Canine Cushing’s; Cholecystectomy; Gallbladder mucocoele; Hypothyroidism; Survival; Biomarkers; Bilirubin; Adrenocortical Hyperfunction/veterinary; Animals; Bilirubin/blood; Dog Diseases/diagnosis; Dog Diseases/mortality; Dog Diseases/surgery; Dogs; Gallbladder Diseases/diagnosis; Gallbladder Diseases/mortality; Gallbladder Diseases/surgery; Gallbladder Diseases/veterinary; Genetic Predisposition to Disease; Hyperbilirubinemia/veterinary; Hyperlipidemias/veterinary; Mucocele/diagnosis; Mucocele/mortality; Mucocele/surgery; Mucocele/veterinary; Retrospective Studies; Treatment Outcome; Adrenocortical Hyperfunction; Dog Diseases; Gallbladder Diseases; Hyperbilirubinemia; Hyperlipidemias; Mucocele; Animal Science and Zoology; Veterinary (all); General Veterinary
Abstract :
[en] Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14-8.23; P<0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19-3.77; P=0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08-3.47; P=0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10-5.50; P=0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30-0.72; P=0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01-1.04; P<0.001) and age (OR, 1.17; 95% CI, 1.08-1.26; P<0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54-0.69) and a specificity of 0.63 (95% CI, 0.59-0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.
Disciplines :
Veterinary medicine & animal health
Author, co-author :
Jaffey, J A ; Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, 900 East Campus Drive, Columbia, MO, 65211, USA. Electronic address: jjaffe@midwestern.edu
Pavlick, M; Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA, 01536, USA
Webster, C R; Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA, 01536, USA
Moore, G E; Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA
McDaniel, K A; Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, 900 East Campus Drive, Columbia, MO, 65211, USA
Blois, S L; Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
Brand, E M; Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
Reich, C F; Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
Motschenbacher, L; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, C-325, St Paul, MN, USA
Hostnik, E T; Department of Veterinary Clinical Sciences, Veterinary Medical Center, Ohio State University, 601 Vernon L Tharp Street Columbus, OH, 43210, USA
Su, D; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996, USA
Lidbury, J A ; Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843, USA
Raab, O; Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
Carr, S V; Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 215 Duck Pond Drive, Blacksburg, VA, 24061, USA
Mabry, K E; Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 215 Duck Pond Drive, Blacksburg, VA, 24061, USA
Fox-Alvarez, W; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608, USA
Townsend, S; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608, USA
Palermo, S; Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
Nakazono, Y; Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
Ohno, K; Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
VanEerde, E; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50010, USA
Fieten, H; Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
Hulsman, A H; Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
Cooley-Lock, K; Department of Clinical Sciences, College of Veterinary Medicine, P.O. Box 6100, Mississippi State University, Mississippi State, MS, 39762-6100, USA
Dunning, M; School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, United Kingdom
Kisielewicz, C; School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, United Kingdom
Zoia, A ; San Marco Veterinary Clinic, via Sorio 114c, 35141, Padua, Italy
Caldin, M; San Marco Veterinary Clinic, via Sorio 114c, 35141, Padua, Italy
Conti-Patara, A; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, 99164, USA
Ross, L; Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, 36849, USA
Mansfield, C; Faculty of Veterinary Science, The University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
Lynn, O; Faculty of Veterinary Science, The University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
Claus, M A; Comparative Health Research Group, College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
Watson, P J; Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
Swallow, A; Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
