Gallbladder Agenesis in a Dog: Clinicopathological, Histopathology, and Computed Tomography Findings

ABSTRACT Three cases of gallbladder agenesis (GA) have been previously reported in the English-speaking veterinary literature. Affected dogs can be either asymptomatic or symptomatic with vomiting, retching, and anorexia previously reported. The previously reported cases and the dog in this report had marked elevations in alanine aminotransferase concentrations, and liver histopathology consistently showed bridging fibrosis and biliary hyperplasia. The condition is most often diagnosed in humans during exploratory surgery, which was also the case in the previous three dogs reported with GA. Computed tomography (CT) or MRI is now recommended for diagnosis of the condition in humans, and this is the first report of CT findings in an affected dog diagnosed without surgery. Bile stasis and cholangiohepatits have been proposed as secondary pathologies in both humans and dogs with GA, and histopathology and CT findings in this case support those theories.

Timing of the termination of mechanical jaundice after antegrade and retrograde decompressive surgeries in mechanical jaundice of various genesis

Aim: to determine in a comparative aspect the effectiveness of various minimally invasive decompressive operations in mechanical jaundice of different genesis. Materials and methods. In 135 patients with mechanical jaundice, the rate of bile duct resolution after cholecystostomy and percutaneous cholangiostomy was studied on the background of pancreatic head tumor. In 643 patients with obstructive bile duct disease in cholelithiasis, timing of the termination of jaundice after minimally invasive retrograde (endoscopic papillosphincterotomy (EPT) and EPT with transpapillary drainage) and percutaneous antegrade (cholecystostomy and cholangiostomy) of decompressive operations was studied. Result. Upon cholelithiasis and hyperbilirubinemia less than 100 μmol/l, jaundice is terminated after both variants of retrograde decompression within 3–5 days, antegrade interventions increase these terms by half. Comparison of retrograde and antegrade decompressive surgeries in mechanical jaundice of medium and severe degree on the background of cholelithiasis indicates that the rate of termination of bile stasis is the highest after EPT with transpapillary drainage. Isolated EPT and percutaneous cholangiostoma with medium-grade gallstones increase the duration of jaundice termination by an average of one week. Upon hyperbilirubinemia more than 200 μmol/l, cholangiostomy is not worse than transpapillary drainage. The longest termination period of obstructive jaundice (28–30 days) is observed after superimposition of microcholecystostoma. In patients with jaundice of a mild degree of tumor genesis, no differences in the results were revealed after both variants of percutaneous decompression. Upon hyperbilirubinemia above 100 μmol/l, when cholangio- and cholecystostomy were compared, a higher rate of decrease in serum bilirubin was observed after percutaneous interventions with a cholecystostomy. Conclusion. At all severity levels of mechanical jaundice on the background of cholelithiasis, the best way of decompression is endoscopic papillotomy with transpapillary drainage. In obturation bile stasis upon the pancreatic head tumor, the best decompressive effect is observed after percutaneous cholecystoostomy.

The Concept of Cholelithiasis as Per Ayurvedic Text

Cholelithiasis (gallstone formation) results from a combination of several factors, including super saturation of bile with cholesterol, accelerated nucleation of cholesterol monohydrate in bile, and bile stasis or delayed gallbladder emptying due to impaired gallbladder motility. In India it is more common in women in north, north-east and east as compared to other zones in the country. The disease Gall Stone has not been described directly in Ayurvedic classics. The word Ashmari in Ayurveda stands for stone which is described only in the context of Bastigat Ashmari (urinary calculi). After analyzing the Ayurvedic texts it was found that the bile secreted from gall bladder can be correlated with Accha Pitta mentioned in Ayurveda due to the similarity in location and function. The pathogenesis of the disease occurs due to the abnormal formation of Kapha during the process of digestion and its vitiation due to Vata. The present article deals with description of formation of gall stone from the Ayurvedic perspective. Along with this the specific remedy for gall stone according to Ayurveda is also described.

Fatal methanol poisoning

Methanol poisoning has become a considerable problem in Iran. Liver can show some features of poisoning after methanol ingestion. Therefore, our concern was to examine liver tissue histopathology in fatal methanol poisoning cases in Iranian population. In this study, 44 cases of fatal methanol poisoning were identified in a year. The histological changes of the liver were reviewed. The most striking features of liver damage by light microscopy were micro-vesicular steatosis, macro-vesicular steatosis, focal hepatocyte necrosis, mild intra-hepatocyte bile stasis, feathery degeneration and hydropic degeneration. Blood and vitreous humor methanol concentrations were examined to confirm the proposed history of methanol poisoning. The majority of cases were men (86.36%). In conclusion, methanol poisoning can cause histological changes in liver tissues. Most importantly in cases with mean blood and vitreous humor methanol levels greater than 127 ± 38.9 mg/dL more than one pathologic features were detected.

Clinical significance of serum alkaline phosphatase level in advanced pancreatic cancer.

