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Alterações ecográficas da árvore biliar associadas à realização de cultura de bílis : estudo retrospetivo de 22 casos
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Resumo(s)
A ecografia abdominal é a modalidade imagiológica mais utilizada na avaliação de
pequenos animais com suspeita de doença hepatobiliar. Com efeito, a ecografia da árvore
biliar, mais especificamente, assume um papel de enorme relevância na tomada de decisão
clínica, no que concerne à colheita de amostras biliares para citologia e/ou cultura bacteriana.
O objetivo principal deste estudo consistiu em avaliar a existência de associação entre
alterações ecográficas da árvore biliar, considerando parâmetros ecográficos estabelecidos,
com o resultado da cultura de biliar, avaliando ainda a frequência dessas alterações na
população. Nos grupos (cão e gato), avaliou-se a frequência das alterações.
Secundariamente, avaliou-se a prevalência de culturas positivas, na população e nos grupos,
e os principais isolados bacterianos identificados.
Não se verificou associação estatisticamente significativa (p>0,05) entre as alterações
ecográficas e o resultado da cultura biliar. Na população em estudo, as alterações ecográficas
mais frequentes foram presença de sedimento biliar (81,8%), com imobilidade de sedimento
(72,2%), espessamento da parede da vesícula biliar, alteração da ecogenicidade da parede
da vesícula biliar e dilatação do ducto biliar comum (77,3%), e irregularidade da superfície
luminal (72,7%). Com menos frequência, observou-se a presença de mucocelo biliar (31,8%)
e, por fim, a presença de litíase biliar (13,6%) e a presença de outro conteúdo da vesícula
biliar anormal (gás) (4,6%). As alterações de espessamento da parede da vesícula biliar,
irregularidade da superfície luminal da vesícula biliar, alteração da ecogenicidade da parede
da vesícula biliar, imobilidade do sedimento biliar e imagem de mucocelo biliar foram
significativas entre grupos (p<0,05). Verificou-se um maior número de alterações da árvore
biliar nos cães relativamente aos gatos, com uma média de 6,3 alterações (cães) e 3,1
alterações (gatos) (p=0,001).
A prevalência de culturas positivas na população total foi de 22,7%. Já considerando
a espécie, a cultura foi positiva em 30,7% dos cães e em 11,1% dos gatos. Os isolados
bacterianos identificados foram Escherichia Coli (40%), Clostridium spp.(20%), Enterococcus
spp.(20%), Salmonella spp.(20%).
Alterações como espessamento da parede da vesícula biliar, ecogenicidade
aumentada da parede da vesícula biliar, irregularidade da superfície luminal da vesícula biliar
e sedimento biliar imóvel parecem ser importantes indicadores para realização de cultura
biliar, dada a sua presença em casos positivos, apesar da sua baixa especificidade. Assim, a
ecografia biliar constitui um passo importante na decisão de realização de uma cultura biliar,
ainda que as alterações observadas não tenham mostrado associação com resultado da
cultura.
