 3–5 cm and 5–8 cm lateral to the subumbilical port on the right side . These positions are general guidelines and can be modified according to surgeon preference and patient size variations.
In the case of SILS access, a port with a diameter of 24 mm and one or two additional 5 mm ports are placed in the umbilical area 4–8 cm lateral and 3–5 cm cephalad on the left or right side, depending on the surgeon's preference2,3. Individual tools can be oriented when various schemes port locations. However, it is recommended to place the fan retractor in the left cranial port, the endoscope in the right paramedian port, and the dissecting forceps in the subumbilical and right lateral ports. In this case, the assistant controls the endoscope and fan retractor, and the surgeon stands slightly to the right and controls the dissecting forceps. This general recommendation, but, of course, changes to this scheme are possible.

Description of the procedure

A welcome advantage of the laparoscopic approach to cholecystectomy is the ability to easily identify individual hepatic ducts. Once the cystic duct is located, dissection is made from right to left around the duct. During this procedure, right-angle forceps are necessary to ensure complete exposure of the cystic duct and artery, especially if extracorporeal sutures must be used to ligate the duct.
5 mm and 10 mm right angle forceps should be available as in dogs with a wide cystic duct the 5 mm right angle forceps will not be long enough to bring the ends to the opposite side of the cystic duct. Another excellent option is to use 5mm right angle rotary forceps as they can be bent to guide the ends around the opposite side of the duct.
Once the cystic duct is isolated, either an appropriately sized applicator clip (it should be wide enough to cover the entire cystic duct when closed) or an extracorporeal suture is placed around it. Suitable monofilament suture material with a long biodegradation period, USO size 0 or 2-0. For cystic duct ligation, a modified Raeder knot is recommended. Typically, two clamps or two ligatures are placed proximally and one clamp or one ligature is placed distally. Metzenbaum scissors are then used to divide the cystic duct between the two proximal ligatures and the distal ligature.
Further separation of the gallbladder from the hepatic fossa is performed using a bipolar electrosurgical device, a J-hook cautery, or a blunt probe. It is recommended to begin dissection from the cystic duct rather than from the apex of the gallbladder. Ventral traction of the ligated portion of the cystic duct (from the side of the gallbladder) promotes its separation from the hepatic fossa. Once the gallbladder is completely separated from the hepatic fossa, a specimen extraction bag is used to place the gallbladder before it is removed from the abdomen. If the gallbladder is large and filled with fluid, it can be decompressed before removal from the abdominal cavity. Once the specimen bag and the gallbladder housed within it emerge from the abdomen, a scalpel can be used to excise a small piece of the gallbladder, allowing its contents to leak into the specimen bag and the gallbladder to collapse, thereby facilitating its removal through the small incision for the port.
Care must be taken to prevent the specimen bag from rupturing or leaking bile into the peritoneal cavity. If a leak of bile into the abdominal cavity has occurred, a transition to laparotomy, complete lavage of the abdominal cavity and evacuation of fluid is necessary.
After the procedure is completed, the cystic duct stump is washed and any remaining blood, fluid or bile is removed. Liver biopsies and gallbladder samples are also obtained to send to the laboratory. Stop introducing carbon dioxide into the abdominal cavity and remove residual CO2. All ports are removed, and the remaining incisions are sutured in 2-3 layers.

Complications and outcome

Possibly moderate or heavy bleeding from damage to the cystic artery or liver vessels, but it can be avoided with careful dissection. In general, it is recommended that the dissection plane be located closer to the gallbladder than to the liver parenchyma, since bleeding is more likely with small accidental liver dissections.
It is also possible for the hepatic duct to rupture due to accidental dissection of the liver parenchyma. Bile may leak from the bile duct during the procedure or after the procedure if clamps or ligatures are not applied correctly. Therefore it is necessary to pay Special attention carefully apply ligatures and inspect the cystic duct after the procedure.
Common bile duct obstruction is likely if a mucus plug or stone is in the common bile duct. However, careful patient selection will prevent this complication.

