Biliary peritonitis in a dog after perforation of the gallbladder during laparoscopic cholecystectomy

Background: Iatrogenic gallbladder perforation during laparoscopic cholecystectomy (LC) is a common complication and occurs in at least one third of human patients undergoing LC. This is attributed to the fragility of the gallbladder wall associated with mucocele and cholecystitis, in addition to the need for repetitive gripping and traction of the gallbladder during its manipulation with laparoscopic instruments. As complications from this event are rare in human patients, conversion to laparotomy is not routinely indicated and the adverse consequences of bile spillage are minimized by abundant irrigation of the peritoneal cavity and adequate antimicrobial therapy. On the other hand, there is little information regarding the outcome of laparoscopic management of this complication in laparoscopic cholecystectomies in dogs, particularly since most surgeons indicate conversion in these cases. Thus, we describe a case of biliary peritonitis that developed in a dog after laparoscopic management of iatrogenic perforation of the gallbladder during a laparoscopic cholecystectomy, in a case of gallbladder mucocele. To the best of our knowledge, there are no reports of biliary peritonitis following laparoscopic management of iatrogenic gallbladder perforation during LC in dogs. Case: A 14-year-old Poodle was referred for clinical evaluation with selective appetite, recurrent episodes of hyporexia, and abdominal discomfort. Ultrasound findings characterized chronic liver disease and gallbladder mucocele. The patient was referred for laparoscopic cholecystectomy, during which the gallbladder was iatrogenically perforated, with extravasation of a large volume of bile content. This complication was managed by copious abdominal irrigation via laparoscopic access and antimicrobial therapy. On the second postoperative day, the patient started to present apathy, hyporexia, emesis, and jaundice. The patient remained hospitalized in the intensive care unit for stabilization and monitoring through hematological examinations and serial abdominal ultrasound. Due to progressive worsening of the clinical picture, an exploratory laparotomy was performed ten days after the initial surgical procedure. This examination showed multiple adhesions and the presence of bile residues adhered to numerous points on the peritoneal surface and pancreas. Despite the intensive treatment instituted, death occurred 10 h after the second surgical procedure. Discussion: The high risk of gallbladder perforation during laparoscopic cholecystectomies correlates with the dissection step or repetitive grasping and traction of the gallbladder with laparoscopic instruments. Conversion is not routinely indicated and laparoscopic management is considered effective in humans. However, in this case, the presence of a large volume of extravasated semisolid bile content and its adherence to the mesothelial surface made it impossible to remove it in its entirety despite the abundant irrigation of the abdominal cavity, resulting in a picture of biliary peritonitis in the postoperative period. In view of the reported negative outcome, the authors encourage the adoption of measures that minimize the risk of gallbladder perforation when performing LC in dogs. These include the use of atraumatic instruments or aspiration of bile content before surgical manipulation. Cases in which such a complication is recorded should be carefully monitored to enable early diagnosis and treatment of biliary peritonitis. Furthermore, conversion should be considered when there is extravasation of large volumes of bile, particularly in the presence of gallbladder mucocele, until future studies establish the safety and effectiveness of laparoscopic management of this complication.

Infecção verdadeira por Capillaria hepatica em cão / True infection by Capillaria hepatica in a dog

Background: Capillaria hepatica is a nematode, zoonotic, with worldwide distribution. The main hosts are rodents, nevertheless other mammals can be affected. Although the parasite has high affinity for the liver, it rarely causes a hepaticdisease in domestic animals and humans. The diagnosis is difficult and usually a biopsy is required. The treatment is difficult and is based in anti-helminthic and corticoid, but prevention is the best strategy against the disease. The aim of thepresent report is to describe a case of hepatic capillariosis in a dog approaching the clinical signs, diagnosis and therapeutic.Case: A 12-year-old Brazilian Terrier bitch, with a history of visit to the farm and regular hunting of rats, frogs, birds andother wild animals, was attended with hyporexia and apathy. At the physical exam the dog presented elevation of rectaltemperature, intense jaundice and abdominal pain. In the biochemical exams was noticed a slight increase in globulins anda sharp increase in alkaline phosphatase (AP), total, direct and indirect bilirubin, suggesting a liver injury. In the ultrasonographic exam, hepatomegaly with dispersed hyperechoic areas were observed, suggesting hepatic steatosis. The patientwas treated with ursodesoxicolic acid and S-adenosil metionin for 30 consecutive days, showing a clinic improvement.Two months after the end of the treatment the animal worsened, showing jaundice, ascites, motor incoordination, weakness, difficulty in food and water ingestion and changes in the mental state. In the complete blood count was observed amacrocytic hypochromic regenerative anemia, leukocytosis with neutrophilia and monocytosis and thrombocytopenia.In biochemical exams was detected decrease in creatinine and albumin and increase in alanine aminotransferase and AP,suggesting hepatopathy by biliary obstruction. There were performed exams for leishmania and ehrlichiosis that testednegative. In the ultrasonographic exam it...

