Cholelithiasis, choledocholithiasis and hepatolithiasis with secondary necrotizing hepatitis and cholangiohepatitis in a dairy cow

Biliary calculi are rare in cattle and occur usually in the gallbladder, without clinical signs. In humans, cholelithiasis is a common cause of hepatic abscess due calculi microbiota. Here is described a case of cholelithiasis, choledocholithiasis and hepatolithiasis in a 10-year-old female mixed breed dairy cow. The animal died during physical examination with signs as cachexia, icterus, and fever. At necropsy, a large number of green calculi were observed in the gallbladder, common duct lumen and in markedly distended biliary ducts. The liver was firm and decreased in volume with multiple abscess and multiple red foci measuring 0.5 cm in diameter in the hepatic parenchyma. Microscopically in the liver, marked ductal proliferation and abscedative cholangiohepatitis with abundant fibrosis and multiple foci of hepatocytes necrosis. In conclusion, choledocholithiasis and hepatolithiasis may occur in cattle and cause significant clinical signs and pathological alterations.(AU)

Cholelithiasis, choledocholithiasis and hepatolithiasis with secondary necrotizing hepatitis and cholangiohepatitis in a dairy cow

Biliary calculi are rare in cattle and occur usually in the gallbladder, without clinical signs. In humans, cholelithiasis is a common cause of hepatic abscess due calculi microbiota. Here is described a case of cholelithiasis, choledocholithiasis and hepatolithiasis in a 10-year-old female mixed breed dairy cow. The animal died during physical examination with signs as cachexia, icterus, and fever. At necropsy, a large number of green calculi were observed in the gallbladder, common duct lumen and in markedly distended biliary ducts. The liver was firm and decreased in volume with multiple abscess and multiple red foci measuring 0.5 cm in diameter in the hepatic parenchyma. Microscopically in the liver, marked ductal proliferation and abscedative cholangiohepatitis with abundant fibrosis and multiple foci of hepatocytes necrosis. In conclusion, choledocholithiasis and hepatolithiasis may occur in cattle and cause significant clinical signs and pathological alterations.

Comparative study of respiratory muscle strength in women undergoing conventional and single-port laparoscopic cholecystectomy

Purpose: To evaluate respiratory muscle strength (PImax and PEmax) before and 24 and 48 h after conventional and single-port laparoscopic cholecystectomy. Methods: Forty women with symptomatic cholelithiasis (18 to 70 years) participated in the study. The patients were divided into two groups: 21 patients undergoing conventional laparoscopic cholecystectomy and 19 patients undergoing single-port laparoscopic cholecystectomy. Differences were considered to be significant when p 0.05. Results: The results showed a greater decline in PImax after 24 h in the group submitted to conventional laparoscopic cholecystectomy, with a significant difference between groups (p=0.0308). Conclusion: Recovery of the parameters studied was more satisfactory and respiratory muscle strength was less compromised in the group submitted to single-port laparoscopic cholecystectomy.(AU)

Cholecystectomy during ceftriaxone therapy. A translational study with a new rabbit model

Purpose: To evaluate the actual incidence of both microlithiasis and acute cholecystitis during treatment with intravenous ceftriaxone in a new rabbit model. Methods: New Zealand rabbits were treated with intravenous ceftriaxone or saline for 21 days. Ultrasound monitoring of the gallbladder was performed every seven days until the 21st day when histopathology, immunohistochemistry for proliferating cell nuclear antigen (PCNA), pro-caspase-3 and CD68, liver enzyme biochemistry, and chromatography analysis of the bile and sediments were also performed. Results: All animals treated with ceftriaxone developed acute cholecystitis, confirmed by histopathology (P < 0.05) and biliary microlithiasis, except one that exhibited sediment precipitation. In the group treated with ceftriaxone there was an increase in pro-caspase-3, gamma-glutamyl transpeptidase concentration, PCNA expression and in the number of cells positive for anti-CD68 (P < 0.05). In the ceftriaxone group, the cholesterol and lecithin concentrations increased in the bile and a high concentration of ceftriaxone was found in the microlithiasis. Conclusion: Ceftriaxone administered intravenously at therapeutic doses causes a high predisposition for lithogenic bile formation and the development of acute lithiasic cholecystitis.(AU)

