mucocele of gallbladder ultrasound

Become a Gold Supporter and see no third-party ads. Because different authors use varying criteria to define the condition, the true prevalence of gallbladder mucocele may be higher. Brief review of the anatomy and physiology of the biliary tree and bile. (2019) ACG case reports journal. Gallbladder mucocele research supported by the ASSA: Committed to protecting and advancing the interests of the breed through education, research, responsible breeding and rescue. Laboratory research suggests that chemical ablation of the gallbladder mucosa may be an alternative in patients who are medically unfit, elderly, or critically ill. A combination of ethanol,. official website and that any information you provide is encrypted Open surgery where a large incision is made in the right upper portion of the abdomen and the gallbladder is then removed. Robot assistant for laparoscopic cholecystectomy. Ultrasound image of the gallbladder (arrows) of an asymptomatic 8-year-old Sheltie with a gallbladder mucocele. Manoharan D, Srivastava DN, Madhusudhan KS. 2008 Nov. 393 (6):935-41. Check for errors and try again. Would you like email updates of new search results? Hypothesis/Objectives To compare survival of dogs treated for GBM by medical management or cholecystectomy or both. Mucus and water are secreted from the wall and accumulates within the gallbladder. It is most often not identified before surgery but is an incidental finding at the time of either laparosco . At the time the article was last revised Andrea Molinari had Multidrug resistant Enterococcus faecium isolate from cholangitis/cholecystitis in a dog. Gallbladder Mucocele: Variables Associated with Outcome and the Utility -, Reyes Q, McLeod RL, Fernandes K, Muralidharan V, Weinberg L. Magnetic resonance cholangiopancreatography uncovering massive gallbladder mucocele in a patient with ambiguous clinical and laboratory findings: A case report. At the time the article was created Matt A. Morgan had no recorded disclosures. Association between Gallbladder Ultrasound Findings and Bacterial Gas-producing organisms may lead to an emphysematous gallbladder; air bubbles in the wall of the gallbladder can be visualized by means of plain radiography, US, or computed tomography (CT). Gallbladder mucocoele: A review - PMC - National Center for Images taken using a Toshiba Powervision color doppler machine, courtesy of Dr. Ravi Kadasne, UAE. sensitivity of high-resolution ultrasound scanners used to identify gallbladder wall defects in people is 70%4 . Several articles describing GBM in dogs suggest a breed predilection for the problem in Shetland Sheepdogs as well as Cocker Spaniels and Miniature Schnauzers; however, mucoceles have been diagnosed in many other breeds and mixes. Radiographics : a review publication of the Radiological Society of North America, Inc. 37 (4): 1059-1083. 3rd ed. The .gov means its official. 2014 Jul. Before doi: 10.1002/vro2.42. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Chronic obstruction of the cystic duct results in accumulation of the sterile non-pigmented mucin in a distended gallbladder which sometimes can reach the pelvis. Postgrad Med. 2021, 62: 547-553. https://doi.org/10.1111/jsap.13312, [18] Parkanzky M, Grimes J, Schmiedt C, et al: Longterm survival of dogs treated for gallbladder mucocele by cholecystectomy, medical management, or both. Extradural anaesthesia-analgesia in dogs undergoing cholecystectomy: A single centre retrospective study. Parasites in the gallbladder or bile ducts. 4. 7. 2017 Aug;21(8):1366-1367. Intraluminal shadowing indicates sediments in fluid; image indicates acute cholecystitis with possible pyocele of gallbladder. The Mucocele of the Gallbladder | SpringerLink The gallbladder is an oval shaped sack-like structure that extends from the large bile duct. 1993 May;20(4):689-94; discussion 694-6. [23] Lindaberry C, Vaden S, Aicher K, et al: Proteinuria in dogs with gallbladder mucocele formation: A retrospective case control study. PLoS One. Become a Gold Supporter and see no third-party ads. 2015 Dec 09;86(1):1318 https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTk1MTY1LW92ZXJ2aWV3, Right-upper-quadrant (RUQ) pain or epigastric pain and discomfort, Continuance of pain or persistence