Yool, D A; Division of Veterinary Clinical Sciences, Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, EH25 9RG, United Kingdom
Gommeren, Kris ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Médecine vétérinaire comparée
Knops, M; Department of Clinical Sciences, Small Animal Medicine, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
Ceplecha, V; Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Palackeho 1/3, 612 42, Brno, Czech Republic
de Rooster, H; Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
Lobetti, R; Bryanston Veterinary Hospital, P.O. Box 67092, Bryanston, South Africa
Dossin, O ; Department of Small Animal Clinical Sciences, ENVT and IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
Jolivet, F; Department of Small Animal Clinical Sciences, ENVT and IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
Papazoglou, L G; Department of Clinical Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Pappalardo, M C F; Vet Support, Small Animal Intensive Care Medicine, Sao Paulo, 04082-002, Brazil
Manczur, F; Department and Clinic of Internal Medicine, University of Veterinary Medicine, H-1400, P.O. Box 2, Hungary
Dudás-Györki, Z; Department and Clinic of Internal Medicine, University of Veterinary Medicine, H-1400, P.O. Box 2, Hungary
O'Neill, E J; Department of Veterinary Clinical Studies, School of Veterinary Medicine, University of Dublin, Belfield, Dublin 4, Ireland
Martinez, C; Department of Veterinary Clinical Studies, School of Veterinary Medicine, University of Dublin, Belfield, Dublin 4, Ireland
Gal, A ; School of Veterinary Science, Massey University, Palmerston North, 4410, New Zealand
Owen, R L; School of Veterinary Science, Massey University, Palmerston North, 4410, New Zealand
Gunn, E; University of Glasgow Small Animal Hospital, Bearsden Road, Glasgow, G61 1QH, United Kingdom
Brown, K; University of Glasgow Small Animal Hospital, Bearsden Road, Glasgow, G61 1QH, United Kingdom
Harder, L K; Small Animal Hospital, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, D-30559, Hannover, Germany
Griebsch, C; University Veterinary Teaching Hospital Sydney, The University of Sydney, 65 Parramatta Road, 2050, Camperdown, New South Wales, Australia
Anfinsen, K P; Department of Companion Animal Clinical Sciences, NMBU School of Veterinary Science, N-0033, Oslo, Norway
Gron, T K; Department of Companion Animal Clinical Sciences, NMBU School of Veterinary Science, N-0033, Oslo, Norway
Marchetti, V; Department of Veterinary Science, University of Pisa, Via Livornese lato monte, 56122, San Piero a Grado, Pisa, Italy
Heilmann, R M; Small Animal Clinic, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, An den Tierkliniken 23, DE-04103, Leipzig, Saxony, Germany
Pazzi, P; Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Old Soutpan Road, Onderstepoort, 0110, South Africa
DeClue, A E; Pride Veterinary Centre, Riverside Road, Pride Park, Derby, UK
Aguirre, A.L., Center, S.A., Randolph, J.F., Yeager, A.E., Keegan, A.M., Harvey, H.J., Erb, H.N., Gallbladder disease in Shetland Sheepdogs: 38 cases (1995–2005). Journal of the American Veterinary Medical Association 231 (2007), 79–88.
Allerton, F., Swinbourne, F., Barker, L., Black, V., Kathrani, A., Tivers, M., Henriques, T., Kisielewicz, C., Dunning, M., Kent, A., Gallbladder mucoceles in Border terriers. Journal of Veterinary Internal Medicine 32 (2018), 1618–1628.
Amsellem, P.M., Seim, H.B. 3rd, MacPhail, C.M., Bright, R.M., Twedt, D.C., Wrigley, R.H., Monnet, E., Long-term survival and risk factors associated with biliary surgery in dogs: 34 cases (1994–2004). Journal of the American Veterinary Medical Association 229 (2006), 1451–1457.
Buback, J.L., Boothe, H.W., Hobson, H.P., Surgical treatment of tracheal collapse in dogs: 90 cases (1983–1993). Journal of the American Veterinary Medical Association 208 (1996), 380–384.
Buote, N.J., Mitchell, S.L., Penninck, D., Freeman, L.M., Webster, C.R., Cholecystoenterostomy for treatment of extrahepatic biliary tract obstruction in cats: 22 cases (1994–2003). Journal of the American Veterinary Medical Association 228 (2006), 1376–1382.
Burkitt, J.M., Haskins, S.C., Nelson, R.W., Kass, P.H., Relative adrenal insufficiency in dogs with sepsis. Journal of Veterinary Internal Medicine 21 (2007), 226–231.
Cao, A.M., Eslick, G.D., Cox, M.R., Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surgical Endoscopy 30 (2016), 1172–1182.
Clemente, G., Fico, V., De Sio, D., De Rose, A.M., The mucocele of the gallbladder. Journal of Gastrointestinal Surgery 21 (2017), 1366–1367.