Ocorrência de cálculo biliar em bovinos abatidos na microrregião Campos da Mantiqueira / Occurrence of gallstone in cattle slaughtered in micro region of Mantiqueira Fields

Este estudo teve por objetivo quantificar a ocorrência de cálculo biliar em bovinos abatidos na microrregião campos da Mantiqueira, além de traçar um perfil dos animais acometidos pela colelitíase. O presente estudo foi realizado no abatedouro do município de São João Del Rei, MG, que recebe animais provenientes dos diversos municípios da região para abate. Foram realizadas as identificações do número de registro, da raça, do sexo, do escore de condição corporal (escala de 1 a 5) e foi estimada a idade dos animais. Foi realizada a verificação de prenhez nas fêmeas. A vesícula biliar foi removida intacta para análise de presença do cálculo biliar. O fígado foi examinado e os dados referentes a problemas hepáticos foram registrados. Os cálculos recuperados foram pesados. Para a análise dos dados, procedeu-se o cálculo da freqüência de casos de colelitíase nos bovinos estudados. Dentre os casos de colelitíase observados, foram calculadas as porcentagens de procedência dos animais, raças, sexo, gestação, faixas de idade e ECC, a fim de traçar um perfil dos animais acometidos. Além disto, foi estudada a existência de correlação entre o cálculo biliar e problemas hepáticos. Foram observados 91 casos de cálculo biliar (9,79%) dentre os 929 bovinos estudados. Os animais mestiços foram os mais acometidos (59/91), seguidos pela raça Holandesa (30/91). Com relação ao sexo, as fêmeas foram as mais acometidas pela colelitíase, totalizando 83 casos. E os animais com idade maior que 120 meses somaram 57,1% dos casos. A maioria dos animais com cálculo biliar apresentou ECC 2 (53/91). A maior parte dos bovinos acompanhados apresentou, como distúrbio hepático, apenas a colelitíase (72/91). O peso médio dos cálculos recuperados foi 2,98 gramas, variando de 0,4 a 23,3 gramas. Foram observados, em associação com o cálculo biliar: Fasciolose (13/91), Hemorragia (3/91), Neoplasia (2/91) e Congestão Hepática (1/91).

This study aimed to quantify the occurrence of gallstones in cattle slaughtered in the microregion of Campos da Mantiqueira, and draw a profile of the animals affected by cholelithiasis. The present study was conducted in slaughterhouse of São João Del Rei, MG, that receive animals from the various region cities for slaughter. ID's registration number, breed, sex, body condition score (scale 1-5) and age of these animals were estimated. A check for pregnancy in females was performed. The gallbladder was removed intact, for analysis of the presence of gallstones. The liver was examined and data relating to liver problems were reported. The recovered gallstones were weighed. For data analysis, we proceeded to calculate the frequency of cases of gallstones in cattle studied. Among the cases of cholelithiasis observed, we calculated the percentages of animal origin, race, sex, pregnancy, age and ECC in order to draw a profile of affected animals. Moreover we studied the correlation between gallstones and liver problems. 91 cases of gallstone (9.79%) among the 929 cattle studied were observed. Crossbred animals were the most affected (59/91), followed by the Netherlands (30/ 91) race. Regarding sex, females were most affected by cholelithiasis, totaling 83 cases. And animals with greater than 120 months old comprised 57.1 % of cases. Most gallstone animals showed ECC 2 (53/91). Most bovine presented only cholelithiasis, without hepatic disorder (72/91). The average weight of 2.98 grams was recovered calculations, ranging from 0.4 to 23.3 grams. Fasciolosis (13/91), hemorrhage (3/91), neoplasm (2/91) and Hepatic Congestion (1/91) were observed in association with gallstones.