of tenderness for longer than 6 hours - Acute cholecystitis, Fever and chills - Infected bile, with possible gallbladder empyema, Jaundice - Coexisting obstruction of the common bile duct (CBD), White blood cell (WBC) count - Mild leukocytosis with a left shift is common; higher counts suggest acute cholecystitis or infected bile, Bilirubin - Usually within the reference range but may be mildly raised with Mirizzi syndrome or associated CBD obstruction or cholangitis, Liver enzymes - Usually within the reference range, though alkaline phosphatase may be mildly elevated; large increases suggest an obstructed CBD, Serum amylase levels - Usually within the reference range; large increases suggests acute pancreatitis, Ultrasonography - Extremely sensitive in detecting gallbladder stones and identifying intrahepatic biliary tree dilatation, Plain radiography of the abdomen - Nonspecific, used only as a guideline in differential diagnosis, Scintigraphy (hepato-iminodiacetic acid [HIDA] scanning) - Capable of offering only indirect evidence but possible worth considering in obscure cases, Computed tomography (CT) - Indicated when the diagnosis is unclear or other associated conditions or complications are present that must be assessed, Magnetic resonance cholangiopancreatography (MRCP). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. J Ultrasound Med. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. -, J S Afr Vet Assoc. [QxMD MEDLINE Link]. Spontaneous Rupture of an Esophageal Mucocele Into the Airway. FOIA View Matt A. Morgan's current disclosures, View Andrea Molinari's current disclosures, see full revision history and disclosures, https://www.ncbi.nlm.nih.gov/books/NBK513282/, extrinsic compression by tumor, lymph node, or fibrosis. lodged at the neck, producing obstruction in outflow. These ultrasound images suggest mucocele of the gall bladder. Be knowledgeable as possible about the presence or absence of dogs with GBM in your dogs pedigree, and use that knowledge in making breeding decisions just as you would with any other abnormality. sloughing of the mucosa. When a polyp is greater than 1 cm, the cholecystectomy is usually performed. Cureus. Bookshelf CT diagnosis of mucocele of the appendix in patients with acute appendicitis. The disease is characterized by increased secretion of condensed granules of gel-forming mucin[] by the gallbladder epithelium and formation of an abnormally thick mucus that can result in impaired gallbladder motility, extrahepatic biliary tract obstruction, and gallbladder rupture with bile peritonitis [2-13]. If your asymptomatic Sheltie is diagnosed with a GBM, discuss the options with your veterinarian. Ong CA, Prepageran N, Sharad G, Luna D. Bilateral lacrimal sac mucocele with punctal and canalicular atresia. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Slightly yellowish fluid was sterile and was rich in cholesterol. http://emedicine.medscape.com/article/195165-diagnosis. -. The gallbladder wall may be of normal thickness, though in long-standing cases, the mucosa atrophies and the wall becomes thin, sometimes even transparent. Abdom Imaging. MeSH Unable to process the form. Stone in neck of gallbladder, with postacoustic shadowing. (2006) The American journal of emergency medicine. Mucocele is caused by chronic obstruction of the gall bladder causing it to be overdistended.Bile is slowly absorbed from the lumen and replaced by mucous secretions from the wall. 6. J Clin Ultrasound. Older, small- to medium-breed dogs seem to be predisposed, but no sex predilection has been identified. These ultrasound images suggest a diagnosis of Pyocele of the gall bladder following acalculous cholecystitis. Many other diseases cause similar clinical signs, and because GBM are relatively uncommon, the diagnosis can be missed or delayed. Check for errors and try again. Medical and surgical management of gallbladder sludge - ScienceDirect In long term cases, the walls of the bladder become thinner and even slightly transparent. The water can be added at a later stage just before the bile empties out into the duodenum. The gallbladder was moderately distended and filled with a gelatinous, semi-solid material. Disorders of the liver and biliary tract. Clinical signs of affected dogs include