Resident in Small Animal Internal Medicine Tufts University Grafton, Massachusetts, United States
Abstract:
Background: Gallbladder mucoceles (GBM) are a common biliary disease in dogs. Medical management can be marred by acute decompensation necessitating a high mortality cholecystectomy. A noninvasive biomarker of GBM progression to predict the need for elective cholecystectomy could decrease morbidity/mortality. Hypothesis/
Objective: Acute decompensation in dogs with GBM is associated with a pro-inflammatory and pro-coagulant state. Animals: Prospectively enrolled 20 clinically asymptomatic dogs with GBM managed medically and 18 symptomatic dogs needing cholecystectomy at an academic hospital.
Methods: Inclusion criteria included ultrasonographic diagnosis of GBM, and a biochemical panel within 24 hours. Exclusion criteria included medications that affect coagulation or inflammation, Greyhounds, and concurrent inflammatory conditions. Blood was obtained for CBC, c-reactive protein (CRP), fibrinogen, D-dimers, and thromboelastography (TEG). Groups were compared with Fishers Exact test, with P< 0.05 considered significant
Results: Surgically and medically managed dogs were similar in age, weight and sex distribution. Surgically managed dogs were statistically more likely to have increased CRP (17/18, 94%), neutrophil counts (10/18, 55%) and fibrinogen (9/18, 50%) than medically managed dogs 0/20 (0%), 0/20 (0%) and 4/20 (20%), respectively. Similar proportions of medically (16/20, 80%) and surgically (17/18, 94%) managed dogs had high TEG G values, although statistically more surgically (9/19, 50%) than medically (3/20, 30%) managed dogs had increases in D-dimers. Conclusions/Clinical importance: These results suggest that longitudinal studies of increases in serum CRP, fibrinogen and neutrophil counts should be done to determine if they might be early biomarkers of progressive disease in dogs with GBM warranting consideration of an elective cholecystectomy.