Infecção verdadeira por Capillaria hepatica em cão / True infection by Capillaria hepatica in a dog

Background: Capillaria hepatica is a nematode, zoonotic, with worldwide distribution. The main hosts are rodents, nevertheless other mammals can be affected. Although the parasite has high affinity for the liver, it rarely causes a hepaticdisease in domestic animals and humans. The diagnosis is difficult and usually a biopsy is required. The treatment is difficult and is based in anti-helminthic and corticoid, but prevention is the best strategy against the disease. The aim of thepresent report is to describe a case of hepatic capillariosis in a dog approaching the clinical signs, diagnosis and therapeutic.Case: A 12-year-old Brazilian Terrier bitch, with a history of visit to the farm and regular hunting of rats, frogs, birds andother wild animals, was attended with hyporexia and apathy. At the physical exam the dog presented elevation of rectaltemperature, intense jaundice and abdominal pain. In the biochemical exams was noticed a slight increase in globulins anda sharp increase in alkaline phosphatase (AP), total, direct and indirect bilirubin, suggesting a liver injury. In the ultrasonographic exam, hepatomegaly with dispersed hyperechoic areas were observed, suggesting hepatic steatosis. The patientwas treated with ursodesoxicolic acid and S-adenosil metionin for 30 consecutive days, showing a clinic improvement.Two months after the end of the treatment the animal worsened, showing jaundice, ascites, motor incoordination, weakness, difficulty in food and water ingestion and changes in the mental state. In the complete blood count was observed amacrocytic hypochromic regenerative anemia, leukocytosis with neutrophilia and monocytosis and thrombocytopenia.In biochemical exams was detected decrease in creatinine and albumin and increase in alanine aminotransferase and AP,suggesting hepatopathy by biliary obstruction. There were performed exams for leishmania and ehrlichiosis that testednegative. In the ultrasonographic exam it...(AU)

Anemia hemolítica imunomediada medicamentosa em uma cadela / Immune-mediated hemolytic anemia in a bitch triggered by drugs

Background: Immune-mediated hemolytic anemia (IMHA) is characterized by an autoimmune response with production of auto-antibodies and destruction of erythrocytes resulting in anemia. Primary IMHA is referred to a condition when the cause is unknown (idiopathic), whereas secondary IMHA involves changes in red blood cells caused by the action of drugs, neoplasms, or infectious diseases. The diagnosis can be made through changes in the blood count, usually of a regenerative character, Coombs test, and autoagglutination test. The present study aimed to report a case of drug-induced hemolytic anemia, with emphasis on the clinical signs, diagnostic methods, and treatment, in a female dog. Case: A 9-year-old mixed-breed bitch weighing 29.6 kg was referred to the Veterinary Medical Teaching Hospital (HCVUFRGS) with a previous diagnosis of gallbladder mucocele that was unresponsive to clinical treatment. After laboratory tests, cholecystectomy was performed, and the procedure required conversion from laparoscopic to open cholecystectomy. Therapy included administration of amoxicillin, dipyrone, tramadol hydrochloride, and meloxicam. Three days after surgery, the dog presented with apathy, lethargy, hyporexia, and a pale and subicteric mucosa. The patient developed hypochromic macrocytic anemia with reticulocytosis, spherocytosis, anisocytosis, and leukocytosis with neutrophilia. The result of the autoagglutination test was positive, confirming the diagnosis. All medications were suspended, and immunosuppressive treatment with dexamethasone was included, with a subsequent switch to prednisolone. After 10 days of treatment, the patient experienced significant improvement, and therapy was discontinued. Discussion: Based on the patient's history, the cause of the IMHA was secondary to drug administration, and it is not possible to distinguish if it was due to one or a combination of drugs, as they were all started and stopped simultaneously. The patient had hypothyroidism, which may have contributed to the production of antibodies against TSH receptors, blocking the hormone's action, thereby causing tissue damage due to T cell-mediated cytotoxicity and the effect of cytokines. The pale and subicteric mucosa, apathy, weakness, lethargy, exercise intolerance, and dyspnea resulted from extravascular hemolysis and bilirubin released from erythrocyte rupture with a subsequent decrease in the number of red blood cells, leading to oxygen transport deficiency. The diagnosis is based on the blood count and results of autoagglutination supported by the response to immunosuppressive therapy. Anemia results in increased production and release of precursor cells from the bone marrow, accompanied by reticulocytosis and increased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). The treatment of IMHA consists of supportive care and immunosuppressive therapy with corticosteroids to ensure suppression of the immune system, preventing response against erythrocytes. Initially, tramadol hydrochloride, dipyrone, and amoxicillin with potassium clavulanate were suspended to interrupt the cause of IMHA, and administration of dexamethasone in an immunosuppressive dose was started. Therefore, it is important to include drug-induced IMHA in the differential diagnosis of patients who present with anemia after using medications. Early diagnosis, initiation of therapy, and adequate care were important factors for the recovery of the animal.

