Hepatic encephalopathy in adult dog secondary to cirrhosis due to congenital biliary agenesis: a case report / Encefalopatia hepática em cão adulto secundária a cirrose causada por agenesia biliar congênita: relato de caso

Gallbladder agenesis is a congenital malformation that is considered extremely rare in dogs. The disease can course asymptomatically or with clinical signs, usually non-specific and including vomiting, anorexia, diarrhea, ascites, and lethargy. The objective of this report was to describe the clinical and anatomopathological aspects of a dog with hepatic encephalopathy secondary to gallbladder agenesis. This condition can be diagnosed during surgery or imaging examinations; however, it is often an incidental finding. In the biochemical examinations, a decrease in alanine aminotransferase and an increase in alkaline phosphatase and hypoalbuminemia were observed. During the necropsy, hepatomegaly was observed with absence of the gallbladder, congestion, cerebral edema, lipiduria, and pulmonary edema. Microscopically, there was intense fibrosis and inflammation in the liver due to chronic cholangiohepatitis (cirrhosis of the liver). The consequence of this lesion secondary to gallbladder agenesis was hepatic encephalopathy. Chronic liver failure exposes the cerebral cortex to toxins that are not metabolized by the liver, such as ammonia, mercaptans, short-chain fatty acids, scatols, indols, and aromatic amino acids. These toxins cause reversible damage to the brain, which results in neurological disorders. In this report, the dog had no clinical neurological signs, and the diagnosis of this condition was observed histologically. Dogs with gallbladder agenesis usually have clinical and pathological findings of hepatobiliary lesions such as cholestasis, cholangiohepatitis, and, in severe cases, hepatic encephalopathy, which are necessary to differentiate from other diseases that affect the hepatobiliary system, such as cholelithiasis, neoplasms, and chronic hepatitis.

A agenesia de vesícula biliar é uma má formação congênita, considerada extremamente rara em cães. A doença pode cursar de forma assintomática ou com sinais clínicos, geralmente, inespecíficos que incluem vômitos, anorexia, diarreia, ascite e letargia. O objetivo deste relato foi descrever os aspectos clínicos e anatomopatológicos de um cão com encefalopatia hepá-tica secundária a agenesia da vesícula biliar, esta condição pode ser diagnosticada durante uma cirurgia ou exames de imagem, entretanto frequentemente é um achado incidental. Como resultados, nos exames bioquímicos observou-se a diminuição da alanina aminotransferase, aumento da fosfatase alcalina e hipoalbuminemia. Durante a necropsia foi observado hepatomegalia com ausência da vesícula biliar, congestão e edema cerebral, lipidúria e edema pulmonar. Microscopicamente, no fígado havia intensa fibrose e inflamação pela colangiohepatite crônica (cirrose hepática). A consequência desta lesão secundária a agenesia da vesícula biliar, foi a encefalopatia hepática. A insuficiência hepática crônica expõe o córtex cerebral às toxinas não metabo-lizadas pelo fígado, tais como a amônia, mercaptanos, ácidos graxos de cadeia curta, escatóis, indóis e aminoácidos aromáti-cos. Essas toxinas causam danos reversíveis ao encéfalo, o que resulta em distúrbios neurológicos. No presente caso, o cão não apresentou sinais clínicos neurológicos e o diagnóstico desta condição foi observado histologicamente. Cães com agenesia de vesícula biliar, geralmente exibem achados clínicos e patológicos de lesões hepatobiliares, como colestase, conlangiohepatite e, em casos graves, encefalopatia hepática, sendo necessário diferenciar de outras doenças que acometem o sistema hepatobiliar, como colelitíase, neoplasias e hepatites crônicas.

Hepatic encephalopathy in adult dog secondary to cirrhosis due to congenital biliary agenesis: a case report / Encefalopatia hepática em cão adulto secundária a cirrose causada por agenesia biliar congênita: relato de caso