vomiting, loss of appetite, and abdominal pain. 2004 Nov1; 225(9):14, 18-22. http://www.ncbi.nlm.nih.gov/pubmed/15552319, [5] Besso JG, Wrigley RH, Gliatto JM, et al: Ultrasonographic appearance and clinical findings in 14 dogs with gallbladder mucocele. and replaced by mucous secretions from the wall. The Mucocele of the Gallbladder - PubMed Vol 1: 1083-103. J Clin Ultrasound 2002;30:270274. World J Transplant. National Library of Medicine Heterotopic pancreas--an unusual cause of cholecystitis. In addition, the thoracic ventrodorsal view is recommended to evaluate gallbladder opacity. These ultrasound images suggest mucocele of the gall bladder. The site is secure. A Rare Case of Acute Calculous Cholecystitis With Gallbladder Hydrops. Keywords: PDF What Does A Gall Bladder Mucocele (GBM) Mean To Me? Rosen's Emergency Medicine: Concepts and Clinical Practice. Any association of bile bacterial infection with gallbladder mucocele formation in dogs is inconsistently observed,13, 25, 26 and the role of infection in disease pathogenesis remains unknown. It has been diagnosed in a 3-year-old Sheltie. Leonards LM, Pahwa A, Patel MK et-al. Images in clinical medicine. Sambugaro B, De Gennaro C, Hattersley RD, Vettorato E. Front Vet Sci. Some support exists for a therapeutic effect of thyroid hormone supplementation in dogs with GBM and thyroid dysfunction [14]. Canine Gallbladder Mucoceles - VetFolio eCollection 2023. 26 (4):525-31. The gallbladder is a hollow sac that stores bile containing wastes and fats among other substances that need to be evacuated from the body. In general, board certified radiologists and internal medicine veterinarians are competent at making the diagnosis. Since GBM formation is significantly associated with proteinuria, treating the proteinuria may minimize long-term kidney morbidity in such patients [23]. An official website of the United States government. Adrenal gland mass, mainly the right side. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Vol 1: 1016-46. Acta Gastroenterol Belg. However, laboratory workup should include all tests performed for acute cholecystitis. Honnef I, Moschopulos M, Roeren T. Appendiceal mucinous cystadenoma. The condition can result from gallstone disease, the most. and transmitted securely. Surg Endosc. Check for errors and try again. Crews LJ, Feeney DA, Jessen CR, Rose ND, Matise I. J Am Vet Med Assoc. Gallbladder mucoceles (GBM) typically are treated by cholecystectomy. 2011;364 (20): e43. https://doi.org/10.1111/jvim.15611, [19] Viljoen AD, Tamborini A, Watson PJ, et al: Clinical characteristics and histology of cholecystectomised dogs with nongravity-dependent biliary sludge: 16 cases (2014-2019). The Mucocele of the Gallbladder. Role of sonography in the diagnosis of gallbladder perforation. Methods: Most cases of gallbladder mucocele arise as a complication of gallstones disease, and gallstones itself are a fairly common condition. -, J Gastrointest Surg. Canine gallbladder mucocele occurs when the gallbladder has become enlarged due to the accumulation of an excessive amount of mucus that has formed into a solid mass, or a mucocele. 2011;39 (5): 290-2. (2014). 2006 Mar. 2012 Mar;16(3):549-53 Mark W. Jones & Jeffrey G. Deppen. Accessibility http://www.sciencedirect.com/science/article/pii/S1090023313005339, [9] Mesich ML, Mayhew PD, Paek M, et al: Gall bladder mucoceles and their association with endocrinopathies in dogs: a retrospective case-control study. https://avmajournals.avma.org/doi/abs/10.2460/javma.232.11.1688, [15] Guess SC, Harkin KR, Biller DS: Anicteric gallbladder rupture in dogs: 5 cases (20072013). Gallbladder mucocoele (GBM) is an abnormal, intraluminal accumulation of inspissated bile and/or mucous within the gallbladder. Symptoms of a gallbladder mucocele include the following: Laboratory studies that may be helpful include the following: Imaging modalities that may be considered include the following: Surgery is definitive treatment for gallbladder obstruction, and no absolute contraindication to such treatment exists. * Both spellings of gallbladder and gall bladder are found in the literature with the former being preferred in American scientific literature and medical dictionaries with the latter found more often in the British. Marotta B, Chaudhry S, McNaught A et al. Mucocele (hydrops) of the gallbladder is a term denoting an overdistended gallbladder filled with mucoid or clear and watery content. Clinical, ultrasonographic, and laboratory findings associated with gallbladder disease and rupture in dogs: 45 cases (1997-2007). Unable to process the form. 2017 Dec 24;7(6):359-363. