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Gall Bladder problems in dogs
Gallbladder, liver and chronic lung problems
Gall bladder infections and e-coli
also see Cushing's
also see Liver
Gallbladder, liver and Chronic lung problems
Question: Hi, Dr. Richards,
Our issue has to do with our 6yr old unneutered male standard dachshund,
Bart. We decided it was time to neuter him (March 1999) and since he was
older our doctor wanted to do a full workup prior to any surgery. He noticed
a slight abnormality on the ECG. We were recommended to a cardiologist and
he was diagnosed with chronic bronchitis and the right side of his heart
was enlarged due to this. He was treated with Baytrill and all signs of the
bronchitis seemed to go away. At this time, we also did blood work and his
ALT was 100. We decided to wait about 6 months and try to neuter again. In
November 1999, his ALT rose to 370. Our doctor felt it was early signs of
liver disease. He put Bart on Vitamin e (200IU) and Lipo-Form. We waited 2
months and retested his enzymes. His ALT was slightly lower but not by much.
All of his other liver enzymes were normal.Our vet sent us to a internist . She requested bile acid testing
and the results showed pre and post were 16 and 47. She wanted to check both
his liver and heart since conditions in either area may show the elevated
test results. She also felt a biopsy may be in order.So late last week we saw both doctors. The cardiologist concluded that Bart
will most likely suffer from chronic lung problems maybe due to the
altitude. His heart has enlarged a bit more and he wants to ultrasound him
again in 6 months. Cardiac issues may end up being a secondary cause based
on the lung issue. He did not prescribe anything yet but some future options
may be bronchial dialators or possibly a tracheal wash. He did not feel that
anything going on in his area was causing the elevated liver enyzmes and
bile acids.We next saw the internist who performed an ultrasound. She felt that his
liver looked normal. However, his gallbladder did not appear black but was
gray and she felt it may be due to a sludge that animals can get similar to
stones in people.
She said that this could cause his elevated ALT and bile acids. So she felt
a bit relieved and did not think a biopsy is appropriate at this time. She
did prescribe actigall for 6 weeks at which time she wants to retest his
bile acids. Our normal doctor seemed a bit more conservative and still felt
it could be early stages of liver disease. No one has prescribed a change
in his diet. The internist wanted to keep all factors the same and see the
effects of the actigall.Based on your experience, can you voice any opinions or guidance? Can
gallbladder issues be separate from liver issues? Is Western medicine the
best approach or are there things in the hoistic arena that can be
beneficial to look into?I have read many of your other letters and I value your opinions and
guidance. We want to make sure we are going down the right path for Bart.Thank you in advance.
Beth
Answer: Beth-
If the gallbladder is not functioning properly it will almost always cause
problems with the liver. Usually, if sludging of bile in the bile ducts or
gallbladder occurs then there is a rise in the alkaline phophatase level
and there is usually a rise in the ALT as well. It would be a little
unusual to have a rise in ALT without a rise in alkaline phosphatase, if
there is bile duct or gall bladder involvement. I am not sure from your
note whether the alkaline phosphatase levels are elevated, but if they
aren't you might want to ask the specialist what impact that has on her
thoughts about the possibility of gall bladder involvement. She may have
experience with cases in which there were rises in ALT independently of
alkaline phosphatase with gall bladder involvement or it is possible that
there was a rise in alkaline phosphatase, as well, and it just didn't get
reported.Actigall (Rx) is the most commonly recommended medication for liver disease
in which poor flow of bile may be involved.Milk thistle is the most commonly recommended alternative medication for
these conditions. I haven't seen a dosage that was related to any sort of
study of dosing requirements but the most common recommendations are to use
the adult human dose for large dogs and about 1/3 of the dose for small dogs.Rises in ALT do indicate that liver cells have been damaged. When the
levels continue to stay elevated it is an indication of ongoing damage. But
the bile acid response testing is a much better indicator of liver function
and it looks pretty good. So I would tend to be conservative and wait and
see what happens at this point, in most cases. I wouldn't be in a big hurry
to change diets, either. We have seen a lot of patients get moderate rises
in the ALT (I think of anything less than about 450 as being a moderate
rise) and have just waited to see what happens. Many of them get better on
their own.It really does sound to me like you are getting pretty good advice from the
specialists. Your vet might be right that there is an ongoing liver
problem, but it probably won't cause a problem to wait and see. Just keep
the follow-up appointments and adjust to the situation as it becomes more
clear. If you see any changes that worry you, get in contact with your
usual vet. He won't mind rechecking the blood tests to see if there have
been changes, I'm sure.Hope this helps.
Mike Richards, DVM
2/16/2000
Gall Bladder infections, e-coli and cushing's
Q: Dear Dr. Richards: We've iwaited out the month for further tests on Duffy for possible
Cushing's disease. Today our vet did another ACTH test and also a gall bladder scan which
suggested the presence of e-coli in the system. He told us that he called the Univ. of Michigan
vet school and spoke with one of the 4 professors he knows and trusts. ( Incidentally, our vet
has been licensed since 1966 so we're hoping he's up on all the latest!) The prof. suggested the
scan. More crit. level urine tests will be done now and then hopefully the profs. will decide if
Duffy has Cushings Disease or e-coli in his system. At this point in time we're totally
befuddled as to how a 10 year old Westie could pick up e-coli in the gall bladder. Any
thoughts on your part Dr.Richards would be greatly appreciated.Rgds and tks. N and K
A: K and N
It is not unusual for gall bladder infections to be from E. coli. This is a normal inhabitant of the digestive tract, as well as sometimes being a pathogen (disease causing organism). Since the gall bladder connects to the digestive tract through the bile ducts, there is a direct path for infection. I think the reason there aren't more infections is that the small intestine is relatively bacteria free, compared to the large intestine. In addition, some gall bladder infections probably occur due to the spread of bacteria through the blood stream. In this case, the bacteria find a quiet place to reside and be safe from the immune system and the gall bladder is the place. This is probably rare but also probably accounts for some gall bladder infections.
This may not be an "either/or" situation -- it is possible that Duffy has both the E.coli infection and Cushing's disease.
In the case of a dog with Cushing's disease there is often a depression in the immune system's function, leading to infections. Sometimes finding infections in areas in which they would not normally be common is a sign of Cushing's disease.
I hope that you are able to sort through these problems with your vet's help and get Duffy back on track.
Mike Richards, DVM
9/14/99
Last edited 08/30/02
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