Gallbladder agenesis is a congenital malformation that is considered extremely rare in dogs. The disease can course asymptomatically or with clinical signs, usually non-specific and including vomiting, anorexia, diarrhea, ascites, and lethargy. The objective of this report was to describe the clinical and anatomopathological aspects of a dog with hepatic encephalopathy secondary to gallbladder agenesis. This condition can be diagnosed during surgery or imaging examinations; however, it is often an incidental finding. In the biochemical examinations, a decrease in alanine aminotransferase and an increase in alkaline phosphatase and hypoalbuminemia were observed. During the necropsy, hepatomegaly was observed with absence of the gallbladder, congestion, cerebral edema, lipiduria, and pulmonary edema. Microscopically, there was intense fibrosis and inflammation in the liver due to chronic cholangiohepatitis (cirrhosis of the liver). The consequence of this lesion secondary to gallbladder agenesis was hepatic encephalopathy. Chronic liver failure exposes the cerebral cortex to toxins that are not metabolized by the liver, such as ammonia, mercaptans, short-chain fatty acids, scatols, indols, and aromatic amino acids. These toxins cause reversible damage to the brain, which results in neurological disorders. In this report, the dog had no clinical neurological signs, and the diagnosis of this condition was observed histologically. Dogs with gallbladder agenesis usually have clinical and pathological findings of hepatobiliary lesions such as cholestasis, cholangiohepatitis, and, in severe cases, hepatic encephalopathy, which are necessary to differentiate from other diseases that affect the hepatobiliary system, such as cholelithiasis, neoplasms, and chronic hepatitis.(AU)

A agenesia de vesícula biliar é uma má formação congênita, considerada extremamente rara em cães. A doença pode cursar de forma assintomática ou com sinais clínicos, geralmente, inespecíficos que incluem vômitos, anorexia, diarreia, ascite e letargia. O objetivo deste relato foi descrever os aspectos clínicos e anatomopatológicos de um cão com encefalopatia hepá-tica secundária a agenesia da vesícula biliar, esta condição pode ser diagnosticada durante uma cirurgia ou exames de imagem, entretanto frequentemente é um achado incidental. Como resultados, nos exames bioquímicos observou-se a diminuição da alanina aminotransferase, aumento da fosfatase alcalina e hipoalbuminemia. Durante a necropsia foi observado hepatomegalia com ausência da vesícula biliar, congestão e edema cerebral, lipidúria e edema pulmonar. Microscopicamente, no fígado havia intensa fibrose e inflamação pela colangiohepatite crônica (cirrose hepática). A consequência desta lesão secundária a agenesia da vesícula biliar, foi a encefalopatia hepática. A insuficiência hepática crônica expõe o córtex cerebral às toxinas não metabo-lizadas pelo fígado, tais como a amônia, mercaptanos, ácidos graxos de cadeia curta, escatóis, indóis e aminoácidos aromáti-cos. Essas toxinas causam danos reversíveis ao encéfalo, o que resulta em distúrbios neurológicos. No presente caso, o cão não apresentou sinais clínicos neurológicos e o diagnóstico desta condição foi observado histologicamente. Cães com agenesia de vesícula biliar, geralmente exibem achados clínicos e patológicos de lesões hepatobiliares, como colestase, conlangiohepatite e, em casos graves, encefalopatia hepática, sendo necessário diferenciar de outras doenças que acometem o sistema hepatobiliar, como colelitíase, neoplasias e hepatites crônicas.(AU)

Hérnia diafragmática peritoneopericárdica em um felino da raça Persa / Peritoneopericardial diaphragmatic hernia in a Persian cat

Background: Peritoneopericardial diaphragmatic hernia is a congenital defect characterized by an anomalous communication between the abdominal cavity and pericardial sac, which can lead to displacement of the abdominal viscera into the thoracic cavity. The occurrence in felines is higher among long-haired breeds, mainly the Persian breed, possibly based onan autosomal recessive inheritance. The diagnosis of PPDH is performed by means of chest radiography with or without contrast, in association with other imaging tests such as ultrasonography and echocardiography. Our objective in this study was to report the occurrence and macroscopic changes in a case of peritoneopericardial diaphragmatic hernia in a Persian feline. Case: A 9-year-old male Persian cat weighing 3.4 kg was referred to the HPET-Private Veterinary Clinic, Salvador, Bahia, with an history of weight loss and chronic intermittent vomiting during the preceding 6 months, with lateral decubitus and breathing difficulties. Ultrasonography revealed findings suggestive of an infiltrative process in the stomach and duodenum, enlarged gastric lymph nodes, and some nodular images indicating slight displacement of the liver. Chest radiography revealed a cardiac silhouette with markedly enlarged dimensions associated with a dorsal deviation of the terminal trachea, and echocardiography revealed a small amount of pericardial effusion. The patient showed initial clinical improvement after blood transfusion; however, after 2 days, he exhibited significant clinical worsening and was therefore euthanized with the owner's consent. Post mortem evaluation revealed partial herniation of the liver and gallbladder into the chest cavity through a diaphragmatic hernia ring. The heart was partially surrounded by the left medial lobe of the liver, which was displaced into the pericardial sac. Herniated hepatic lobes had an irregular capsular surface with evident lobulation and tension lipidosis. In the abdominal cavity, the remainder of the liver (right lateral and medial lobes) was observed to be slightly enlarged, with an irregular surface, diffusely reddish with intense evidence of the lobular pattern and white and firm multifocal areas (fibrosis). In the duodenum, close to the pylorus, there was a nodule measuring 2.8 x 2.5 x 1.0 cm, with a whitish and ulcerated surface. When cut, it was soft and exhibited a homogeneous, whitish compact surface. Histopathological examinationshowed marked proliferation of fibrous connective tissue, which for the most part separated the lobes by septa and surrounded the portal space (fibrosis), a marked diffuse chronic inflammatory infiltrate composed of lymphocytes and plasma cells. In addition, marked bile duct hyperplasia and multifocal areas of fatty degeneration (steatosis). Discussion: The diagnosis was based on the association of clinical and pathological findings. Considering the age and clinical signs presented by the patient in this report, as well as the presence of few radiographic signs that were indicative of PPDH, the first differential diagnosis thought was pericardial neoplasia. Peritoneopericardial diaphragmatic hernia in felines is always of congenital origin and may occur asymptomatically depending on the number and involvement of herniated viscera. In this case, the patient's diagnosis of peritoneopericardial hernia was a necropsy finding; the fact that in agreement with previous reports of high rates of incidental diagnoses reinforces the importance of performing necropsy for confirmation or diagnosis of unexpected pathologies. In the present case, peritoneopericardial diaphragmatic hernia in isolation may not have led to severe anemia that culminated in the patient's death. The anatomopathological findings were compatible with biliary cirrhosis and multifocal liver fibrosis, accompanied by the presence of anemia and consequent hypovolemia.