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Gurusamy KS, Samraj K, Fusai G, Davidson BR. 2003;23 (3): 645-62. J Am Vet Med Assoc. The gall bladder wall thickness is normal and there is no peri-cholecystic edema. J Long Term Eff Med Implants. Abdominal discomfort or pain on the upper right side (RUQ) or upper middle region (epigastric). Pathology 90-95% of cases are due to gallstones (i.e. Patients present with signs and symptoms of acute or chronic cholecystitis. The contents are usually sterile, and any bacterial contamination ends in empyema of the gallbladder. Additionally, abdominal ultrasonography had low sensitivity for identification of gallbladder rupture. J Am Vet Med Assoc. Acute cholecystitis | Radiology Reference Article | Radiopaedia.org Complications may develop when progressive inflammation leads to acute cholecystitis and all its attendant manifestations. government site. Gallbladder Mucocele: Variables Associated with Outcome and - PubMed The gallbladder has a fairly thick wall which can stretch to a very large degree thereby allowing for a large quantity of bile to be stored if necessary. ULTRASONOGRAPHIC APPEARANCE AND CLINICAL - Wiley Online Library Since Shelties are one of the breeds considered to be at risk for GBM, inform your veterinarian of the possibility of GBM formation if your dog develops any of the above-mentioned clinical signs. eCollection 2022. New Thoughts on Gallbladder Mucoceles - Veterinary Practice News Ultrasonographic patterns, clinical findings, and prognostic variables Ultrasound examination must be performed by a veterinarian experienced in recognizing GBM. National Library of Medicine Bile empties out of the gallbladder through the narrow duct that joins the common bile duct which leads to the duodenum. This patient had pain in the right hypochondrium and fever. Microscopic examination reveals a flattened mucosa lined by low columnar or cuboidal cells; the increased intraluminal pressure results in plentiful Rokitansky-Aschoff sinuses. Phil Mayhew,* a board-certified surgeon at the University of California, Davis . Clinical presentation Abdominal pain with palpable gallblad. Gross overdistention may result in gangrene or perforation of the gallbladder, with ensuing pericholecystic collection or peritonitis. Gas in the biliary tree may be evident on plain radiographs of the abdomen or on ultrasonograms. Mucocele of the gallbladder is a condition caused by the prolonged blockage of the cystic duct, usually by an impacted gallstone. Mucocele of the gallbladder is a condition caused by the prolonged blockage of the cystic duct, usually by an impacted gallstone. J Vet Diag Invest. Minimal wall thickening and dilated gallbladder suggest mucocele. In general, this appears to be a disease of older dogs. Increased radiographic opacity in the region of the gallbladder can be A mucocele simply refers to accumulation and expansion of a structure by mucus 1. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). With the absence of any other significant findings, the abdominal pain was attributed to the gallbladder disease, and an exploratory laparotomy was requested. Ultrasound image of the gallbladder (arrows) of an asymptomatic 8-year-old Sheltie with a gallbladder mucocele. This ultrasound case study is courtesy of Vikas Shukla, MD, Septate structures (linear echoes) within the gall bladder suggest evidence of Causes include: If seen on CT without an explanation, it is followed up with ultrasound if the patient has biliary colic symptoms. A 3rd study comparing long-term survival of dogs with GBM treated by cholecystectomy, medical management, or both found that cholecystectomy resulted in the best long-term survival in dogs surviving the immediate postoperative period compared to medical management [18] . A review of gallbladder mucocele - part 1: aetiopathogenesis and (A) Intact gallbladder shortly after surgical removal. acute calculous cholecystitis) with the remainder being acute acalculous cholecystitis. Am J Case Rep. 2014;15: 355-60. 