Diagnóstico e tratamento de mucocele da vesícula biliar em cão / Diagnosis and treatment of gall bladder mucocele in dog

A mucocele de vesícula biliar se caracteriza pelo acúmulo anormal de bile semissólida na vesícula biliar. O presente trabalho relata o caso de uma cadela idosa, da raça yorkshire atendida em um Hospital Veterinário particular (Serviço Médico Veterinário – SEMEVE), com quadro de vômitos, anorexia, prostração e tremores, iniciados no dia do atendimento. Durante a anamnese, a tutora relatou que a paciente tinha sido diagnosticada há três anos com dislipidemia, sendo descartadas afecções endócrinas como causa do quadro. Ao exame físico, o animal apresentava sensibilidade à palpação abdominal e discreta icterícia em esclera. Durante o ultrassom de abdômen foi diagnosticada a mucocele de vesícula biliar, através da ecogenicidade, padrão apresentado pela bile e histórico clínico do animal. O tratamento inicial foi com antibioticoterapia, fluidoterapia suplementada com vitamina b e potássio, analgésico, antiemético e protetor gástrico. Devido a piora do quadro apresentada nos exames, 48 horas após o internamento, foi realizada colecistectomia. No transcirúrgico identificou-se aderência do omento à vesícula biliar e líquido ao redor dela. Foi realizada cultura com antibiograma da bile e mantida a terapia alopática. O histopatológico da vesícula biliar apontou colecistite aguda supurada. A cultura isolou a bactéria Sthapylococcus intermedius. Após 60 dias de realizada a cirurgia, o animal encontrava-se clinicamente saudável e como os exames para controle apontaram resolução completa das alterações, foi dada alta médica.

The gallbladder mucocele (GBM) is characterized by abnormal accumulation of semisolid bile in the gallbladder. This case repor is about a female dog, Yorkshire, attended on a private Veterinary Hospital (Serviço Médico Veterinário – SEMEVE). The dog had vomiting, anorexia, prostration and tremors that started on the day of the appointment. During the anamnesis, the tutor reported that the patient had been diagnosed with dyslipidemia three years before, however, endocrine disorders were ruled out as the cause of the condition. At the physical examination, the animal presented sensitivity to abdominal palpation and mild sclera jaundice. During the abdominal ultrasound it was diagnosed gallbladder mucocele, through echogenicity and the pattern presented by the bile associated with the clinical history of the animal. The initial treatment was with antibiotic therapy, fluid therapy supplemented with vitamin B and potassium, analgesic, antiemetic and gastric protector. Due to the worsening of the dog seen in the exams, 48 hours after admission, cholecystectomy was performed. In the transurgical procedure, omentum adherence to the gallbladder and fluid around it was identified. Culture with bile antibiogram was performed and allopathic therapy was maintained. The histopathology of the gallbladder showed acute suppurated cholecystitis. The culture isolated the bacterium Sthapylococcus intermedius. After 60 days of the surgery, the animal was clinically healthy and the tests for control showed complete resolution of the changes, so it was given medical discharge.

Diagnóstico e tratamento de mucocele da vesícula biliar em cão / Diagnosis and treatment of gall bladder mucocele in dog

A mucocele de vesícula biliar se caracteriza pelo acúmulo anormal de bile semissólida na vesícula biliar. O presente trabalho relata o caso de uma cadela idosa, da raça yorkshire atendida em um Hospital Veterinário particular (Serviço Médico Veterinário SEMEVE), com quadro de vômitos, anorexia, prostração e tremores, iniciados no dia do atendimento. Durante a anamnese, a tutora relatou que a paciente tinha sido diagnosticada há três anos com dislipidemia, sendo descartadas afecções endócrinas como causa do quadro. Ao exame físico, o animal apresentava sensibilidade à palpação abdominal e discreta icterícia em esclera. Durante o ultrassom de abdômen foi diagnosticada a mucocele de vesícula biliar, através da ecogenicidade, padrão apresentado pela bile e histórico clínico do animal. O tratamento inicial foi com antibioticoterapia, fluidoterapia suplementada com vitamina b e potássio, analgésico, antiemético e protetor gástrico. Devido a piora do quadro apresentada nos exames, 48 horas após o internamento, foi realizada colecistectomia. No transcirúrgico identificou-se aderência do omento à vesícula biliar e líquido ao redor dela. Foi realizada cultura com antibiograma da bile e mantida a terapia alopática. O histopatológico da vesícula biliar apontou colecistite aguda supurada. A cultura isolou a bactéria Sthapylococcus intermedius. Após 60 dias de realizada a cirurgia, o animal encontrava-se clinicamente saudável e como os exames para controle apontaram resolução completa das alterações, foi dada alta médica.(AU)

The gallbladder mucocele (GBM) is characterized by abnormal accumulation of semisolid bile in the gallbladder. This case repor is about a female dog, Yorkshire, attended on a private Veterinary Hospital (Serviço Médico Veterinário SEMEVE). The dog had vomiting, anorexia, prostration and tremors that started on the day of the appointment. During the anamnesis, the tutor reported that the patient had been diagnosed with dyslipidemia three years before, however, endocrine disorders were ruled out as the cause of the condition. At the physical examination, the animal presented sensitivity to abdominal palpation and mild sclera jaundice. During the abdominal ultrasound it was diagnosed gallbladder mucocele, through echogenicity and the pattern presented by the bile associated with the clinical history of the animal. The initial treatment was with antibiotic therapy, fluid therapy supplemented with vitamin B and potassium, analgesic, antiemetic and gastric protector. Due to the worsening of the dog seen in the exams, 48 hours after admission, cholecystectomy was performed. In the transurgical procedure, omentum adherence to the gallbladder and fluid around it was identified. Culture with bile antibiogram was performed and allopathic therapy was maintained. The histopathology of the gallbladder showed acute suppurated cholecystitis. The culture isolated the bacterium Sthapylococcus intermedius. After 60 days of the surgery, the animal was clinically healthy and the tests for control showed complete resolution of the changes, so it was given medical discharge.(AU)