Meningocele e meningoencefalocele em leitões: aspectos patológicos e de imagem / Meningocele and meningoencephalocele in piglets: pathologic and imaging aspects

Background: Meningocele and meningoencephalocele are rare congenital deformities characterized by herniation of the meninges and of the meninges and brain tissue through a bone defect in the skull (cranioschisis), respectively. Descriptions of these malformations in pigs are scarce in the international literature and non-existent in Brazil, with only one case of cranioschisis with brain exposure (without protrusion of the meninges and covered by skin) reported to date. Here, we report a case of meningocele and another of meningoencephalocele in piglets in the state of Bahia and describe the main related anatomopathological and imaging characteristics (radiographic and ultrasonographic). Case: The congenital malformations occurred in newborn piglets from a farm located in the city of Catu, Bahia, Brazil, which presented with an evident large saccular area positioned dorsally to the head. The animals died 48 h after birth and were referred to the Laboratory of Animal Pathology of the Federal University of Bahia, for the studies and diagnostic conclusion. Postmortem ultrasound examinations showed that the region was filled with fluid and associated with a small brain protrusion in case 1 and a defect in the skull bone, which had its orifice dimensions estimated. Despite the superimposition of structures, the skull malformation was identified on radiographic examination (case 1) and measured on ultrasonographic examination (cases 1 and 2). During necropsy, the piglets presented with a marked marked bulge of saccular appearance under the skin in the frontal region. The saccular formation was floating, internally covered by dura mater and filled with reddish serous liquid (liquor). Discussion: The diagnoses of meningoencephalocele and...

Meningocele e meningoencefalocele em leitões: aspectos patológicos e de imagem / Meningocele and meningoencephalocele in piglets: pathologic and imaging aspects

Background: Meningocele and meningoencephalocele are rare congenital deformities characterized by herniation of the meninges and of the meninges and brain tissue through a bone defect in the skull (cranioschisis), respectively. Descriptions of these malformations in pigs are scarce in the international literature and non-existent in Brazil, with only one case of cranioschisis with brain exposure (without protrusion of the meninges and covered by skin) reported to date. Here, we report a case of meningocele and another of meningoencephalocele in piglets in the state of Bahia and describe the main related anatomopathological and imaging characteristics (radiographic and ultrasonographic). Case: The congenital malformations occurred in newborn piglets from a farm located in the city of Catu, Bahia, Brazil, which presented with an evident large saccular area positioned dorsally to the head. The animals died 48 h after birth and were referred to the Laboratory of Animal Pathology of the Federal University of Bahia, for the studies and diagnostic conclusion. Postmortem ultrasound examinations showed that the region was filled with fluid and associated with a small brain protrusion in case 1 and a defect in the skull bone, which had its orifice dimensions estimated. Despite the superimposition of structures, the skull malformation was identified on radiographic examination (case 1) and measured on ultrasonographic examination (cases 1 and 2). During necropsy, the piglets presented with a marked marked bulge of saccular appearance under the skin in the frontal region. The saccular formation was floating, internally covered by dura mater and filled with reddish serous liquid (liquor). Discussion: The diagnoses of meningoencephalocele and...(AU)