Ocorrência de cálculo biliar em bovinos abatidos na microrregião Campos da Mantiqueira / Occurrence of gallstone in cattle slaughtered in micro region of Mantiqueira Fields

Este estudo teve por objetivo quantificar a ocorrência de cálculo biliar em bovinos abatidos na microrregião campos da Mantiqueira, além de traçar um perfil dos animais acometidos pela colelitíase. O presente estudo foi realizado no abatedouro do município de São João Del Rei, MG, que recebe animais provenientes dos diversos municípios da região para abate. Foram realizadas as identificações do número de registro, da raça, do sexo, do escore de condição corporal (escala de 1 a 5) e foi estimada a idade dos animais. Foi realizada a verificação de prenhez nas fêmeas. A vesícula biliar foi removida intacta para análise de presença do cálculo biliar. O fígado foi examinado e os dados referentes a problemas hepáticos foram registrados. Os cálculos recuperados foram pesados. Para a análise dos dados, procedeu-se o cálculo da freqüência de casos de colelitíase nos bovinos estudados. Dentre os casos de colelitíase observados, foram calculadas as porcentagens de procedência dos animais, raças, sexo, gestação, faixas de idade e ECC, a fim de traçar um perfil dos animais acometidos. Além disto, foi estudada a existência de correlação entre o cálculo biliar e problemas hepáticos. Foram observados 91 casos de cálculo biliar (9,79%) dentre os 929 bovinos estudados. Os animais mestiços foram os mais acometidos (59/91), seguidos pela raça Holandesa (30/91). Com relação ao sexo, as fêmeas foram as mais acometidas pela colelitíase, totalizando 83 casos. E os animais com idade maior que 120 meses somaram 57,1% dos casos. A maioria dos animais com cálculo biliar apresentou ECC 2 (53/91). A maior parte dos bovinos acompanhados apresentou, como distúrbio hepático, apenas a colelitíase (72/91). O peso médio dos cálculos recuperados foi 2,98 gramas, variando de 0,4 a 23,3 gramas. Foram observados, em associação com o cálculo biliar: Fasciolose (13/91), Hemorragia (3/91), Neoplasia (2/91) e Congestão Hepática (1/91).(AU)

This study aimed to quantify the occurrence of gallstones in cattle slaughtered in the microregion of Campos da Mantiqueira, and draw a profile of the animals affected by cholelithiasis. The present study was conducted in slaughterhouse of São João Del Rei, MG, that receive animals from the various region cities for slaughter. ID's registration number, breed, sex, body condition score (scale 1-5) and age of these animals were estimated. A check for pregnancy in females was performed. The gallbladder was removed intact, for analysis of the presence of gallstones. The liver was examined and data relating to liver problems were reported. The recovered gallstones were weighed. For data analysis, we proceeded to calculate the frequency of cases of gallstones in cattle studied. Among the cases of cholelithiasis observed, we calculated the percentages of animal origin, race, sex, pregnancy, age and ECC in order to draw a profile of affected animals. Moreover we studied the correlation between gallstones and liver problems. 91 cases of gallstone (9.79%) among the 929 cattle studied were observed. Crossbred animals were the most affected (59/91), followed by the Netherlands (30/ 91) race. Regarding sex, females were most affected by cholelithiasis, totaling 83 cases. And animals with greater than 120 months old comprised 57.1 % of cases. Most gallstone animals showed ECC 2 (53/91). Most bovine presented only cholelithiasis, without hepatic disorder (72/91). The average weight of 2.98 grams was recovered calculations, ranging from 0.4 to 23.3 grams. Fasciolosis (13/91), hemorrhage (3/91), neoplasm (2/91) and Hepatic Congestion (1/91) were observed in association with gallstones.(AU)

Pathological Findings of Cholelithiasis in Two Horses

Despite of being a relatively rare disease in horses, cholelithiasis is the most common cause of biliary obstructionin this species. Simultaneous intrahepatic and extrahepatic gallstones are the most frequent presentation. Usually, there areno clinical signs associated with this condition, although biliary obstruction could occur as a consequence. Two cases ofcholelithiasis in horses, including gross and histopathological findings are described. In one of the cholelithiasis cases therewas no association with clinical signs or cause of death, but in the other one, chronic loss of weight may have been causedby cholelithiasis.

