Percutaneous cholecystocentesis in cats with suspected hepatobiliary disease

Abstract

Objectives The objective was to evaluate the safety and diagnostic utility of percutaneous ultrasound-guided cholecystocentesis (PUC) in cats with suspected hepatobiliary disease. Methods Medical records of 83 cats with suspected hepatobiliary disease that underwent PUC were retrospectively reviewed. Results At the time of PUC, at least one additional procedure was performed in 79/83 cats, including hepatic aspiration and/or biopsy (n = 75) and splenic aspiration (n = 18). Complications were noted in 14/83 cases, including increased abdominal fluid (n = 11), needle-tip occlusion (n = 1), failed first attempt to penetrate the gall bladder wall (n = 1) and pneumoperitoneum (n = 1). There were no reports of gall bladder rupture, bile peritonitis or hypotension necessitating treatment with vasopressor medication. Blood products were administered to 7/83 (8%) cats. Seventy-two cats (87%) survived to discharge. Of the cats that were euthanized (9/83) or died (2/83), none were reported as a definitive consequence of PUC. Bacteria were identified cytologically in 10/71 samples (14%); all 10 had a positive aerobic bacterial culture. Bile culture was positive in 11/80 samples (14%). Of the cases with a positive bile culture, cytological description of bacteria corresponded to the organism cultured in fewer than 50% of cases. The most common cytologic diagnosis was hepatic lipidosis (49/66). The most common histopathologic diagnosis was cholangitis (10/21). Conclusions and relevance PUC was safe in this group of cats with suspected hepatobiliary disease. Complications were likely associated with ancillary procedures performed at the time of PUC. Bile analysis yielded an abnormal result in nearly one-third of cats with suspected hepatobiliary disease. Complete agreement between bile cytology and culture was lacking. Further evaluation of the correlation between bile cytology and bile culture is warranted.

Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs

“…This finding is similar to a previous study in which 36% of cats and 28% of dogs with suspected hepatobiliary disease were reported to be culture‐positive for bacterial infection of bile . Another study reported positive culture results in 14% of cats . The prevalence of positive culture results in the cats and dogs in our study is likely higher than an average population because in each case clinical suspicion of infection likely influenced the decision to sample and culture bile.…”

“…A higher complication rate was reported (17%) in a recent study, but was suspected to be associated with ancillary procedures performed at the same time as percutaneous cholecystocentesis . Bacteria identified by bile culture were similar to previous reports and were predominantly aerobic enteric pathogens, most notably E. coli and Enterococcus species . Our study may have underestimated the prevalence of anaerobic infections because not all animals had cultures performed under anaerobic conditions.…”

Serum vitamin D status in sick cats with and without cholestatic liver disease

“…Several cats with CLD in this study had cholangitis and it is known these cats often have concurrent inflammation the intestine. [11][12][13][14][15] In the current study, sick cats without liver disease also had low serum 25(OH)D concentrations. Several studies have demonstrated that cats with IBD, intestinal lymphoma, feline immunodeficiency virus and mycobacterial infections, as well as sick cats hospitalized for a (Table 3).…”

“…Vitamin D deficiency accompanies chronic cholestatic liver disease (CLD) in humans reflecting the liver's central role in absorption of fat-soluble vitamin D and synthesis of the active form of vitamin D. [1][2][3][4][5][6][7][8][9][10] Cholestatic cholangiopathies are a common form of liver disease in cats. [11][12][13][14][15][16][17] Cats with these disorders frequently have inadequate concentrations of another fat-soluble vitamin, vitamin K. [18][19][20] Low vitamin D status, determined from serum 25-hydroxycholecalciferol (25[OH]D) concentrations, occurs in cats with inflammatory bowel disease (IBD), intestinal small cell lymphoma and infections. [21][22][23][24] Low serum 25(OH)D measurements also predict mortality in hospitalized cats.…”

Cholangitis der Katze – Diagnostisches Vorgehen und Therapiemöglichkeiten

“…Dabei ist die Gallenblase möglichst weit zu entleeren, um einerseits genügend Probenmaterial für die bakteriologische und zytologische Untersuchung zu erhalten. Andererseits kann das Risiko des Auslaufens der Gallenblase nach Entfernen der Nadel minimiert werden [8,9]. Ultraschallgestützt sollte die perkutane Aspiration der Gallenblase durch die Leber erfolgen (transhepatischer Zugang), um das Risiko einer Leckage zu minimieren (▶ Abb.…”