Crews, L.J., Feeney, D.A., Jessen, C.R., Rose, N.D., Matise, I., Clinical, ultrasonographic, and laboratory findings associated with gallbladder disease and rupture in dogs: 45 cases (1997–2007). Journal of the American Veterinary Medicine Association 234 (2009), 359–366.
De Marco, V., Noronha, K.S.M., Casado, T.C., Nakandakare, E.R., Florio, J.C., Santos, E.Z., Gilor, C., Therapy of canine hyperlipidemia with bezafibrate. Journal of Veterinary Internal Medicine 31 (2017), 717–722.
Dereszynski, D.M., Center, S.A., Randolph, J.F., Brooks, M.B., Hadden, A.G., Palyada, K.S., McDonough, S.P., Messick, J., Stokol, T., Bischoff, K.L., et al. Clinical and clinicopathologic features of dogs that consumed foodborne hepatotoxic aflatoxins: 72 cases (2005–2006). Journal of the American Veterinary Medicine Association 232 (2008), 1329–1337.
Ekmektzoglou, K.A., Zografos, G.C., A concomitant review of the effects of diabetes mellitus and hypothyroidism in wound healing. World Journal of Gastroenterology 12 (2006), 2721–2729.
Ferguson, D., Crowe, M., McLaughlin, L., Gaschen, F., Survival and prognostic indicators for cycad intoxication in dogs. Journal of Veterinary Internal Medicine 25 (2011), 831–837.
Gomez Selgas, A., Bexfield, N., Scase, T.J., Holmes, M.A., Watson, P., Total serum bilirubin as a negative prognostic factor in idiopathic canine chronic hepatitis. Journal of Veterinary Diagnostic Investigation 26 (2014), 246–251.
Gonzalez-Rodriguez, F.J., Paredes-Cotore, J.P., Ponton, C., Rojo, Y., Flores, E., Luis-Calo, E.S., Barreiro-Morandeira, F., Punal, J.A., Fernandez, A., Paulos, A., et al. Early or delayed laparoscopic cholecystectomy in acute cholecystitis? Conclusions of a controlled trial. Hepatogastroenterology 56 (2009), 11–16.
Gookin, J.L., Correa, M.T., Peters, A., Malueg, A., Mathews, K.G., Cullen, J., Seiler, G., Association of gallbladder mucocele histologic diagnosis with selected drug use in dogs: a matched case-control study. Journal of Veterinary Internal Medicine 29 (2015), 1464–1472.
Gutt, C.N., Encke, J., Koninger, J., Harnoss, J.C., Weigand, K., Kipfmuller, K., Schunter, O., Gotze, T., Golling, M.T., Menges, M., et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Annals of Surgery 258 (2013), 385–393.
Hanson, J.M., Teske, E., Voorhout, G., Galac, S., Kooistra, H.S., Meij, B.P., Prognostic factors for outcome after transsphenoidal hypophysectomy in dogs with pituitary-dependent hyperadrenocorticism. Journal of Neurosurgery 104 (2007), 830–840.
Hickman, M.S., Schwesinger, W.H., Page, C.P., Acute cholecystitis in the diabetic. A case-control study of outcome. Archives of Surgery 123 (1988), 409–411.
Jaffey, J.A., Graham, A., VanEerde, E., Hostnik, E., Alvarez, W., Arango, J., Jacobs, C., DeClue, A.E., Gallbladder mucocele: variables associated with outcome and the utility of ultrasonography to identify gallbladder rupture in 219 dogs (2007–2016). Journal of Veterinary Internal Medicine 32 (2018), 195–200.
Johansson, M., Thune, A., Blomqvist, A., Nelvin, L., Lundell, L., Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. Journal of Gastrointestinal Surgery 7 (2003), 642–645.
Johansson, M., Thune, A., Nelvin, L., Stiernstam, M., Westman, B., Lundell, L., Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. British Journal of Surgery 92 (2005), 44–49.