Pathological Findings of Cholelithiasis in Two Horses

Despite of being a relatively rare disease in horses, cholelithiasis is the most common cause of biliary obstructionin this species. Simultaneous intrahepatic and extrahepatic gallstones are the most frequent presentation. Usually, there areno clinical signs associated with this condition, although biliary obstruction could occur as a consequence. Two cases ofcholelithiasis in horses, including gross and histopathological findings are described. In one of the cholelithiasis cases therewas no association with clinical signs or cause of death, but in the other one, chronic loss of weight may have been causedby cholelithiasis.(AU)

Colecistectomia videolaparoscópica em felino com colelitíase / Videolaparoscopic cholecystectomy in feline with cholethiasis

A colelitíase, ou litíase biliar, é rara em felinos. O presente relato descreve o caso de um felino, macho, sem raça definida, com seis anos de idade que apresentava anorexia, dor abdominal, vômito e hipertermia. Ao exame ultrassonográfico de abdômen, a vesícula biliar apresentava formato irregular, paredes espessas e estruturas hiperecogênicas na região do seu colo e saída do ducto cístico, sugerindo presença de cálculos biliares. O paciente foi submetido à videolaparoscopia seguida de colecistectomia. Após sete dias, o animal obteve alta hospitalar e, aos 60 dias de pós-operatório, não demonstrou recidiva dos sinais clínicos.

Cholelithiasis, or gallstones, is rare in cats. This report describes the case of a six years-old mongrel cat male that had anorexia, abdominal pain, vomiting and hyperthermia. The abdominal ultrasound revealed a gallbladder with irregular shape andhyperechogenic structures, in the gallbladder's neck and in the output of the cystic duct, suggesting gallstones. The patient was undergone to a laparoscopic cholecystectomy. The animal was hospitalized for a week and after sixty days the owner no longer report clinical signs previously presented.

Colecistectomia videolaparoscópica em felino com colelitíase / Videolaparoscopic cholecystectomy in feline with cholethiasis

A colelitíase, ou litíase biliar, é rara em felinos. O presente relato descreve o caso de um felino, macho, sem raça definida, com seis anos de idade que apresentava anorexia, dor abdominal, vômito e hipertermia. Ao exame ultrassonográfico de abdômen, a vesícula biliar apresentava formato irregular, paredes espessas e estruturas hiperecogênicas na região do seu colo e saída do ducto cístico, sugerindo presença de cálculos biliares. O paciente foi submetido à videolaparoscopia seguida de colecistectomia. Após sete dias, o animal obteve alta hospitalar e, aos 60 dias de pós-operatório, não demonstrou recidiva dos sinais clínicos.(AU)

Cholelithiasis, or gallstones, is rare in cats. This report describes the case of a six years-old mongrel cat male that had anorexia, abdominal pain, vomiting and hyperthermia. The abdominal ultrasound revealed a gallbladder with irregular shape andhyperechogenic structures, in the gallbladder's neck and in the output of the cystic duct, suggesting gallstones. The patient was undergone to a laparoscopic cholecystectomy. The animal was hospitalized for a week and after sixty days the owner no longer report clinical signs previously presented.(AU)

The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis / A influência da regulação do acesso aos serviços de saúde e da incorporação tecnológica no perfil de mortalidade da pancreatite aguda biliar

PURPOSE: The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis (ABP) was evaluated. METHODS: The cases seen in a tertiary hospital were studied during two periods of time: 1995-1999 and 2000-2004, i.e., before and after the implementation of medical regulation. RESULTS: Among the 727 patients with acute pancreatitis, 267 had ABP and were classified according to APACHE II scores. The cases being referred to the tertiary hospital decreased from 441 to 286 (p < 0.001). The patients' profile regarding age, gender, severity, cholestasis incidence and mortality were similar during the first and second periods of study (n = 154 and n = 113, respectively). The number of patients with hematocrit > 44 percent was smaller during the second study period (p<0.002). The use of magnetic resonance cholangiography, videolaparoscopic cholecystectomy, and access to the ICU were found to be more frequent during the second study period. Regarding the deaths occurring within 14 days of hospitalisation, 73.4 percent and 81.3 percent were observed during the first and second study periods, respectively. CONCLUSION: Since the improvement in clinical and technological approach was not enough to modify the mortality profile of ABP, further studies on the treatment of inflammatory responses should be carried out.(AU)

