Surgical removal of the gallbladder is called cholecystectomy. Most of us have heard of gallbladder surgery in people. It is not as common a surgery in animals.




This page has pictures of a surgery to remove the gall bladder in a 10 year old female spayed Sheltie. At the end of this page you can see what gall stones look like.

It might help to read our Liver Page before going any further on this page.

The blood panel on this dog has very high liver values, so this pet was probably ill before the owners noticed any symptoms. This is common, because pets are stoic and they hide symptoms from owners. This is why we recommend a yearly Wellness Exam. If one had been done on this dog, the blood panel might have caught an elevation in the liver tests before they became so elevated, and we could have made a diagnosis and instituted treatment much earlier, and before it become seriously ill.

Graphic surgical pictures on this page.

History

Our patient was presented to Dr. P for an exam regarding some significant symptoms. They included anorexia (poor appetite) for several days, weight loss, and lethargy.

Physical Exam

It was obvious during the exam that she was underweight. Everything else checked out OK except the white’s of her eyes (called the sclera) and her gums (mucous membranes). They were yellow tinged.

This is commonly called jaundice, the correct medical term is icterus. Icterus usually indicates a severe anemia or liver or gallbladder disease.

Jaundiced gums

This is an example of severely jaundiced gums in a dog with a liver problem. Our Sheltie’s gums were nowhere near this yellow.

Diagnostic Tests

Blood Panel

Her initial blood panel showed high elevations in the liver enzymes of Alk Phos., AST, GGT, and bilirubin.

Elevated alk phos on the blood panel

This blood panel is typical of a dog with a liver problem. You can see the significant elevations in the liver enzymes

Urinalysis with bilirubin

A urinalysis on this same dog showed significant amounts of bilirubin, another indication of a liver problem. This is called bilirubinuria. 

Radiographs

A radiograph was taken of her abdomen to look for any problems We could see hepatomegaly (enlarged liver) on her radiograph. We have a great page on Learning How to Read a Radiograph for more information.

X-Ray showing enlarged liver

This is what an enlarged liver looks like on an abdominal radiograph. It extends beyond the cartilage of the last rib, an indication it is enlarged

Initial treatment consisted of fluids, antibiotics, Actigall, Denamarin,, vitamin supplements, and I/D food. Our Sheltie friend rapidly got better on the treatment. Shed returned three weeks later when the symptoms recurred.

We needed to determine if there was inflammation, infection, or even cancer of the liver? The elevated bilirubin can also occur with a gallbladder problem.  It was time for an abdominal ultrasound by Dr. Ann Reed, our visiting radiologist.

Ultrasound

The ultrasound determined that she had a  problem with her gallbladder. The gallbladder stores bile that is produced by the liver. When you eat the gallbladder secretes some bile into the small intestines, through the common bile duct, to help digest fat.

Before we show the ultrasound we will do a review of liver and gallbladder anatomy. It is from a cat that died from hepatic lipidosis.  The yellow and mottled appearance of the liver is fatty infiltration of the hepatocytes (liver cells). The whole liver should be that reddish color you see in the top left liver lobe.

Hepatic lipidosis liver

The gallbladder is in between some liver lobes. This picture will help visualize the ultrasound below. 

Ultrasound of gallbladder

The gallbladder is circled. Everything below and to the right of the circle is the liver

Ultrasound of large bile duct

The two + marks are delineating the enlarged common bile duct when looked at the liver from a different angle. You will get to meet this organ in person later in this page.

Ultrasound of thickened gallbladder

The gallbladder is distended and thickened

Gallbladder ultrasound report

The problem is a gallbladder mucocele. The full report is below.

Liver ultrasound report

This is her full ultrasound report on all of her abdominal organs. It is time to remove her gallbladder.

In some patients the ultrasound of the liver reveals a rupturing gallbladder. In these patients we need to get right into surgery.

Ultrasound of rupturing gallbladder

This is a report from a different patient that needs immediate surgery, unlike our Sheltie

This is an example of how ultrasound has revolutionized our diagnostic capability. Our patients don’t talk to us, and prior to ultrasound, it would have been difficult to know the gallbladder is rupturing and immediate surgery is needed.

Blood Clotting Panel

Before we do any surgery involving the liver we make sure the blood clotting system of the body is working well. The liver is intimately involved with the internal blood clotting mechanism, and we need to make sure we are not going to encounter a severe bleeding problem during and after surgery.

We do this with a clotting blood panel. This test makes sure her red blood cells are adequate (no anemia is present), and also checks her clotting time

Clotting panel report

Her clotting panel was normal. APTT stands for Activated Partial Thromboplastin Time. 

Pre-anesthetic EKG

Since this is an elderly patient we perform an EKG (electrocardiogram) just prior to surgery to make sure the are no contraindications to anesthesia based on an arrhythmia. Our heart page has lots of good info on EKG’s and other cardiac tests.

EKG Report From Cardiologist

This is how we get the report

Our patient is now ready for gall bladder removal This is a specialized surgery that is tedious and requires an experienced surgeon. In this case we called in Dr. Linda Larsen, a board certified veterinary surgeon. She has done many of these surgeries over the decades working with us.

Surgical instruments

Gallbladder removal also requires a lot of special surgical equipment in addition to an experienced surgeon

Surgery

Pre-surgical Preparation

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine, because surgery is not an area to cut corners. This preparation starts before the day of surgery.

Our patient was brought into our hospital the night before surgery to start her IV fluids and put on her Fentanyl (Duragesic) pain patch. The fluids support her liver and kidneys for her upcoming surgery. The pain patch takes 12 hours to achieve therapeutic levels, and lasts 72 hours.

