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Pathology of the Liver and Biliary Tract – 5 Diseases of the Biliary Tract
Shannon Martinson, April 2016 http://people.upei.ca/smartinson/
Normal anatomy & function
Hepatobiliary Injury and responses
Manifestations of hepatic failure
Developmental anomalies & Miscellaneous lesions
Circulatory disturbances
Metabolic & nutritional disturbances
Infectious diseases of the liver (hepatitis)
Toxin-induced liver diseases
Diseases of uncertain cause
Proliferative lesions of the liver
Diseases of the gall bladder
OUTLINE
Gallbladder
• stores, concentrates and releases bile
Hepatic bile ducts
• carry bile from different lobules of the liver
Common bile duct
• Carry bile to intestine
Cystic duct
Gall bladder
Bile duct Hepatic ducts
Konig-Liebich. Veterinary Anatomy of Domestic Mammals, 3rd ed., Schattauer
THE BILIARY TRACT – STRUCTURE AND FUNCTION
Secretion provides: 1. Bile acids for digestion of dietary fats 2. Excretory route for various metabolites and drugs 3. Buffers that neutralize acid pH from the stomach
Bile = Water, Cholesterol, Bile acids, Bilirubin, Inorganic ions
Biliary Tract , Sheep
• Stones = cholesterol, bile pigments, bile salts, calcium and proteinaceous matrix
• Supersaturation and precipitation of bile • Secondary to ascending bacterial
infections? • Not significant until obstruction occurs
THE BILIARY TRACT – DISEASES
Gallbladder Stones (Choleliths)
Cholelith, elephant
Gallbladder stone, pig
Gallbladder stone, pig
• Caused by cholangitis, parasites, fibrosis, gallstones
• Result: post hepatic icterus, hepatic atrophy and biliary fibrosis
THE BILIARY TRACT – DISEASES
Biliary Obstruction
Colelithiasis, cat Ascaris suum, pig
• Fasting / Anorexia*
• Secondary to biliary obstruction
• Lantana camara toxicosis
• Cholestasis, icterus and photosensitization
THE BILIARY TRACT – DISEASES
Gallbladder Distension
Gallbladder distension (left) and normal GB (right) sheep
Gallbladder distension, sheep, Lantana camara toxicosis
• Gallbladder dilation
• Accumulation of mucoid secretion
• Small breed dogs – Shelties, Cocker spaniels
• Cause?
• Decreased gall bladder motility
• Abnormal bile composition
• Bile stasis
• Cystic mucinous hyperplasia
• Sequelae
• Extrahepatic biliary obstruction
• Ischemic necrosis and rupture
THE BILIARY TRACT – DISEASES
Gallbladder Mucocele
• Usually traumatic in origin
• Steady leakage of bile into the peritoneal cavity
• Chemical peritonitis
• May be sterile or infected with enteric bacteria rapidly fatal
THE BILIARY TRACT – DISEASES
Rupture of the Biliary Tract / Gallbladder
Gallbladder infarction
Gallbladder rupture, bile peritonitis, cow
Causes • Right Heart Failure • Infectious canine hepatitis - dogs • Salmonella – cattle
THE BILIARY TRACT – DISEASES
Gallbladder Edema
Noah’s Arkive
Aflatoxicosis, pig
Salmonellosis, bovine
ICH, dog
• Intra-and extrahepatic bile ducts
• Extends to the parenchyma (cholangiohepatitis)
• Portal of entry for bacterial agents:
• Hematogenous
• Ascending from the intestine (obstruction and bile stasis)
• Two important entities in companion animals:
• Suppurative cholangiohepatitis
• Lymphocytic cholangitis (next slide)
THE BILIARY TRACT – DISEASES
Cholangitis Suppurative cholangiohepatitis
Duodenum
Suppurative cholangitis • Older cats > dogs • Ascending bacterial infection • Often associated with IBD or pancreatitis in cats
• Cats 4 years and under (Persian)
• Ascites, icterus, hypergammaglobulinemia
• Active stage:
• Lymphocytic inflammation in and around bile ducts → periportal parenchyma
• Chronic stage:
• ↓ of lymphocytes
• Bridging fibrosis
• Etiology:
• Immune-mediated disorder?
• No concurrent pancreatitis / enteritis
Pathologic Basis of Veterinary Disease(2006), 4th ed.
THE BILIARY TRACT – DISEASES
Lymphocytic Cholangitis – Feline progressive lymphocytic
cholangiohepatitis
Cholangitis Noah’s arkive
• Inflammation of gallbladder
• Acute or chronic
• Fibrinous cholecystitis
• Salmonellosis in cattle*
• Hemorrhagic cholecystitis
• Salmonellosis in cattle*
• Arsenic toxicosis
THE BILIARY TRACT – DISEASES
Cholecystitis
Pathologic Basis of Veterinary Disease(2006), 4th ed.
Salmonellosis, fibrinous cholecystitis, calf
• Cystic proliferation of the mucus-producing glands of the gallbladder and bile ducts
• Old dogs and sheep
• Often associated with GB mucocele*
http://w3.vet.cornell.edu/nst/nst.asp
THE BILIARY TRACT – DISEASES
Cystic Mucinous Hyperplasia
Pathologic Basis of Veterinary Disease, 5th ed.
Gallbladder Neoplasia
• Very rare in animals
• Adenomas (cattle)
• Carcinoma
THE BILIARY TRACT – DISEASES
Gallbladder adenoma, boa constrictor
Gallbladder carcinoma with hepatic invasion, dog
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