OBJETIVO: Avaliou-se a influência do acesso aos recursos assistenciais e tecnológicos sobre a mortalidade na pancreatite aguda biliar (PAB). MÉTODOS: Os casos de PAB tratados num hospital universitário foram estudados em dois períodos: 1995 a 1999 e 2000 a 2004, antes e depois da implantação da Regulação Médica. RESULTADOS: Do total de 727 casos com pancreatite aguda atendidos, 267 apresentavam PAB e tiveram a gravidade avaliada pelo escore de APACHE II. Houve redução dos encaminhamentos de casos entre os períodos, de 441 para 286 (p < 0,001). O perfil dos pacientes com PAB no primeiro período (n = 154) e no segundo (n =113) foi semelhante quanto à idade, sexo, gravidade, incidência de colestase e mortalidade. A incidência de pacientes com hematócrito > 44 foi menor no segundo período (p < 0,002). O emprego de colangiografia por ressonância magnética, da colecistectomia por videolaparoscopia e do acesso à terapia intensiva foi significantemente maior no segundo período. A maioria dos óbitos ocorreu até os 14 dias de admissão, 73,4 por cento no primeiro período e 81,3 por cento no segundo. CONCLUSÃO:A melhora do suporte tecnológico e clínico não foi suficiente para modificar o perfil de mortalidade na PAB, o que indica a necessidade de avaliar terapêuticas para a sua resposta inflamatória.(AU)

Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy / Avaliação da resposta do cortisol, da corticotropina e da cinética das plaquetas após colecistectomias laparoscópica e aberta

OBJETIVO: Comparar o comportamento dos níveis séricos de cortisol, ACTH e da cinética das plaquetas nas colecistectomias laparoscópica e aberta. MÉTODOS: Esse estudo prospectivo compara 31 pacientes portadores de colelitíase sintomática que se submeteram a colecistectomia eletiva, sendo que 17 por via laparoscópica e 14 por via aberta. Amostras de sangue periférico foram colhidas na internação do paciente, na indução anestésica, às 2, 6, 12, 24 e 48 horas da incisão cirúrgica. A contagem de plaquetas foi realizada no microscópio óptico- aumento de 100X- pela coloração de Hematoxilina- eosina . As dosagens de cortisol e ACTH foram realizadas através da técnica de quimioluminescência. RESULTADOS: Observou-se que as concentrações de cortisol e ACTH elevaram-se significativamente (p< 0.05) nas primeiras horas em relação aos valores do pré-operatório. As 2 horas, houve elevação maior do nível de cortisol no grupo laparoscópico com diferença estatisticamente significante (p=0,0365;p<0.05) em relação ao grupo aberto. Observou-se retorno a valores basais no pós-operatório tardio (24 e 48 horas) somente para o ACTH, enquanto que o nível sérico de cortisol manteve-se elevado nesse mesmo período, com valores maiores e estatisticamente significante ( p24=0,0248 e p48=0,0320;p< 0.05) no grupo aberto em relação ao laparoscópico. As plaquetas apresentaram curvas de respostas diferentes entre os grupos, todavia mantiveram níveis normais em todos os momentos estudados. Não houve diferença estatística significante (p<0.05) entre os períodos pós e pré-operatórios em ambos os grupos. CONCLUSAO: A resposta hormonal ocorre em ambos procedimentos estudados, porém o estresse cirúrgico é maior e mais duradouro na cirurgia aberta quando comparada à laparoscópica. Não obstante, a cinética das plaquetas não mostrou variação significativa em ambos procedimentos diante da injúria tecidual. (AU)