Doing both of these things the night before surgery yields a calm patient ready for surgery the next day, making anesthesia smoother and less risky on an older dog.

On the day of surgery all of our surgery patients receive a physical exam just prior to surgery. This lets us catch any last minute problems that might have cropped up since her initial physical exam and diagnostic tests. This is when we do the pre-anesthetic EKG also. We want this diagnostic data to be as current as possible.

Doctor examining a dog prior to anesthesia

Our gallbladder surgery patient getting her pre-anesthetic exam just prior to surgery

 When everything is to our satisfaction we will administer a sedative. This will calm her down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Many pets with Fentanyl patches do not need any additional sedative.

Surgeon scrubbing hands before gloving

Once our surgeon has reviewed all lab data, and has performed the pre-anesthetic physical exam, she starts her aseptic scub while our patient is being anesthetized

Surgeon organizing sterile instruments

After scrubbing and gowning our surgeon opens the sterile instrument pack to make sure everything is in order and all instruments are sterile.

While all of this is transpiring with our surgeon our patient is brought into the surgery suite and a final prep is performed.  We want our surgeon waiting for her patient, not the other way around.  All of this is to minimize anesthetic time.

Anesthesia

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem. This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Screen of anesthetic monitor

This is the screen we constantly monitor during surgery

The background noise you here in this video is the oxygen generator

Nurse anesthetist with stethoscope

In addition to our monitoring equipment, our nurse anesthetist stays “hands on” in monitoring important physiologic parameters like heart and respiratory rate and quality

She also checks something called Capillary Refill Time to make sure the heart is pumping enough oxygenated blood to the organs. When she presses on the gums to make them blanch white for a second, she measures how long it takes them to go back to their original pink color. It should be less than two seconds.

We have a detailed page on anesthesia to learn much more on how we anesthetize a wide variety of different species (like the duck below) at our hospital.

Wildlife duck anesthetized

Modern anesthetics allows us to safely anesthetize high risk animals like this duck with a fractured wing. You can see her surgery in our Wildlife Care page.

Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

Surgery

Graphic surgical pictures to follow.

Every major surgery we perform begins with proper patient preparation. This will help prevent infection, which could be a serious complication in this surgery because we have a large opening into the abdomen during gallbladder surgery.

Nurse scrubbing abdomen

Our nurse is using a special cleaning agent and scrubbing the skin 3x in a circular motion. After our patient is clean our surgeon completes the draping. 

Surgeon with magnifying light

This is an intricate surgery, so Dr. Larsen uses her high intensity magnifying light for better visualization

Student extern observing surgery

Our student extern Vince Palmeri had a wonderful teaching opportunity observing this unique surgery

Making the skin incision into the abdomen

The surgery begins with an incision into the abdomen at a special location called the linea alba. It is here that the tendons of the stomach muscles come together, and will hold the sutures after we close the abdomen.

Appearance of the swollen liver

The swollen liver is apparent as soon as she enters the abdomen. Notice the proper color of this relatively healthy liver compared to the previous picture of the cat with hepatic lipidosis. 

Surgeon finding the gallbladder

The first thing our surgeon does is locate the gall bladder

Gallbladder being dissected

Now the careful dissection of the gall bladder starts so it can be removed

Controlling bleeding around the gallbladder

After careful dissection it is almost fully exposed at this point

Enlarged common bile duct

As dissection of the gall bladder continued Dr. Larsen traced  down to the common bile duct. The arrow points to the gall bladder under our surgeon’s finger. The vertical bluish structure below the gall bladder is the enlarged common bile duct going into the small intestine. You saw this in the ultrasound, and now is your chance to meet a common bile duct in person. 

Bile removal from distended gallbladder

The bile that is stored in the gall bladder is removed with a suction apparatus. This allows better visualization.

Placing ligatures at gallbladder

When she is satisfied with the exposure Dr. Larsen puts several very strong sutures where the gall bladder attaches to the liver

Removed gallbladder on sponge

Here is the trouble maker after it has been removed

Performing the liver biopsy

A biopsy is taken of the liver to give us substantial information as to its health

Liver biopsy report from pathologist

This is the pathologist’s report from that liver biopsy. Notice that the pathologist states that the changes in the liver are consistent with a gallbladder mucocele. 


Abdomen flush with saline

The abdomen is flushed many times to remove any contaminants 

Suturing muscle layer

The long incision in the linea alba is sutured. After this layer, there are several more layers of sutures placed in the subcutaneous tissue and the skin.

At this point our patient is given a local anesthetic on the suture line, an additional pain injection, and the skin incision is treated with therapy laser to decrease swelling and aid in healing,. You can can how we use it on the video below.

Gall Stones

On occasion a gallbladder might have stones in it. This is not necessarily a problem as long as the pet is not in pain, eating well and not losing weight, and the stones don’t impeded the bile flow into the small intestines. If those symptoms appear, or abdominal ultrasound detects a significant problem with the gallbladder, we will remove it, stones and all.

x-ray of gallstones

This is what three gallstones look like in the gallbladder of a cat

This is a different gall bladder removed from a small dog. This gall bladder was thickened due to stones in it.

Inside of thickened gallbladder

The inside of the gall bladder after removal. The chronic thickening is apparent.

Gall stones after removal

These are the gall stones that were found inside of it

Pathologist report on gallbladder

The pathology report on this gall bladder

Analysis of gallstones

This is the analysis of these stones

We have a page that lists many more of the surgeries we perform at LBAH. Click here to view it.

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