Parotid salivary mucocele in a companion rabbit (Oryctolagus cuniculus): a report on the clinical and laboratory characteristics and surgical treatment - case report / [Mucocele salivar parotídea em coelho doméstico (Oryctolagus cuniculus): relato de características clínico-laboratoriais e tratamento cirúrgico - relato de caso]

The present report aimed to describe the main characteristics of the parotid salivary mucocele in an adult male rabbit, which presented with a painless fluctuating mass with fluid content. Owing to the need for repeated fluid drainage, surgical excision was the chosen mode of treatment. Preoperative evaluation included radiography and blood analysis. The patient underwent surgical excision of the affected gland. Inhalation anesthesia was maintained by means of isoflurane and the cardio-respiratory parameters were monitored throughout the surgery. A bipolar electrocautery was used to assist in the incision and polyglactin 910 and nylon were the suture materials used in the wound closure technique. Post-operative medications included analgesics, anti-inflammatory agents and antibiotics. Histopathology of the excised glandular tissue revealed a mixed inflammatory infiltrate, fibroblasts, hemorrhage and hyperemia. The observations in this case suggest that surgical excision of the affected gland is the treatment of choice for the management of mucocele in companion rabbits, which has already been identified for other animals. Periodic acid-reactive Schiff staining confirmed the diagnosis of salivary mucocele. The complementary investigations helped to rule out the differential diagnosis and indicated a favorable prognosis, in view of the fact that the case was successfully resolved without complications or recurrence.(AU)

O presente relato teve como objetivo descrever as principais características da mucocele salivar parotídea em um coelho macho adulto, que apresentou uma massa flutuante indolor e com um conteúdo líquido em seu interior. Devido à necessidade de repetidas punções deste fluido, optou-se pela excisão cirúrgica como forma de tratamento. A avaliação pré-operatória incluiu radiografias e análises sanguíneas. O paciente foi submetido ao tratamento cirúrgico com excisão da glândula afetada. A anestesia inalatória foi mantida com isoflurano e os parâmetros cardio-respiratórios foram monitorados durante a cirurgia. Um eletrocautério bipolar foi utilizado para auxiliar na incisão e os fios poliglactina 910 e nylon foram utilizados na técnica de sutura. As medicações pós-operatórias incluíram agentes analgésicos, anti-inflamatórios e antibióticos. A histopatologia do tecido glandular removido revelou infiltrado inflamatório misto, fibroblastos, hemorragia e hiperemia. As observações neste caso sugerem que a remoção cirúrgica da glândula afetada seja o tratamento de escolha no manejo da mucocele em coelhos de companhia, o que já vem sendo identificado para outros animais. A coloração do ácido periódico reativo de Schiff confirmou o diagnóstico da mucocele salivar. Os exames complementares ajudaram a excluir as doenças que fazem parte do diagnóstico diferencial e indicaram um prognóstico favorável, tendo em vista o fato que este caso foi resolvido com sucesso, sem complicações ou recorrência.(AU)

Rânula bilateral com recidiva em glândula mandibular e sublingual em cão / Ranula bilateral with recurrence in submandibular gland and sublingualin dog

A mucocele sublingual é uma afecção incomum em cães, porém de grande importância para a medicina veterinária, devido aosprejuízos gerados por suas consequências. Deste modo, o presente relato tem como objetivo descrever o caso de mucocelesublingual em cão com posterior recidiva em glândula mandibular e sublingual, bem como discutir sua importância para a medicinaveterinária. Foi atendido no Hospital Veterinário Dix-Huit Rosado Maia HOVET/ Universidade Federal Rural de Semiárido(UFERSA), um cão macho, com um ano e 10 meses de idade, apresentando aumento de volume bilateral na região sublingualhá, aproximadamente, dois meses. Após exame clínico suspeitou-se de mucocele da glândula sublingual bilateral (rânula)indicando-se o tratamento de ressecção da glândula sublingual esquerda devido ao aspecto nodular e marsupalização da glândulasublingual direita. Passado um mês da alta médica o animal retornou ao HOVET UFERSA com queixa de aparecimento de umnovo aumento de volume sublingual e na região cervico-ventral suspeitando-se de uma possível mucocele cervical e recidivada mucocele sublingual esquerda. Indicou-se como tratamento a sialoadenectomia sublingual e mandibular. Cerca de dez diasapós a última cirurgia o cão não apresentava mais aumento de volume da área afetada e não havia sinais de alteração quanto àprodução de saliva. O tratamento sugerido proporcionou bons resultados promovendo a reparação tecidual e reestruturação dolocal afetado e diminuindo o índice de recidiva.(AU)