Kesimer, M., Cullen, J., Cao, R., Radicioni, G., Mathews, K.G., Seiler, G., Gookin, J.L., Excess secretion of gel-forming mucins and associated innate defense proteins with defective mucin un-packaging underpin gallbladder mucocele formation in dogs. PLoS One, 10, 2015, e0138988.
Kilpatrick, S., Dreistadt, M., Frowde, P., Powell, R., Milne, E., Smith, S., Morrison, L., Gow, A.G., Handel, I., Mellanby, R.J., Presence of systemic inflammatory response syndrome predicts a poor clinical outcome in dogs with a primary hepatitis. PLoS One, 11, 2016, e0146560.
Kim, K.H., Han, S.M., Jeon, K.O., Kim, H.T., Li, Q., Ryu, M.O., Song, W.J., Park, S.C., Youn, H.Y., Clinical relationship between cholestatic disease and pituitary-dependent hyperadrenocorticism in dogs: a retrospective case series. Journal of Veterinary Internal Medicine 31 (2017), 335–342.
Kimura, Y., Takada, T., Kawarada, Y., Nimura, Y., Hirata, K., Sekimoto, M., Yoshida, M., Mayumi, T., Wada, K., Miura, F., et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. Journal of Hepato-Biliary-Pancreatic Surgery 14 (2007), 15–26.
Kolla, S.B., Aggarwal, S., Kumar, A., Kumar, R., Chumber, S., Parshad, R., Seenu, V., Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surgical Endoscopy 18 (2004), 1323–1327.
Kutsunai, M., Kanemoto, H., Fukushima, K., Fujino, Y., Ohno, K., Tsujimoto, H., The association between gall bladder mucoceles and hyperlipidaemia in dogs: a retrospective case control study. The Veterinary Journal 199 (2014), 76–79.
Ladenson, P.W., Levin, A.A., Ridgway, E.C., Daniels, G.H., Complications of surgery in hypothyroid patients. The American Journal of Medicine 77 (1984), 261–266.
Lai, P.B., Kwong, K.H., Leung, K.L., Kwok, S.P., Chan, A.C., Chung, S.C., Lau, W.Y., Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. British Journal of Surgery 85 (1998), 764–767.
Lau, H., Lo, C.Y., Patil, N.G., Yuen, W.K., Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surgical Endoscopy 20 (2006), 82–87.
Lee, S., Kweon, O.K., Kim, W.H., Increased leptin and leptin receptor expression in dogs with gallbladder mucocele. Journal of Veterinary Internal Medicine 31 (2017), 36–42.
Lester, C., Cooper, J., Peters, R.M., Webster, C.R., Retrospective evaluation of acute liver failure in dogs (1995–2012): 49 cases. Journal of Veterinary Emergency and Critical Care (San Antonio) 26 (2016), 559–567.
Lo, C.M., Liu, C.L., Fan, S.T., Lai, E.C., Wong, J., Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Annals of Surgery 227 (1998), 461–467.
Macready, D.M., Johnson, L.R., Pollard, R.E., Fluoroscopic and radiographic evaluation of tracheal collapse in dogs: 62 cases (2001–2006). Journal of the American Veterinary Medical Association 230 (2007), 1870–1876.
Malek, S., Sinclair, E., Hosgood, G., Moens, N.M., Baily, T., Boston, S.E., Clinical findings and prognostic factors for dogs undergoing cholecystectomy for gall bladder mucocele. Veterinary Surgery 42 (2013), 418–426.
Mattin, M.J., Boswood, A., Church, D.B., Brodbelt, D.C., Prognostic factors in dogs with presumed degenerative mitral valve disease attending primary-care veterinary practices in the United Kingtom. Journal of Veterinary Internal Medicine 33 (2018), 432–444.
Mayhew, P.D., Holt, D.E., McLear, R.C., Washabau, R.J., Pathogenesis and outcome of extrahepatic biliary obstruction in cats. Journal of Small Animal Practice 43 (2002), 247–253.
Mesich, M.L., Mayhew, P.D., Paek, M., Holt, D.E., Brown, D.C., Gall bladder mucoceles and their association with endocrinopathies in dogs: a retrospective case-control study. Journal of Small Animal Practice 50 (2009), 630–635.