1. Mayhew P. D., Mehler S. J., Radhakrishnan A. Laparoscopic cholecystectomy of uncomplicated gallbladder mucocele in six dogs. Vet Surg, 2008; 37: 625–630.
2. Monnet E. Laparoscopic cholecystectomy in 16 dogs: Short-term outcome. Proceedings of the Veterinary Endoscopy Society Annual Meeting, Santa Barbara, CA, April 12–14, 2015.
3. Scott J., Singh A., Mayhew P. D., Case J. B., et al. Peri-operative outcome and complications following laparoscopic cholecystectomy in dogs: 20 cases (2008–2015). Scientific Presentation Abstracts: 2016. Veterinary Endoscopy Society 13th Annual Scientific Meeting, Jackson Hole, Wyoming, June 12–14, 2016.

It's no secret that our pets can get sick not only with their special breed diseases(more about), but also suffer from completely human ailments. So, for example, your dog may be diagnosed with: cholecystitis. And here a lot of questions arise - how to treat cholecystitis in a dog, and how to prevent relapse of the disease...

Our publication will try to help you answer these questions...

Cholecystitis in dogs - description of the disease

A disease in which the bile ducts of an animal are affected, and such lesions are accompanied by inflammatory processes localized in the gallbladder, is called cholecystitis. It is quite difficult to identify this disease in a timely manner, therefore, when your pet is diagnosed with this disease, it is most often already in an advanced state.

Causes of cholecystitis in dogs

Of course, after you hear such a diagnosis, you are interested in answers to questions about why your pet got sick, what caused the development of cholecystitis in a dog, whether you could somehow prevent the development of this disease... Well, similar Disease in animals can arise from several causes. And above all, The main causative agent of cholecystitis is microbes. Penetrating into the animal’s body from the intestines, by hepatic artery or through the biliary tract they enter the gallbladder. Also microbes causing cholecystitis, can be transported by lymphogenous route.

As you can see, there are many reasons that can lead to the development of the disease, however, it is not always possible to establish exactly what caused the development of cholecystitis in a dog in each specific case.

Symptoms of cholecystitis in dogs

As a rule, the initial and middle stages of the disease occur asymptomatically in the animal’s body, only against the background of an exacerbation in dogs the appetite decreases, vomiting begins, stomach upset, the mucous membranes of the mouth and nose may turn yellow, the dog itself looks lethargic and depressed, and when palpating the area liver and abdominal cavity, the animal begins to whine, as there is pronounced pain in this place. Also, in sick animals there is periodic increase. And, as a result of difficulties with the outflow of bile, signs of obstructive jaundice may appear.

Diagnosis of cholecystitis

Treatment of cholecystitis in dogs

• If the disease is advanced and the animal’s condition is serious, the dog is prescribed a number of therapeutic procedures aimed at relieving the inflammatory process, normalizing the processes of bile secretion and digestion.
• For disinfection biliary tract and improving the outflow of bile itself, allohol, corn silk tincture, holagon, magnesium sulfate are prescribed.
• To relieve spasms of the gallbladder and bile ducts, antispasmodics, atropine sulfate, and no-spa are prescribed.
• For pain relief, analgin, baralgin and other painkillers are used. However, the prescription of these medications, as well as the determination of their dosage, depending on the weight of the dog, its age, and its general condition should be handled by a doctor.
• The final stage of treatment involves thermal physiotherapeutic procedures to improve the resorption of exudate, remove pain syndrome and improving blood circulation.

Cholecystitis is an inflammation of the gallbladder. Cholecystitis in dogs usually occurs with inflammation of the biliary tract - cholangitis.

Anatomical data of the gallbladder in a dog.

The gallbladder is a reservoir for bile, in which bile thickens 3-5 times, since it is produced more than is required for the digestion process. The color of gallbladder bile in dogs is red-yellow.

The bladder lies on the quadrate lobe of the liver high from its ventral edge and is visible from both the visceral and diaphragmatic surfaces. The bubble has bottom, body And neck. The wall of the bladder is formed by the mucous membrane, a layer of smooth muscle tissue and the outside is covered with peritoneum, and the part of the bladder adjacent to the liver is loose connective tissue. The cystic duct originates from the bladder and contains spiral fold.

As a result of the fusion of the cystic duct and the common hepatic duct, the common bile duct is formed, which opens
into the S-shaped gyrus of the duodenum next to the pancreatic duct at the apex major papilla duodenum. At the point where it enters the intestine, the duct has bile duct sphincter(sphincter of Oddi).

Thanks to the presence of the sphincter, bile can flow directly into the intestines (if the sphincter is open) or into the gallbladder (if the sphincter is closed).