The sublingual mucocele is a rare disease in dogs, but very important for veterinary medicine due to losses generated by itsconsequences. Thus, this report aims to describe the case of sublingual mucocele in a dog with subsequent relapse in mandibularand sublingual gland and discuss their importance to veterinary medicine. It was the Veterinary Hospital Dix-Huit Rosado Maia -HOVET / Universidade Federal Rural de Semi-árido (UFERSA), a male dog with one year and 10 months, an increase of bilateralvolume in the sublingual region for approximately two months. After clinical examination was suspected of mucocele of bilateralsublingual gland (ranula) indicating the treatment of sublingual left gland resection due to nodular and marsupalização the rightsublingual gland. After one month of a medical release the animal returned to HOVET - UFERSA with emergence of complaint froma further increase in sublingual volume and cervical-ventral region suspecting it is a possible cervical mucoceles and recurrenceof sublingual mucocele left. It is stated as a treatment to sublingual and mandibular sialoadenectomy. About ten days after the lastsurgery, the dog had no more swelling of the affected area and no signs of change with saliva production. However, the suggestedtreatment provided good results by promoting tissue repair and restructuring of the affected area and decreasing the recurrence rate.(AU)

Mucocele em cães: relato de caso / Mucocele in dogs: case report

Mucoceles are benign pseudocystic lesions caused by the rupture or obstruction of the salivary glands and their matching excretory ducts. This disease leads to the accumulation of mucus in the connective tissue. Affected patients may be asymptomatic or present anorexia, getting vulnerable to secondary diseases. The recommended treatment is the surgical removal of the salivary gland and the connection of the involved duct; this process is essencial to avoid recurrences and to provide a favorable prognosis to the patient. Due to the fact that it is an unusual occurrence in dogs, this work has as objective to present a case report about the mucocele’s appearence in such species, achieving the definitive diagnosis by fine-needle aspiration cytology of the affected area.

Mucocele em cães: relato de caso / Mucocele in dogs: case report

Mucoceles are benign pseudocystic lesions caused by the rupture or obstruction of the salivary glands and their matching excretory ducts. This disease leads to the accumulation of mucus in the connective tissue. Affected patients may be asymptomatic or present anorexia, getting vulnerable to secondary diseases. The recommended treatment is the surgical removal of the salivary gland and the connection of the involved duct; this process is essencial to avoid recurrences and to provide a favorable prognosis to the patient. Due to the fact that it is an unusual occurrence in dogs, this work has as objective to present a case report about the mucoceles appearence in such species, achieving the definitive diagnosis by fine-needle aspiration cytology of the affected area.(AU)

Rigid endoscopy to aid the treatment of cervical mucocele in a dog

Background: Sialocele or salivary mucocele is the accumulation of saliva in the glandular connective tissue due to a leakage from damaged salivary duct, which is surrounded by granulation tissue. The mucocele can be classified according to its location (cervical, pharyngeal or sublingual, the latter being known as ranula). The treatment consists of salivary gland and duct excision. However, in some cases, the definition of which side is affected is a challenge for surgeons. Keeping this in view, the aim of the present study was to describe the use of rigid endoscopy to determine the affected gland in a dog with cervical mucocele.Case: A five-year-old Dachshund, weighting 8.2 kg, was presenting progressive swelling in the ventral cervical area. The animal presented apathy, appetite loss and saliva drooling. A fluctuant, non-painful, fluid filled mass was noted on physical examination. Sialocele was diagnosed and surgery was undertaken to excise the involved gland and mass. The patient was positioned in dorsal recumbence. A skin incision was performed in the cranial-ventral aspect of the mass as it was not possible to precise the affected side. Following drainage of the content, the inner aspect of the sialocele capsule was digitally palpated using the surgeons index finger. However, it was still not possible to determinate the affected side...(AU)

Rigid endoscopy to aid the treatment of cervical mucocele in a dog

Background: Sialocele or salivary mucocele is the accumulation of saliva in the glandular connective tissue due to a leakage from damaged salivary duct, which is surrounded by granulation tissue. The mucocele can be classified according to its location (cervical, pharyngeal or sublingual, the latter being known as ranula). The treatment consists of salivary gland and duct excision. However, in some cases, the definition of which side is affected is a challenge for surgeons. Keeping this in view, the aim of the present study was to describe the use of rigid endoscopy to determine the affected gland in a dog with cervical mucocele.Case: A five-year-old Dachshund, weighting 8.2 kg, was presenting progressive swelling in the ventral cervical area. The animal presented apathy, appetite loss and saliva drooling. A fluctuant, non-painful, fluid filled mass was noted on physical examination. Sialocele was diagnosed and surgery was undertaken to excise the involved gland and mass. The patient was positioned in dorsal recumbence. A skin incision was performed in the cranial-ventral aspect of the mass as it was not possible to precise the affected side. Following drainage of the content, the inner aspect of the sialocele capsule was digitally palpated using the surgeons index finger. However, it was still not possible to determinate the affected side...