183 Background: Alkaline phosphatase (ALP) is an enzyme that is elevated by various hepatobiliary diseases. Generally its elevation is thought to indicate bile stasis. There are some reports that show ALP is an important prognostic factor for several cancers such as colon, lung, and gastric cancer. Often it is speculated that ALP elevation indicates bile stasis caused by liver metastasis. However, the significance of ALP elevation in advanced pancreatic cancer (APC) patients is not well evaluated. The aim of this study was to determine the significance of elevated serum ALP as a prognostic factor in patients with APC even without jaundice and liver metastasis. Methods: Serum ALP levels were measured in 393 patients with APC receiving gemcitabine monotherapy before treatment, and according to those levels, patients were subgrouped (ALP<upper normal limit (UNL), UNL-500 U/L, 501-700 U/L, 701-1000 U/L, 1000U/L < ALP). The clinical data of each group were analyzed to see characteristics of elevated ALP patients. The relationship between ALP level and survival, response were also examined. Results: The elevated ALP group included poor performance status (PS>1) patients (41.3%, p=0.001), and associated with low serum albumin (3.31±0.38, p<0.01). The elevated ALP group (median survival time (MST) 112 days) showed significantly worse prognosis and lower disease control rate compared to the normal ALP group (MST 217days) (p<0.001, p<0.001). Multivariate analysis revealed ALP (p<0.001), CRP (p<0.001), ascites (p<0.001), distant metastasis (p=0.003), white blood cell count (p=0.005), PS (p=0.020), AST (p=0.020), and ALT (p=0.020) were independent prognostic factors. Similar results were seen in liver metastasis free patients without jaundice. Conclusions: Elevated serum ALP level correlated with poor performance status and low serum albumin. ALP was also the independent prognostic factor in liver metastasis free APC patients without jaundice. No significant financial relationships to disclose.

Acute Lantana camara poisoning in a Boer goat kid : case report

Acute Lantana camara poisoning in a Boer goat kid is described. The animal was part of a flock of boer goats that was introduced from the Kalahari thornveld, where the plant does not occur, to an area where the plant grew abundantly. At necropsy, the animal was severely icteric, dehydrated and constipated, with hepatosis, distention of the gall-bladder and nephrosis, but no skin lesions. Histopathological findings of the liver confirmed moderate hepatosis with single-cell necrosis and bile stasis. The pathology is consistent with that described in acute Lantana poisoning in cattle, sheep and goats. The absence of photosensitisation may be attributed to relatively mild liver damage, or the rapid course of this toxicosis.

Long-Term Results of Hepatic Resection for Hepatolithiasis

Long-term results of hepatic resection for hepatolithiasis in 34 patients having intrahepatic biliary strictures were studied. The left lateral and the right posterior segmental ducts were commonly and often simultaneously involved. Fourteen patients had multiple segmental involvement. Hepatic resection included left sided resection (n=27), right sided resection (n=6), and repeated bilateral resection (n=1). Seven patients had biliary tumors: 3 cholangiocarcinomas, 2 gall bladder cancers, cystadenocarcinoma, and dysplasia of intrahepatic ducts. Nineteen patients received bilioenteric anastomosis. Retained stones and recurrent stones developed in 3 and 4 patients, respectively. Twenty-six patients had no remaining symptoms; 2 died of operative complication or cholangiocarcinoma; 6 presented symptoms caused by retained stones (n=2), recurrent stones (n=2), bile stasis (n=1), or neuralgia (n=1). In 4 of the 6 patients, unrelieved posterior duct strictures caused the symptoms. With a mean follow-up period of 4.5 years, 30 patients are symptoms free, and 27 are stone free. In patients with right lobar or bilobar type, intra- and extrahepatic type, and confluence strictures, bilioenteric anastomosis is required. Hepatic resection is a rational treatment for hepatolithiasis, however, meticulous management of biliary tract abnormalities, particularly the posterior duct stricture, is mandatory.

The Possible Role of Sphincteroplasty and Surgical Sphincterotomy in the Pathogenesis of Recurrent Common Duct Brown Stones

The hypothesis has been tested that postcholecystectomy common duct stones of the brown subtype are a consequence of three factors: bile infection, old age and previous sphincterotomy. It was found that: (i) 27 of 39 consecutive patients with recurrent common duct stones had brown stones. Nineteen of these 27 patients (70.3%) had previous sphincterotomy or sphincteroplasty: (ii) six of 15 patients with stone and bile analysis both at the time of cholecystectomy and at the second operation and who had sterile operative bile and non brown stones at the first operation, formed brown stones after T-tube drainage and after the onset of bile infection; (iii) patients with both intra and postoperative negative bile culture (n = 39 out of 137) had a lower mean age (50.5 years) and less frequently had a sphincterotomy than did individuals with a negative culture at operation, who subsequently had bile infection (n = 37; mean age 58.5 years; sphincterotomy in 88.8% of cases).In addition, in a follow up study of 105 patients with sphincterotomy and with sphincteroplasty (including ERCP or i.v. cholangiography in all cases), mean follow-up interval 6.1 years, 11.3 % of patients had brown recurrent common duct stones.It is suggested that, since brown recurrent common duct stones are secondary to bile stasis and infection and the duodenum is going to be colonized by bacteria with increasing age, sphincterotomy (and subsequent stricture), facilitating bile contamination and bacterial overgrowth, could be one of the major determinants of brown recurrent common duct stones (RCS) formation. In particular, more than 11% of the patients with a sphincterotomy are going to form in the future RCS of the brown subtype.