Malarky and the Gallbladder Mucocele

10355373_10152658818434549_8389330943715295002_nI’m taking part in the Caring For Critters Round Robin hosted by Jodi from Heart Like A Dog. The Round Robin is like a relay race, each day a fellow blogger will share a post about a specify injury or illness they have experienced. Please keep in mind, I am not a vet and this is not advice on how to handle any illness your pet might have. This is just Malarky and my experience. Always consult your veterinarian before choosing any course of treatment.

 

 

You are probably thinking the same thing I was when the vet gave me the diagnosis. A gallbladder muco-what?

I had never heard the term before. Not even after having worked in vet hospitals for 8 years. I never even heard of a dog having a problem with their gallbladder.Turns out there was a good reason I never heard of it.

A gallbladder mucocele (GBM) is basically an accumulation of thick mucous in the gallbladder that causes the gallbladder to become distended. If left untreated the gallbladder can rupture causing infection. Years ago, it wasn’t commonly diagnosed. Not because it didn’t occur, but because diagnostic tools like ultrasound were not as available as they are now so it wasn’t being diagnosed. Unfortunately, this meant dogs who developed a GBM most likely died as a result.

Malarky’s symptoms were pretty vague. It started out with a little vomiting and lack of appetite. Malarky had a few episodes of gastritis before. By the next day she is usually back to her normal self. Not this time. This time I found myself at the emergency vet clinic at 10:00 at night after coming home from work and finding her hunched up, in a lot of pain and not wanting to move.

Symptoms can include vomiting, anorexia, lethargy, polyuria, polydipsia, and diarrhea. Symptoms can be present for a few days to a few weeks. The veterinarian may find the dog’s abdomen is painful, they have an enlarged liver. They may be jaundice and may have an elevated temperature. About 25% of dogs show no symptoms and the GBM is diagnosed incidentally on x-rays.

Radiographs and lab work showed there was something going on in her liver. An ultrasound would give more information, but with a tentative diagnosis of “it could be liver cancer” I opted to start with conservative treatment so Malarky was hospitalized. Malarky definitely looked more comfortable when I visited her over the next day. A quick ultrasound scan was done because the managing vet was concerned about GBM, but it was felt to be primary liver disease so we continued with conservative treatment. My hope was to continue over the weekend with my secret hope that she would improve enough for me to take her to my own vet or so we could do an non emergent ultrasound. Unfortunately her liver values continued to rise. The managing vet really felt she needed an ultrasound that day so with the veterinary internist and surgeon off and out of town, I  transferred Malarky to another emergency clinic.

Bloodwork will help narrow down the area of the body affected. It won’t diagnosed a GBM. X-rays don’t always show a GBM but may be taken to rule out other disorders. Ultrasound is more sensitive and the most common way to diagnose GBM.

There a full ultrasound gave us the diagnosis- a gallbladder mucocele. Malarky needed her gallbladder removed. I had to leave her there and wait at home. The surgeon called as they were prepping Malarky to go into surgery and she called me after Malarky had come out of anesthesia over 2 hours later. she said surgery had gone well. there was no obstruction of any of her bile ducts.The tissue on the gallbladder was starting to thin so it sounds like it was removed just in time.

A cholecystectomy ,surgical removal of the gallbladder, is the recommended treatment for GBM for dogs who show signs of the gallbladder having ruptured or who are very ill. There is a 22-40% mortality rate with surgery usually in dogs who have more extensive disease and require a more involved surgery. Dogs who aren’t showing any symptoms or cannot undergo surgery may be able to be managed with medication and regular monitoring of the gallbladder with ultrasound.

When I visited Malarky the next day, she was pretty out of it. The Fentanyl patch she was wearing for pain really made her groggy, but I was just happy that she had made it through surgery. She had to spend the next two days at the hospital while they monitored her liver values and watched for any post-op problems.

Her livers values were still elevated so she came home on Denamarin and ursodiol to help it heal. Along with some antibiotics, she came home with the Fentanyl patch on and was still a bit groggy because of it. She was also under the normal post-op restrictions- no running or playing, no jumping on or off furniture, can only go potty on a leash and must wear an Elizabethan collar to keep her from bothering her stitches. Luckily Malarky was a great patient, though she really wanted to run outside even when she was all dopey from the pain meds.

Treatment after surgery involves treating any coexisting disease. Denamarin which is milk thistle and SAM-e and ursodiol helps protect the liver. Some dogs may need to be on long term antibiotics if they are found to have a bacterial infection.

Malarky’s recovery went well and her blood work improved. Some dogs are more predisposed to developing GBM so about a month after surgery Malarky was tested and found to be hypothyroid. She started on a supplement to bring her thyroid levels back into the normal range.

Though any dog can develop gallbladder mucoceles, it seems to be seen more in small to medium sized breeds and with the average age about 10 years old. Shelties, miniature schnauzers and cocker spaniels are predisposed to developing a GBM. Certain endocrine disorders like hypothyroidism and Cushing’s disease are a risk factor for developing a GBM.

It took about 5 months for Malarky’s liver values to get back down to normal. She was able to come off the medication for her liver and luckily her liver values stayed normal off of them. She hasn’t had any complications from her surgery and isn’t expected to develop any. Just like in people she will be able to live her life without a gallbladder with no problems. And she’s been making up for not being able to run after surgery.

 

For more information on gallbladder mucoceles, visit:

American College of Veterinary Surgeons

Clinician’s Brief

DVM 360

Merck Manual

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The Round Robin as a relay race, each day a fellow blogger will share a post about a specify injury or illness they have experienced. Yesterday Jan from Wag ‘N Woof Pets shared a post on the Challenges of a Senior Dog. Be sure to visit The Daily Dog Blog tomorrow to read Julie’s post.

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