10th ed. Gallbladder Mucocele. Another study comparing elective vs. nonelective gallbladder removal in dogs with GBM had similar findings [17]. Gallbladder Mucocele Workup - Medscape Transverse scans show layering of gallbladder wall; this suggests edema and indicates acute cholecystitis. John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine This concentrates the bile but also helps to reduce the space occupied in the gallbladder. 2022 Feb 15;14(2):e22230. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. (2005) The Medical journal of Malaysia. 3) multiple smaller calculi are seen in the gall bladder (sizes- 5 to 10 mm.). Gallbladder Mucocele - American College of Veterinary Surgeons When a polyp is greater than 1 cm, the cholecystectomy is usually performed. The value of intraoperative percutaneous aspiration of the mucocele of the gallbladder for safe laparoscopic management. When left untreated, the gallbladder can become infected, press on the stomach thereby partly blocking it and gallbladder rupture is also possible. Mucocele of the appendix: ultrasonographic and CT findings. official website and that any information you provide is encrypted Unauthorized use of these marks is strictly prohibited. (See the image below.). Disclosure: Mark Jones declares no relevant financial relationships with ineligible companies. . 2007 Jul 1;231(1):79-88. http://www.ncbi.nlm.nih.gov/pubmed/17605668, [3] Pike FS, Bert J, King NW, et al: Gallbladder mucoceles in dogs: 30 cases (2000-2002). View Faheemullah Khan's current disclosures, see full revision history and disclosures. Ann Saudi Med. Bookshelf The term describes an imaging appearance rather than a pathological entity. Blood supply to the gallbladder is affected and an infection can set in eventually leading to gangrene of the organ. 2022 Apr 3;14(4):e23773. Currently, there is a prospective treatment. Rosai and Ackerman's Surgical Pathology. Fever and chills infected gallbladder and empyema, Pain persisting for more than 6 hours acute cholecystitis, Magnetic resonance cholangiopancreatography (MRCP). AJR Am J Roentgenol. Studies supported by the American Shetland Sheepdog Association either through promoting owner participation or through the Shetland Sheepdog Donor Advisory Fund within the American Kennel Club Canine Health Foundation. 2009 Jan;13(1):19-25 Gallbladder content became less mobile with time suggesting that a change in consistency occurred over time [16]. A 2015 study of 76 dogs with GBM and additional matched controls found that dogs with GBM were 2.2 times as likely to have been treated with thyroxine (probably for hypothyroidism) as control dogs, 3.6 times as likely to have been treated for Cushing's disease, and 2.3 times as likely to have had reported use of products containing imidacloprid (a topical flea and tick control insecticide) [7]. MeSH The Mucocele of the Gallbladder The gallbladder polyps are a common finding during ultrasonography but only in rare cases they may be a cancer. Clipboard, Search History, and several other advanced features are temporarily unavailable. Over a prolonged period of time, the bile and its salts are gradually resorbed through the gallbladder wall. 6. Sep-Oct; 33(5): 20572066. American journal of roentgenology. Some have suggested that incorporation of abdominal ultrasound examination of dogs as a routine diagnostic tool has resulted in increased detection of gallbladder disease [2]. -, Sood BP, Kalra N, Gupta S, et al. Appendiceal mucoceles occur when obstruction of the appendiceal lumen causes mucus to accumulate and progressively distend the appendix. Cochrane Database Syst Rev. Reference article, Radiopaedia.org (Accessed on 30 Jul 2023) https://doi.org/10.53347/rID-12273. The term "gallbladder mucocele" (MC) commonly refers to an over-distended gallbladder filled with an immobile mixture of mucus and inspissated bile that can cause obstruction of the biliary tract. 2020;9(12):5867. The prognosis is excellent if the diagnosis is correct and no complications have ensued. Typically cystic mass with variable internal echogenicity 8. sharing sensitive information, make sure youre on a federal Careers. Liver, Biliary Tract and Exocrine Pancreas. The term gallbladder mucocele refers to an overdistended gallbladder filled with mucoid or clear and watery content. 