Clinical picture. Cholecystitis is characterized by indigestion. A sick dog burps after feeding, frequent vomiting(). The vomit is liquid in nature, with undigested food, and a small amount of mucus. Sometimes the presence of bile can be detected in vomit. As a result of irritation bile acids on the intestinal mucosa, the dog experiences flatulence (), bloating and diarrhea (). Dryness occurs as a result of advancing dehydration. skin, six becomes dull, the dog looks unkempt. When the bile ducts are blocked feces become pale in color. Some dogs become constipated (). The dog becomes lethargic, apathetic, and reluctant to move. The body temperature may rise for a short time, and sometimes we experience a fever.

As a result, the dog pain A characteristic pose appears - the animal lies on its stomach and arches its back upward. Palpation in the abdominal area is painful.

On clinical examination, the dog's gums and sclera are pale and icteric (). Urine due large quantity bilirubin has a bright carrot tint.

Chronic cholecystitis Usually the dog is asymptomatic and is detected only during an exacerbation of the disease. In the dog, owners note lethargy after eating, nausea, vomiting, bowel irregularities accompanied by diarrhea or constipation.

Diagnosis. The diagnosis of cholecystitis is made by the veterinary specialists of the clinic based on the clinical examination, collecting medical history and additional methods research:

• General blood test - we find increased amount leukocytes, with shift leukocyte formula towards immature cells. Advanced level bilirubin and bile acids. Increased alkaline phosphatase activity. High level transaminases
• Urine and feces analysis - increased content levels of bile acids and bilirubin.
• X-ray examination - we detect the presence of stones in the gall bladder.
• Ultrasound - decrease in the lumen of the bile ducts, thickening of the bile itself.

Differential diagnosis. Cholecystitis is differentiated from liver diseases (), gastroenteritis (), peritonitis.

Treatment. Veterinary specialists at the clinic treat cholecystitis based on the form of the disease and the general condition of the sick dog. At severe course diseases, when experts believe that there is a threat of rupture of the gallbladder and the development of peritonitis, they resort to emergency surgery associated with the removal of an inflamed gallbladder.

If the disease is in acute phase, then to begin with the dog can be prescribed therapeutic fasting for 2-3 days or a strict diet following a certain diet.

To eliminate pain, the dog is prescribed painkillers and antispasmodics - baralgin, no-shpu, papaverine, spasgan, atropine sulfate.

To normalize the outflow of bile and at the same time for the purpose of disinfection of the biliary tract, it is used choleretic drugs- allohol, magnesium sulfate, cholenzyme, ursosan, ursofalk.

An excellent choleretic agent are such herbal medications, like immortelle flowers and corn silk. These drugs are used in the form of infusion and decoction.

If the cause of cholecystitis is intestinal infection, then the sick dog is prescribed, after titrating the isolated microorganisms for sensitivity to antibiotics, a course of antibiotic therapy. Typically, veterinary specialists use cephalosporin antibiotics when treating cholecystitis.

Based on the fact that the disease affects the liver, the dog is prescribed hepatoprotectors – Essentiale Forte, Heptral.

To eliminate dehydration and at the same time to detoxify the dog’s body, infusion therapy by intravenous administration– 5-10% glucose solution, saline solution, polyglucin, hemodez, rheopolyglucin, calcium chloride, borglucanate.

Prevention. Prevention of cholecystitis in dogs should be based on compliance with rational full feeding( , ). Do not feed your dog cheap food or table food. Spicy, fried, smoked, sweet and flour products. Dry food should only be High Quality. When feeding a dog, owners should pay attention to the presence of vitamins in the food, especially vitamin A ().

Prevent your dog from becoming obese. Take the dog for walks every day and provide physical exercise.

Periodically treat dogs for helminthic diseases.

For the purpose of prevention infectious diseases gastrointestinal tract to vaccinate against infectious diseases of dogs common in the region of residence ().

If diseases of the gastrointestinal tract occur, take timely measures to treat them.

When walking, avoid injuries to the abdominal area.

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Choleretic Agents

Substances that help increase the output of bile in duodenum, are called choleretic. An increase in bile output may be due to the following reasons:

1) increasing the formation of bile in the liver and increasing its enzymatic activity. This is how essential oils, allohol, corn silk, and immortelle flowers work. These drugs have a stimulating effect on liver cells and the neurohumoral regulation of bile formation;

2) restoration of the tone of the bile ducts and gallbladder, which increases the excretion of bile into the intestines. This is how they act antispasmodics(atropine, papaverine, etc.), Carlsbad salt, magnesium sulfate. Effect of substances of this type comes down to mechanically facilitating the movement of bile along the excretory tract;

3) anti-inflammatory effects of chemotherapeutic and antiseptics, also helping to restore the functioning of the liver and bile ducts and increase bile secretion.