ANÁLISES COMPARATIVAS ENTRE EXAMES ULTRASSONOGRÁFICO E HISTOPATOLÓGICO DA VESÍCULA BILIAR EM CÃES

Na medicina veterinária, doenças restritas à vesícula biliar (VB) são incomuns em cães. Dentre as doenças que acometem os cães e apresentam maior prevalência estão a colecistite, a mucocele da VB, a colelitíase e as neoplasias. O exame histopatológico da VB é apontado como padrão ouro. Entretanto o exame ultrassonográfico abdominal está cada vez mais inserido na rotina da clínica veterinária e se constitui como um exame seguro, pouco invasivo, inócuo e de baixo custo. Ele permite que casos de afecções da VB antes subdiagnosticados passem a ter um diagnóstico mais preciso. Nesse contexto, o objetivo deste estudo foi identificar, quantificar e correlacionar as diferentes lesões da VB de cães diagnosticadas por exames ultrassonográficos e histopatológicos. Foram avaliadas as VB de 60 cadáveres de cães admitidos na rotina do Setor de Patologia Veterinária da Escola de Veterinária da Universidade Federal de Minas Gerais (EV-UFMG), sem predileção por sexo, idade e raça. Os resultados demonstraram que o exame ultrassonográfico, quando correlacionado com o exame histopatológico, apresentou 83% de concordância na análise dos dados gerais para a presença ou ausência de alterações da VB. O nível de concordância no teste de Kappa foi 0,63, o que é considerado um valor substancial. Em comparação, a concordância de Kappa nas afecções estudadas de forma individual obteve-se uma correlação baixa. Correlacionando os dados das análises não paramétricas e os do exame histopatológico, 35% das amostras apresentaram mucocele da VB, 33,3% não apresentaram nenhum tipo de alteração e 30% foram diagnosticadas com hiperplasia mucinosa cística (HMC). As semelhanças entre os achados ultrassonográficos das diferentes afecções da VB como a HMC, mucocele e colecistite indicam que o exame ultrassonográfico não apresenta boa acurácia diagnóstica. Contudo, mais estudos devem ser realizados a fim de se aprofundar o entendimento da correlação entre ultrassonografia e histopatologia para o direcionamento de conclusões diagnósticas.

In veterinary medicine, diseases restricted to the gallbladder (GB) are uncommon in dogs. Among the diseases that affect dogs and are more prevalent are cholecystitis, GB mucocele, cholelithiasis and neoplasms. Histopathological examination of GB is indicated as the gold standard. However, abdominal ultrasound examination is increasingly being performed in veterinary clinics and constitutes a safe, low-invasive, harmless and low-cost examination. It allows cases of GB disorders that were previously underdiagnosed to have a more accurate diagnosis. In this context, the objective of this study was to identify, quantify and correlate the different GB lesions of dogs diagnosed by ultrasound and histopathological exams. The GB of 60 cadavers of dogs admitted to the Veterinary Pathology Sector of the Veterinary School of the Federal University of Minas Gerais (EV-UFMG) were evaluated, with no predilection for sex, age and race. The results demonstrated that the ultrasound examination, when correlated with the histopathological examination, showed 83% agreement in the analysis of the general data for the presence or absence of GB changes. The level of agreement in the Kappa test was 0.63, which is considered a substantial value. In comparison, Kappa's agreement in the conditions studied individually obtained a low correlation. Correlating the data from the non-parametric analyzes and those from the histopathological exam, 35% of the samples presented with a GB mucocele, 33.3% did not present any type of alteration and 30% were diagnosed with cystic mucinous hyperplasia (CMH). The similarities between the ultrasound findings of different GB disorders such as CMH, mucocele and cholecystitis - indicate that the ultrasound examination does not present a good diagnostic accuracy. However, further studies should be carried out in order to deepen the understanding of the correlation between ultrasound and histopathology to guide diagnostic conclusions.

Obstrução respiratória causada por mucocele salivar faríngea em um cão / Respiratory obstruction caused by salivary mucocele pharyngeal in a dog

Conforme Dunnig (2007) não é recomendado o tratamento apenas por aspiração ou drenagem, devido à ocorrência de recidiva em poucos dias. A relevância clínica deste caso está relacionada à viabilidade da cricotireoidotomia para melhora da angústia respiratória e a utilização da técnica de marsupialização como tratamento eficaz, pois não ocorreu recidiva no caso relatado, embora a realização dessa técnica possa apresentar comprometimento da via aérea superior e possibilidade de disfunção da deglutição em caso de recidiva.

Obstrução respiratória causada por mucocele salivar faríngea em um cão / Respiratory obstruction caused by salivary mucocele pharyngeal in a dog

Conforme Dunnig (2007) não é recomendado o tratamento apenas por aspiração ou drenagem, devido à ocorrência de recidiva em poucos dias. A relevância clínica deste caso está relacionada à viabilidade da cricotireoidotomia para melhora da angústia respiratória e a utilização da técnica de marsupialização como tratamento eficaz, pois não ocorreu recidiva no caso relatado, embora a realização dessa técnica possa apresentar comprometimento da via aérea superior e possibilidade de disfunção da deglutição em caso de recidiva.(AU)

AVALIAÇÃO HEPÁTICA DOS CÃES (Canis familiaris) COM HIPERADRENOCORTICISMO POR MEIO DOS EXAMES ULTRASSONOGRÁFICO, CITOPATOLÓGICO E LABORATORIAIS