Mori, A., Lee, P., Izawa, T., Oda, H., Mizutani, H., Koyama, H., Arai, T., Sako, T., Assessing the immune state of dogs suffering from pituitary gland dependent hyperadrenocorticism by determining changes in peripheral lymphocyte subsets. Veterinary Research Communications 33 (2009), 757–769.
Park, F.M., Blois, S.L., Abrams-Ogg, A.C., Wood, R.D., Allen, D.G., Nykamp, S.G., Downie, A., Hypercoagulability and ACTH-dependent hyperadrenocorticism in dogs. Journal of Veterinary Internal Medicine 27 (2013), 1136–1142.
Pike, F.S., Berg, J., King, N.W., Penninck, D.G., Webster, C.R., Gallbladder mucocele in dogs: 30 cases (2000–2002). Journal of the American Veterinary Medical Association 224 (2004), 1615–1622.
Poldervaart, J.H., Favier, R.P., Penning, L.C., van den Ingh, T.S., Rothuizen, J., Primary hepatitis in dogs: a retrospective review (2002–2006). Journal of Veterinary Internal Medicine 23 (2009), 72–80.
Rogers, E., Jaffey, J.A., Graham, A., Hostnik, E.T., Jacobs, C., Fox-Alvarex, W., Van Eerde, E., Arango, J., Williams, F. III, DeClue, A.E., Cholecystitis in dogs with gallbladder mucocele. Journal of Veterinary Emergency and Critical Care, 2019 in press.
Rose, L., Dunn, M.E., Bedard, C., Effect of canine hyperadrenocorticism on coagulation parameters. Journal of Veterinary Internal Medicine 27 (2013), 207–211.
Saber, A., Hokkam, E.N., Operative outcome and patient satisfaction in early and delayed laparoscopic cholecystectomy for acute cholecystitis. Minimally Invasive Surgery, 2014, 2014, 162643.
Safer, J.D., Thyroid hormone and wound healing. Journal of Thyroid Research, 2013, 2013, 124538.
Safer, J.D., Crawford, T.M., Holick, M.F., A role for thyroid hormone in wound healing through keratin gene expression. Endocrinology 145 (2004), 2357–2361.
Tamborini, A., Jahns, H., McAllister, H., Kent, A., Harris, B., Procoli, F., Allenspach, K., Hall, E.J., Day, M.J., Watson, P.J., et al. Bacterial cholangitis, cholecystitis, or both in dogs. Journal of Veterinary Internal Medicine 30 (2016), 1046–1055.
Walter, R., Dunn, M.E., d'Anjou, M.A., Lecuyer, M., Nonsurgical resolution of gallbladder mucocele in two dogs. Journal of the American Veterinary Medical Association 232 (2008), 1688–1693.
Wang, A.S., Armstrong, E.J., Armstrong, A.W., Corticosteroids and wound healing: clinical considerations in the perioperative period. The American Journal of Surgery 206 (2013), 410–417.
Wennogle, S.A., Randall, E.K., Priestnall, S.L., Twedt, D.C., Simpson, K.W., Eubacterial fluorescence in situ hybridisation and histologic features in 25 dogs with gallbladder mucocele. Journal of Small Animal Practice 60 (2019), 291–297.
Willard, M.D., Twedt, D.C., Gastrointestinal, pancreatic, and hepatic disorders. Willard, M.D., Tvedten, H., (eds.) Small Animal Clinical Diagnosis by Laboratory Methods, fifth edn., 2012, Elsevier/Saunders, St. Louis, 191–225.
Worley, D.R., Hottinger, H.A., Lawrence, H.J., Surgical management of gallbladder mucoceles in dogs: 22 cases (1999–2003). Journal of the American Veterinary Medical Association 225 (2004), 1418–1422.
Youn, G., Waschak, M.J., Kunkel, K.A.R., Gerard, P.D., Outcome of elective cholecystectomy for the treatment of gallbladder disease in dogs. Journal of the American Veterinary Medicine Association 252 (2018), 970–975.
