So, there we were, on vacation in the Magic Kingdom, when we get the fateful call that one of our dogs is sick. It seems like we lived this nightmare last year, and we were just about in the same place in the park. However, Tink, an eleven-year-old, female spayed English Jack Russell Terrier, had elevated liver enzymes when I checked her last month. I was thinking about evaluating her further with ultrasound when we got home from the trip. Tink was staying at VSNT with her roommates, Patch and Sarge. Patch is another EJRT and Sarge is a Boxer. Anyway, the first clue there was a problem was when Tink vomited, then refused to eat breakfast the next day. I know none of you know Tink, but let me assure you, she never misses breakfast, lunch or dinner, and really lives to try to find other food, or trick the other dogs out of their food! So, lab work was run, and Tink’s liver enzymes had gone up dramatically in just a few short weeks since her teeth were cleaned. The way the enzymes were looking, it was most consistent with biliary tract disease. Ultrasound of her abdomen indicated the gall bladder had a lot of material present that was much denser than it should have been, and the gall bladder was too big for a dog that was not eating. She was painful in the abdomen, and slightly dehydrated.
She was treated with fluids, antibiotics, anti-nausea medications, and some pain medication, which helped. The next morning, she felt better, but her liver enzymes were higher, as was the bilirubin. This made it necessary to go in surgically, where we found her gall bladder was full of very thick, solid material that would not exit the bile duct. She had to have her gall bladder removed (a cholecystectomy).
We do not know for certain what causes gall bladder disease in dogs. JRT are not an especially common breed to develop this problem, but miniature Schnauzers and Yorkshire Terriers seem to be more common in our practice. Tink has had an elevated cholesterol for some time, and it is difficult to keep her weight down. This seems to be common in the history as well. The only treatment to eliminate the condition is to remove the gall bladder. We usually take a biopsy of the liver also, and perform bacterial cultures of the liver and the gall bladder material. These tests help us determine if an underlying disease might be present that we need to address. In most cases, the liver enzymes are elevated secondarily to the diseased gall bladder.
Since we do not know what causes the disorder, I recommend quarterly monitoring of the liver with lab work to make sure we do not need to intervene with medication. We often use urosodiol, a tertiary bile acid, as it makes the bile a little thinner, less toxic, and more water soluble. Almost all of our patients do very well after having their gall bladder removed.