ABSTRACT - Abdominal ultrasound is an imaging modality frequently used in the evaluation of small animals with suspected hepatobiliary disease. Biliary tree ultrasound, specifically, plays an extremely important role in the clinical decision making process regarding the collection of bile samples for cytology and /or bacterial culture. The main objective of this study was to evaluate the existence of an association between ultrasonographic findings of the biliary tree, considering established ultrasound parameters, with the result of the biliary culture. In doing so, also evaluating the frequency of these findings in the population. In the groups created (dog and cat), the frequency of changes was also evaluated. Secondly, the prevalence of positive cultures in the population and in each group was caclulated, and the main bacterial isolates were identifed. There was no statistically significant association (p>0,05) between ultrasonographic findings and the result of the culture. In this population, the most frequent findings were the presence of biliary sludge (81,8%), with immobility of the sludge (72,2%), thickening of the gallbladder wall, alteration of the echogenicity of the gallbladder wall and dilation of the common bile duct (77,3%), and luminal surface irregularity (72,7%). Less frequently, presence of gallbladder mucocele (31,8%) and, finally, the presence of gallstones (13,6%) and presence of other abnormal gallbladder content (gas) (4,6%). Changes in the thickness of the gallbladder wall, irregularity of the luminal surface of the gallbladder, alteration in the echogenicity of the gallbladder wall, immobility of the sludge and image of gallbladder mucocele were significant between groups (p <0,05). There were a greater number of changes in the biliary tree in dogs compared to cats, with an average of 6,3 changes (dogs) and 3,1 changes (cats) (p=0,001). The prevalence of positive cultures in the population was 22,7%. Considering the species, the culture was positive in 30,7% of dogs and in 11,1% of cats. The bacterial isolates identified were Escherichia Coli (40%), Clostridium spp. (20%), Enterococcus spp. (20%) and Salmonella spp. (20%). Ultrasonographic findings such as thickening of the gallbladder wall, increased echogenicity of the gallbladder wall, luminal surface irregularity of the gallbladder and immobile sludge seem to be important indicators for performing a biliary culture, given their presence in positive cases, despite low specificity. Biliary ultrasound is an important step in the decision to perform a biliary culture, even though no association was shown between ultrasonographic findings and the result of the culture.
ABSTRACT - Abdominal ultrasound is an imaging modality frequently used in the evaluation of small animals with suspected hepatobiliary disease. Biliary tree ultrasound, specifically, plays an extremely important role in the clinical decision making process regarding the collection of bile samples for cytology and /or bacterial culture. The main objective of this study was to evaluate the existence of an association between ultrasonographic findings of the biliary tree, considering established ultrasound parameters, with the result of the biliary culture. In doing so, also evaluating the frequency of these findings in the population. In the groups created (dog and cat), the frequency of changes was also evaluated. Secondly, the prevalence of positive cultures in the population and in each group was caclulated, and the main bacterial isolates were identifed. There was no statistically significant association (p>0,05) between ultrasonographic findings and the result of the culture. In this population, the most frequent findings were the presence of biliary sludge (81,8%), with immobility of the sludge (72,2%), thickening of the gallbladder wall, alteration of the echogenicity of the gallbladder wall and dilation of the common bile duct (77,3%), and luminal surface irregularity (72,7%). Less frequently, presence of gallbladder mucocele (31,8%) and, finally, the presence of gallstones (13,6%) and presence of other abnormal gallbladder content (gas) (4,6%). Changes in the thickness of the gallbladder wall, irregularity of the luminal surface of the gallbladder, alteration in the echogenicity of the gallbladder wall, immobility of the sludge and image of gallbladder mucocele were significant between groups (p <0,05). There were a greater number of changes in the biliary tree in dogs compared to cats, with an average of 6,3 changes (dogs) and 3,1 changes (cats) (p=0,001). The prevalence of positive cultures in the population was 22,7%. Considering the species, the culture was positive in 30,7% of dogs and in 11,1% of cats. The bacterial isolates identified were Escherichia Coli (40%), Clostridium spp. (20%), Enterococcus spp. (20%) and Salmonella spp. (20%). Ultrasonographic findings such as thickening of the gallbladder wall, increased echogenicity of the gallbladder wall, luminal surface irregularity of the gallbladder and immobile sludge seem to be important indicators for performing a biliary culture, given their presence in positive cases, despite low specificity. Biliary ultrasound is an important step in the decision to perform a biliary culture, even though no association was shown between ultrasonographic findings and the result of the culture.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Ecografia biliar cultura biliar colecistocentese vesícula biliar árvore biliar biliary ultrasound biliary culture cholecystocentesis gallbladder biliary tree
Contexto Educativo
Citação
Cosme ARM 2021. Alterações ecográficas da árvore biliar associadas à realização de cultura de bílis : estudo retrospetivo de 22 casos [dissertação de mestrado]. Lisboa: FMV-Universidade de Lisboa.
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária