Gall Bladder problems in dogs


Gallbladder, liver and Chronic lung problems

Question: Hi, Dr. Richards,

Our issue has to do with our 6yr old unneutered male standard dachshund, Bart. We decided it was time to neuter him (March 1999) and since he was older our doctor wanted to do a full workup prior to any surgery. He noticed a slight abnormality on the ECG. We were recommended to a cardiologist and he was diagnosed with chronic bronchitis and the right side of his heart was enlarged due to this. He was treated with Baytrill and all signs of the bronchitis seemed to go away. At this time, we also did blood work and his ALT was 100. We decided to wait about 6 months and try to neuter again. In November 1999, his ALT rose to 370. Our doctor felt it was early signs of liver disease. He put Bart on Vitamin e (200IU) and Lipo-Form. We waited 2 months and retested his enzymes. His ALT was slightly lower but not by much. All of his other liver enzymes were normal.

Our vet sent us to a internist . She requested bile acid testing and the results showed pre and post were 16 and 47. She wanted to check both his liver and heart since conditions in either area may show the elevated test results. She also felt a biopsy may be in order.

So late last week we saw both doctors. The cardiologist concluded that Bart will most likely suffer from chronic lung problems maybe due to the altitude. His heart has enlarged a bit more and he wants to ultrasound him again in 6 months. Cardiac issues may end up being a secondary cause based on the lung issue. He did not prescribe anything yet but some future options may be bronchial dialators or possibly a tracheal wash. He did not feel that anything going on in his area was causing the elevated liver enyzmes and bile acids.

We next saw the internist who performed an ultrasound. She felt that his liver looked normal. However, his gallbladder did not appear black but was gray and she felt it may be due to a sludge that animals can get similar to stones in people. She said that this could cause his elevated ALT and bile acids. So she felt a bit relieved and did not think a biopsy is appropriate at this time. She did prescribe actigall for 6 weeks at which time she wants to retest his bile acids. Our normal doctor seemed a bit more conservative and still felt it could be early stages of liver disease. No one has prescribed a change in his diet. The internist wanted to keep all factors the same and see the effects of the actigall.

Based on your experience, can you voice any opinions or guidance? Can gallbladder issues be separate from liver issues? Is Western medicine the best approach or are there things in the hoistic arena that can be beneficial to look into?

I have read many of your other letters and I value your opinions and guidance. We want to make sure we are going down the right path for Bart.

Thank you in advance.


Answer: Beth-

If the gallbladder is not functioning properly it will almost always cause problems with the liver. Usually, if sludging of bile in the bile ducts or gallbladder occurs then there is a rise in the alkaline phophatase level and there is usually a rise in the ALT as well. It would be a little unusual to have a rise in ALT without a rise in alkaline phosphatase, if there is bile duct or gall bladder involvement. I am not sure from your note whether the alkaline phosphatase levels are elevated, but if they aren't you might want to ask the specialist what impact that has on her thoughts about the possibility of gall bladder involvement. She may have experience with cases in which there were rises in ALT independently of alkaline phosphatase with gall bladder involvement or it is possible that there was a rise in alkaline phosphatase, as well, and it just didn't get reported.

Actigall (Rx) is the most commonly recommended medication for liver disease in which poor flow of bile may be involved.

Milk thistle is the most commonly recommended alternative medication for these conditions. I haven't seen a dosage that was related to any sort of study of dosing requirements but the most common recommendations are to use the adult human dose for large dogs and about 1/3 of the dose for small dogs.

Rises in ALT do indicate that liver cells have been damaged. When the levels continue to stay elevated it is an indication of ongoing damage. But the bile acid response testing is a much better indicator of liver function and it looks pretty good. So I would tend to be conservative and wait and see what happens at this point, in most cases. I wouldn't be in a big hurry to change diets, either. We have seen a lot of patients get moderate rises in the ALT (I think of anything less than about 450 as being a moderate rise) and have just waited to see what happens. Many of them get better on their own.

It really does sound to me like you are getting pretty good advice from the specialists. Your vet might be right that there is an ongoing liver problem, but it probably won't cause a problem to wait and see. Just keep the follow-up appointments and adjust to the situation as it becomes more clear. If you see any changes that worry you, get in contact with your usual vet. He won't mind rechecking the blood tests to see if there have been changes, I'm sure.

Hope this helps.

Mike Richards, DVM 2/16/2000

Gall Bladder infections, e-coli and cushing's

Q: Dear Dr. Richards: We've iwaited out the month for further tests on Duffy for possible Cushing's disease. Today our vet did another ACTH test and also a gall bladder scan which suggested the presence of e-coli in the system. He told us that he called the Univ. of Michigan vet school and spoke with one of the 4 professors he knows and trusts. ( Incidentally, our vet has been licensed since 1966 so we're hoping he's up on all the latest!) The prof. suggested the scan. More crit. level urine tests will be done now and then hopefully the profs. will decide if Duffy has Cushings Disease or e-coli in his system. At this point in time we're totally befuddled as to how a 10 year old Westie could pick up e-coli in the gall bladder. Any thoughts on your part Dr.Richards would be greatly appreciated.

Rgds and tks. N and K

A: K and N

It is not unusual for gall bladder infections to be from E. coli. This is a normal inhabitant of the digestive tract, as well as sometimes being a pathogen (disease causing organism). Since the gall bladder connects to the digestive tract through the bile ducts, there is a direct path for infection. I think the reason there aren't more infections is that the small intestine is relatively bacteria free, compared to the large intestine. In addition, some gall bladder infections probably occur due to the spread of bacteria through the blood stream. In this case, the bacteria find a quiet place to reside and be safe from the immune system and the gall bladder is the place. This is probably rare but also probably accounts for some gall bladder infections.

This may not be an "either/or" situation -- it is possible that Duffy has both the E.coli infection and Cushing's disease.

In the case of a dog with Cushing's disease there is often a depression in the immune system's function, leading to infections. Sometimes finding infections in areas in which they would not normally be common is a sign of Cushing's disease.

I hope that you are able to sort through these problems with your vet's help and get Duffy back on track.

Mike Richards, DVM 9/14/99


Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...