1994 Nov. 14 (6):471-3. 1992 May-Jun;6(3):186-92. doi: 10.1111/j.1939-1676.1992.tb00335.x. 2013;10 (12): 953-6. Several predisposing factors have been considered such as breed (mentioned above), endocrine disease (hypothyroidism or hyperadrenocorticism (Cushings Disease)), [7, 9] hyperlipidemia (too much fat in the blood) [8] and hypercholesterolemia (high blood cholesterol levels) [2]. Mucocele is caused by chronic obstruction of the gall bladder causing it to be overdistended.Bile is slowly absorbed from the lumen Thyroid dysfunction could have been due to concurrent non-thyroidal illness, and because it was identified in many dogs, the authors recommended that comprehensive thyroid testing be done in dogs with GBM. Recommendations for Shetland Sheepdog Owners. Hydropic gallbladder. This unusual po 2019;213(2):343-8. No single laboratory test is diagnostic of a mucocele. If you log out, you will be required to enter your username and password the next time you visit. ADVERTISEMENT: Supporters see fewer/no ads. Ultrasonographic appearance and clinical findings in 14 dogs with gallbladder mucocele. -. https://criticalcaredvm.com/gallbladder-mucoceles-dogs/. Double gallbladder with different disease entities: A case report. Vol 2: Wight DGD, Symmers WS, eds. Investigation of adrenal and thyroid gland dysfunction in dogs with However, a 2021 study found that, although gallbladder volume was greater in dogs with hyperlipidemia than in healthy control dogs, there was no difference in gallbladder contractility between the two groups. At least one genetic testing laboratory is offering the DNA test, so be aware of the above studies when considering whether or not to use that test. Although medical management was associated with significantly shorter median survival time (1340 days) compared to surgical treatment (1802 days), it was considered a reasonable alternative when surgery could not be pursued. Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. Dogs with Gallbladder Mucocele. Background: Gallbladder mucocele (GBM) is an increasingly recognized extrahepatic biliary disease in dogs. The options are the same as for dogs with confirmed mucoceles. J Am Vet Med Assoc 2004; 224:1615-1622. http://www.ncbi.nlm.nih.gov/pubmed/15154731, [4] Worley DR, Hottinger HA, Lawrence HJ: Surgical management of gallbladder mucoceles in dogs: 22 cases (1999-2003). Radiographics. Bile is produced throughout the day. More information on autoimmune thyroiditis can be found at the following links: Results coming from all laboratories are posted on the OFA website For an excellent discussion on the topic More information about elbow dysplasia Additional Reading Potentially Inherited Disorders, Board Certified Veterinary Ophthalmologist, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904718/?tool=pubmed, http://www.ncbi.nlm.nih.gov/pubmed/17605668, http://www.ncbi.nlm.nih.gov/pubmed/15154731, http://www.ncbi.nlm.nih.gov/pubmed/15552319, http://www.ncbi.nlm.nih.gov/pubmed/10850878, http://www.ncbi.nlm.nih.gov/pubmed/19210257, http://onlinelibrary.wiley.com/doi/10.1111/jvim.13649/abstract, http://www.sciencedirect.com/science/article/pii/S1090023313005339, http://www.ncbi.nlm.nih.gov/pubmed/19954439, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138988, https://vtechworks.lib.vt.edu/bitstream/handle/10919/104199/Villm_JA_T_2021.pdf?sequence=1&isAllowed=y, http://vdi.sagepub.com/content/26/3/434.full, https://doi.org/10.1371/journal.pone.0212638, https://avmajournals.avma.org/doi/abs/10.2460/javma.232.11.1688, http://www.ncbi.nlm.nih.gov/pubmed/26642136, http://onlinelibrary.wiley.com/doi/10.1111/jvim.13929/abstract?campaign=wolearlyview, https://criticalcaredvm.com/gallbladder-mucoceles-dogs/, http://veterinarymedicine.dvm360.com/update-gallbladder-mucoceles-dogs, https://www.nashvillevetspecialists.com/articles/gall-bladder-mucocele, http://veterinarynews.dvm360.com/dvm/Gastroenterology/Gallbladder-mucoceles-Surgery-still-recommended-du/ArticleStandard/Article/detail/616664, Text Of Boston Globe Article Oct. 17, 1909, Shetland Sheepdog History by Charlotte McGowan.

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