Liver and Pancreatic Disease: Test Your Knowledge!

Question

What has happened to this dog's gall bladder?

Answer

This is a gall bladder mucocoele which has been caused by the accumulation of semi-solid to solid mucinous bile-laden concretions in the bladder accompanied by cystic mucinous hyperplasia of the gallbladder wall.

The exact reason for their formation is unknown and many factors are likely implicated in their formation including gall bladder stasis, choleocystitis and localised inflammation. They are seen in some breeds with increased frequency such as Shetland sheepdogs and Cocker spaniels. Endocrine disease, including Hyperadrenocorticism, hypothyroidism and other lipid abnormalities, have been associated with mucocoele formation.

Surgery, as performed in this dog, is usually required and, if successful, is associated with a good long-term outcome.

Test Your Knowledge Cardiac Conundrum

Question 8

A 6-year-old neutered male Labrador presents to you with a 2-week history of exercise intolerance and a collapsing episode 2 hours before presentation. The collapse happened when the dog tried to chase a cat. The dog seemed unconscious to the owner, there was no tonic or tonic-clonic activity and the collapse episode lasted less than 30 seconds with a fast and complete recovery afterward.

On physical examination the heart rate was 40 bpm with a regular and strong femoral pulse, no cardiac murmur was detected and the clinical examination was otherwise unremarkable. You performed an ECG to characterize the bradycardia.

What’s your ECG diagnosis? And, what is the most appropriate treatment for this patient?

Answer

The ECG shows a complete atrioventricular dissociation (P waves are not associated with the QRS complexes) with a slow ventricular escape rhythm. This is a third degree atrioventricular block (complete AV block). The recommended treatment for complete AV block is a pacemaker implantation.  

Third degree AV block is the most common indication for pacemaker implantation. In veterinary cardiology the most frequently implanted pacemaker system is a rate-responsive, single chamber and single lead (VVIR) pacemaker.