O hiperadrenocorticismo (HAC), também conhecido como Síndrome de Cushing, é resultante da exposição crônica ao excesso de glicocorticóides, sendo considerada uma das endocrinopatias mais comuns em cães. Seu diagnóstico é feito a partir do histórico, anamnese, sinais clínicos, exame físico, exames laboratorias e de imagem, além dos testes endócrinos, os quais correspondem à função da adrenal. Sabe-se que o fígado é afetado pela doença em decorrência do excesso de cortisol no organismo que causa alterações no metabolismo de gorduras, carboidratos e proteínas. Diante da complexidade do diagnóstico da doença e das alterações hepáticas que esta determina, o objetivo do presente estudo foi avaliar o fígado de cães com hiperadrenocorticismo, por meio dos exames ultrassonográfico, citopatológico e laboratoriais. Foram incluídos 20 cães já diagnosticados com HAC, de origem pituitária ou adrenal, e em tratamento com trilostano. As fêmeas (75%; 15/20), das raças Poodle e Yorkshire Terrier (50%; 10/20), de porte pequeno (< que 10kg) e acima de 6 anos de idade foram as mais afetadas. A manifestação clínica resultante do hipercortisolismo não sofreu grande variação em relação à descrita na literatura, no entanto, cabe ressaltar que a polifagia e o aumento abdominal foram menos relatados que a poliúria (90%; 18/20). Em relação à avaliação bioquímica, observou-se aumento de triglicerídeos (80%; 16/20), aumento de proteínas totais (75%; 15/20), aumento de fosfatase alcalina (60%; 12/20), aumento de GGT (55%; 11/20), aumento da ALT (45%, 9/20), hipercolesterolemia (45%; 9/20), hiperglobulinemia (35%; 7/20), hiperalbuminenia (30%; 6/20); aumento de ureia (20%; 4/20); hipoalbuminemia (15%; 3/20), diminuição da glicemia (15%; 3/20), aumento da glicemia (10%; 2/20), diminuição da GGT (10%; 2/20) e aumento da creatinina (5%; 1/20). Todos os cães apresentaram pelo menos uma alteração bioquímica, indicando que a alteração hepática estava presente, podendo estar relacionada ao HAC ou ao tratamento com trilostano. Ao exame ultrassonográfico notou-se aumento das dimensões das adrenais em 85% (17/20) dos animais e ecotextura heterogênea (30%; 6/20), aumento das dimensões associado a hiperecogenicidade hepática (40%; 8/20) e presença de lama bilar (45%; 9/20) e mucocele (5%; 1/20). No entanto, não foi encontrada associação significativa entre as alterações hepáticas ou biliares e alterações concomitantes das glândulas adrenais (X² = 0,004; p-valor=0,95). O exame citopatológico obteve amostra diagnóstica em 95% (19/20) dos animais e revelou hepatopatia esteroidal (50%; 10/20), hiperplasia nodular regenerativa (20%; 4/20), amiloidose hepática (10%; 2/20) e sem alterações dignas de nota (15%; 3/20). Desta forma, mostrou-se uma técnica fundamental na diferenciação das lesões hepáticas deste órgão, especialmente naqueles fígados hiperecóicos ou heterogêneos ao exame ultrassonográfico. Concluiu-se que o acometimento hepático estava presente nos cães do estudo em todos os exames realizados, reforçando a importância da hepatoproteção em tais animais.

Hyperadrenocorticism (HAC), also known as Cushing's syndrome, is resulting from exposure to excess glucocorticoids, considered one of the most common endocrinopathies in dogs. The diagnosis is made from history, anamnesis, clinical signs, physical examination, laboratory and imaging exams, in addition to the endocrine tests, which correspond to the adrenal function. It is known that the liver is affected by the disease as a result of excess cortisol no body that causes the metabolism of fats, carbohydrates and proteins. In view of the complexity of the diagnosis of the disease and the liver diseases that this determination, the objective of the present study was evaluated by dogs with hyperadrenocorticism, through ultrasonographic, cytopathological and laboratory tests. We included 20 dogs already diagnosed with HAC, of pituitary or adrenal origin, and in treatment with trilostane. Poodle's females (75%, 15/20) and Yorkshire Terrier (50%, 10/20), small (<10 kg) and over 6 years of age were the most affected. Clinical manifestation resulting from hypercortisolism did not change much in relation to the description in the literature, however, it should be noted that polyphagia and increase of abdominal composites than polyuria (90%, 18/20). All dogs presented at least one biochemical change, indicating that hepatic impairment was present, and may be related to HAC or trilostane treatment. In relation to the biochemical evaluation, it was observed an increase of triglycerides (80%, 16/20), increase of total proteins (75%, 15/20), increase of alkaline phosphatase (60%, 12/20), increase of GGT , hyperalbuminemia (30%, 6/20), hyperglobulinemia (35%, 7/20), hyperalbuminemia (30%, 6/20) ; Increased urea (20%, 4/20); hypoalbuminemia (15%, 3/20), decreased glycemia (15%, 3/20), increased glycemia (10%, 2/20), decreased GGT (10%, 2/20) and increased creatinine (5%, 1/20). Ultrasound examination revealed an increase adrenal's dimensions in 85% (17/20) of the animals and heterogeneous ecotexture (30%, 6/20), increased dimensions associated with hepatic hyperechogenicity (40%, 8/20) and presence of bile sludge (45%, 9/20) and mucocele (5%, 1/20). However, no significant association was found between hepatic or biliary changes and concomitant adrenal gland changes (X² = 0.004; p-value = 0.95). The cytopathological examination obtained a diagnostic sample in 95% (19/20) of the animals and revealed steroidal liver disease (50%, 10/20), nodular regenerative hyperplasia (20%, 4/20), hepatic amyloidosis (10%, 2/20 ) And without significant changes (15%, 3/20). In this way, it has been shown a fundamental technique in the differentiation of the hepatic lesions of this organ, especially in those hyperechoic or heterogeneous livers on the ultrasonographic examination. It was concluded that hepatic commotion was present in all study dogs, reinforcing the importance of hepatoprotection in these animals.