Bile formation is regulated by the central nervous system and autonomic innervation. Substances that stimulate the central nervous system nervous system And pair sympathetic innervation, increase bile formation, and substances that depress the central nervous system and stimulate sympathetic innervation reduce bile secretion. Anticholinergic substances inhibit bile formation, but by relaxing the muscle tone of the biliary tract and sphincter, they facilitate the excretion of bile. Substances that relax spasms also act smooth muscle: magnesium sulfate, Carlsbad salt. Sulfates entering the duodenum irritate its receptors and cause the so-called bladder reflex - contraction of the gallbladder and increased peristalsis of the biliary tract. Magnesium sulfate and sodium sulfate also increase bile formation.

Bile itself, bile acids and their salts, acting on the duodenum, reflexively enhance bile formation. Hydrochloric acid, many hormones and enzymes stimulate the formation of bile. To enhance the excretion of bile, substances that dilute bile are used: sodium bicarbonate, sabur, alkaline mineral water. Many choleretic agents act in combination. Choleretic drugs are used for diseases of the liver and biliary tract.

Allohol - Allocholum. Tablets containing dried animal bile (0.08 g), dry garlic extract (0.04 g), dry nettle extract (0.005 g) and Activated carbon(0.025 g). Available in tablets of 0.3 g.

Action. Allochol stimulates the secretory activity of the liver, increases the tone of the bile ducts, revitalizes secretion and intestinal motility, and has an anti-fermentation and anti-putrefactive effect in the gastrointestinal canal.

Apply for chronic inflammation of the liver, biliary tract and gallbladder.

Oral doses: dogs - 1-2 tablets, cats - 0.25-0.5 tablets. Prescribed 3 times a day after feeding.

Dehydrocholic acid - Acidum dehydrocholicum. White crystalline powder with a bitter taste. Slightly soluble in water, soluble in alcohol. Available in tablets of 0.2 g.

Action. Belongs to the group of bile acids that stimulate the production of bile by liver cells.

Apply for chronic inflammation of the liver, bile ducts and gallbladder. Contraindicated for use in acute and subacute liver dystrophies.
Oral doses (g): horses - 3-6, pigs - 1-3, dogs - 0.2-2.0. Prescribed 3 times a day.

Corn Silk - Stigmata Maydis. Corn stalks with silks collected during the ripening period of corn cobs. Stigmas contain stigmasterol, systosterol, essential oil, vitamins C and K.

Action. Corn silk increases the secretion of bile, reduces its viscosity, stimulates contractions of the gallbladder, enhances blood clotting and has a diuretic effect.

Apply as a choleretic and diuretic for inflammation of the liver, gallbladder, bile ducts. As a choleretic, diuretic and lactic agent, it is good to use corn silage, harvested during the milky ripeness of corn cobs, for large and small animals. Dried corn silks are used in the form of an infusion of 1:10 or 1:20.
Oral doses (g): horses - 30-60, sheep and pigs - 20-40, dogs - 10-20. Prescribed 3 times a day in the form of infusion or collection with food.

Cholenzym - Cholenzymum. Tablets containing dry bile (1 part), dried powders of the pancreas and intestines of slaughter cattle (1 part each).

Valid and used as choleretic agent with inflammation of the liver, biliary tract and gall bladder. Also prescribed for inflammation of the stomach and intestines.

Dose: dogs - 0.5-1 tablet 2-3 times a day.

Sandy immortelle flowers - Flores Helichrysi arenarii. The baskets of wild immortelle (Cmina) collected before the flowers bloom contain flavonoids, glycosides, essential oil, vitamins K and C, and carotene.

Action. Stimulate the liver, enhance bile formation, increase the tone of the gallbladder and bile ducts, increase secretory function stomach and pancreas.

Apply as a choleretic agent for diseases of the liver, gall bladder and bile ducts. Prescribed in the form of collection, infusion and extract.

Doses (g): large cattle 15-40, pigs - 2-5, dogs 0.5-1. Prescribed 2-3 times a day.

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