The gallbladder rests in the abdomen, firmly affixed to the liver and serving as a storage receptacle for bile, a fluid that is essential for digesting food in the stomach and intestines. The bile duct transports bile from the liver into the gallbladder and into the small intestine, and the liver functions in the secretion of the bile. All of the components of the digestive system work in tandem, and if one fails to function properly, the result is that most of the body will suffer ill effects. Inflammation of the gallbladder is sometimes associated with gallstones, and is often associated with obstruction and/or inflammation of the common bile duct and/or the liver/bile system. Severe cases can result in rupture of the gallbladder and subsequent severe inflammation of the bile duct (bile peritonitis), necessitating combined surgical and medical treatments.

Some of the symptoms that can be indicative of an inflamed gallbladder or bile duct are a sudden loss of appetite, lethargy, vomiting, and abdominal pain. Mild to moderate jaundice with fever is common with conditions of the bile duct. Look for yellow eyes, and yellowing of the gums. Shock due to infection and reduction in blood volume can occur. Signs of shock include shallow breathing, abnormally low body temperature (hypothermia), pale or gray gums, and a weak but rapid pulse.

Obstruction of the Bile Duct

Obstruction of the bile duct is most often caused by pancreatic disease. Pancreatic swelling, inflammation, or fibrosis can cause compression of the bile duct. Diagnosis is based on laboratory tests, x?rays, and ultrasonographic evidence of pancreatic disease. Treatment of pancreatitis will often relieve the obstruction. If this is not successful, surgery may be necessary to connect the gallbladder directly to the intestine. If gallstones are the cause of obstruction, the gallbladder may need to be removed. Cancer of the pancreas, bile ducts, liver, intestines, and lymph nodes can also cause obstruction. A biopsy is needed to confirm the diagnosis. When cancer is present, surgery can provide some relief but is not a cure.

Inflammation of the Gallbladder (Cholecystitis)

Inflammation of the gallbladder (cholecystitis) is usually caused by bacterial infections that start in the intestines and either travel up the common bile duct or are spread through the blood. In some cases, the wall of the gallbladder is damaged, and bile leaks into the abdomen causing severe abdominal infection and inflammation, which can be fatal. Loss of appetite, abdominal pain, jaundice, fever, and vomiting are common signs. The dog may be in a state of shock due to abdominal inflammation.

The inflammation can also spread to the surrounding branches of the bile duct and the liver. Diagnosis can be confirmed by biopsy for bacterial cultures and tissue analysis. Treatment usually consists of removal of the gallbladder and appropriate antibiotic medication to treat infection. The outlook is good if appropriate antibiotics are started early but is less favorable if diagnosis and treatment are delayed.

Gallstones

Gallstones rarely cause disease. When it does occur, disease is usually seen in older, female, small-breed dogs. Signs include vomiting, jaundice, abdominal pain, and fever. Treatment consists of removal of the stones and appropriate antibiotics.

Rupture of the Gallbladder or Bile Duct

Rupture of the gallbladder or bile duct is most often due to gallstone obstruction, inflammation of the gallbladder, or blunt trauma. Rupture of the bile duct may also occur as a result of cancer or certain parasites. Rupture leads to leakage of bile into the abdomen, causing a serious condition called bile peritonitis, which may be fatal if the rupture is not repaired. Treatment includes surgery, which consists of tying off the bile duct, removing the gallbladder, or connecting the gallbladder with the small intestine.

Diagnosis

Most if not all dogs and cats with gall bladder disease are sick. They often are vomiting, anorexic, and may even have a yellow coloring of their skin, the whites of their eyes and their gums. Blood work will often times show an increase in liver enzymes, an increase in total bilirubin, and an increase in the white blood cell count. In addition some dogs and cats will also have increases in lipase and amylase and urine analysis may exhibit bilirubin in the urine. Abdominal ultrasound is the most effective and non invasive diagnostic tool used to evaluate the gall bladder, bile ducts, and liver. It is with the aid of ultrasound that helps us determine if surgery is necessary to treat your dog or cat.

Surgical Management

Once we have made the diagnosis of a diseased gall bladder or an obstructed bile duct surgery is necessary. A large incision is made on the midline of the abdomen to allow adequate access to the liver, gall bladder, bile ducts, and intestines. Once we have determined the cause of your animal’s illness the appropriate surgery is performed. If the gall bladder is diseased (without the presence of a secondary obstruction) a cholecystectomy (gall bladder removal) is done. However if there is an obstruction of the flow of bile from the gall bladder to the small intestine the obstruction will need to be relieved. This can be done by either cutting directly into the duct where the obstruction is located or by finding the duct opening in the small intestine and catheterizing and relieving the obstruction.  Regardless of what procedure is done, gall bladder disease, and biliary obstructions have a guarded prognosis. Many dogs will be in the hospital post operatively from anywhere to 2-7 days. Once they on the road to recovery they will go home with pain medications, antibiotics, and exercise restriction for 10-14 days.