Platynosomum fastosum-induced Infections in Domestic Shorthair Cats: a Retrospective Study of Seven Cases

The clinical and the pathological findings associated with Platynosomum fastosum-induced infections are described in Domestic shorthair cats by the retrospective analyses of archival records. Icterus was the most predominant clinical alteration observed; three cats demonstrated clinical manifestations of hepatic encephalopathy. The laboratory findings of two cases confirmed severe hepatic dysfunction due to elevations in the serum concentrations of alanine aminotransferase, phosphatase alkaline, and gamma-glutamyl transferase. Hypertrophy of bile ducts occurred in all animals. All cats demonstrated adenomatous hyperplasia of biliary epithelium and/or periductal fibrosis associated with intraductal trematode and/or intralesional ova of P. fastosum. One cat had pathological alterations consistent with cystic mucinous hyperplasia and gallbladder mucocele associated with intralesional ova of P. fastosum, while dilated cystic intra-hepatic structures associated with chronic platynosomiasis occurred in another cat. Platynosomiasis was an incidental finding in one cat.(AU)

Temporomandibular joint ankylosis and salivary mucocele in a cat: case report / Anquilose da articulação temporomandibular e mucocele em um gato: relato de caso

An approximately 1.5-year-old, not neutered mixed breed cat was referred for evaluation of inability to open its mouth, and soft tissue swelling around the intermandibular region. Both signs were present since the cat was adopted, 1 year before presentation. The cause of the signs was not determined prior to referral. Based on the physical and radiographic examinations, left temporomandibular joint ankylosis and salivary mucocele were diagnosed. The lateral aspect of the condyloid process of the left mandible was removed and the salivary mucocele was treated by right mandibular and sublingual gland resection and drainage of the mucocele. After surgery, the cat showed good functional use of the mandible without discomfort.(AU)

Relata-se o caso de um gato de aproximadamente um ano e meio de idade, macho, não castrado, que foi encaminhado por apresentar incapacidade de abrir a boca e aumento de volume flutuante na região intermandibular. As lesões estavam presentes há um ano, desde quando o gato foi encontrado e adotado. A causa não foi determinada. Baseado nos exames físicos e radiográficos diagnosticou-se anquilose da articulação temporomandibular esquerda e mucocele salivar. O aspecto lateral do processo condilar da mandíbula esquerda foi removido, e a mucocele foi tratada por ressecção das glândulas salivares mandibular e sublingual direita e por drenagem da mucocele. Após a cirurgia, o gato mostrou bom uso funcional da mandíbula, sem sinais de desconforto.(AU)

Cistoadenoma mucinoso do apêndice: relato de caso

Mucinous cystadenoma of the vermiform appendix, a type of mucocele of appendix, is a benign neoplasm characterized by focal or diffuse metaplasia of the superficial epithelium of mucosae, associated with appendix dilation and mucinous secretion into the appendiceal lumen. At present study the authors report a case of mucinous cystadenoma of appendix observed in a 65-yr-old woman with pain and palpated mass in the right lower quadrant of the abdomen started one year ago. Cystadenoma of the appendix was suspected throughout ultrasonography and CT scan of abdomen and confirmed by histology. Pacient also presented gallstones, and a right renal cyst. Laparotomy was indicated, appendicectomy and cholecystectomy performed and, renal cyst removed. At present issue we hope to contribute for early detection of this disease, and better understanding of its classification and pathogenesis.

O cistoadenoma mucinoso do apêndice ceca l, um tipo de mucocele do apêndice, é uma neoplasia benigna caracterizada pela metaplasia focal ou difusa do epitélio superficial da mucosa, associada à dilatação do apêndice e produção de muco para a luz apendicular. No presente estudo os autores relatam um caso de cistoadenoma mucinoso do apêndice observado em uma mulher de 65 anos de idade, com dor e massa palpável no quadrante inferior direito do abdome, cujo quadro teve início há 1 ano. O diagnóstico de cistoadenoma do apêndice foi suspeitado através da ultrassonografia e tomografia computadorizada do abdome, e confirmado pelo exame histopatológico. A paciente também apresentava cálculos na vesícula biliar e um cisto renal à direita. A laparotomia foi indicada sendo realizada a apendicectomia, a colecistectomia e a exérese do cisto renal. Na presente discussão esperamos contribuir para o diagnóstico precoce dessa doença e a melhor compreensão de sua classificação e patogenia.