CATARRHAL ICTERUS (JAUNDICE) IN DOGS.
Pampered artificial life of dogs as predisposition. Eating carrion. Chills especially when heated and exhausted. Infection from bowels. Obstruction of gall duct by inflammation, calculi, neoplasms. Catarrhal exudate as a protector of microbes. Toxins from intestines, food or water. Youth, lack of acclimation, mental shock, blocking of bowel, blood effusion in gall bladder, incubation. Symptoms: signs of gastro-enteritis, prostration with invasion of the liver and especially of the kidney. Icteric urine without jaundiced mucosa. Gravity of icterus with suppression of urine. Hypochondriac tenderness, arched back, dullness, irregular bowels, excited circulation and breathing, preliminary fever tends to subside, tympany, colic, trembling. Death in one or two days or more. Lesions: congestion, degeneration, ecchymosis, ulceration of gastro-duodenal mucosa, extending into liver ducts and acini, bile inspissated, liver enlarged, yellowish brown, softened, fatty, shrunken, distorted hepatic cells. Kidneys congested, ecchymosed, cortical part with necrotic foci; lymph glands congested. Diagnosis: by icterus of tissues and urine tests. Prognosis: grave in acute cases, more hopeful in tardy ones. Treatment: antiseptics, cholagogues, salol, salicylates, alkalies, carbonates, tartrates, iodides, laxatives, cold enemata, aloes, electricity, water freely, pilocarpin, strychnia, aqua regia, digitalis, bitters, muriatic acid, convalescent diet.
Causes. The dog is much more subject to jaundice than the horse, and the affection is liable to be much more severe, than in solipeds. He leads a more artificial life, especially in cities, where the lack of open air exercise, and of the facility for attending to nature’s wants, together with an excessive, varied, stimulating diet predisposes him to constipation, indigestion, and disorders of the stomach, bowels and liver. In other cases the devouring of decomposing food and foul water proves a cause of direct microbian infection, and of poisoning by ptomaines and toxins generated out of the body. Exposure manifestly has something to do with the prevalence of canine icterus, which is more common in spring and especially in autumn than at other seasons. In hunting dogs, out of condition, the suddenly induced over-exertion and fatigue, and the succeeding chill in cold air or water, become accessory factors.
It appears to be most commonly the result of the transference of germs from the intestine, either by way of the bile ducts, or with the blood through the portal vein. The first form is usually the sequel of muco-enteritis affecting the duodenum, with swelling of the walls of the common bile and pancreatic duct at its orifice, or from obstruction by gall-stones, concretions, impacted bowels or neoplasms. With the arrest of the biliary flow the intestinal ferments gain an entrance into the common duct and the sac of Vater, finding protection from the antiseptic bile in the resulting catarrhal exudate, and in this way they reach the gall-bladder, the biliary radicles and the acini. With the entrance of bacteria or toxins by the portal vein on the other hand, there is first a troubled condition of the acini and hepatic cells, an over-secretion of thick bile, and blocking of the passages so that little is passed into the intestine, the greater part being absorbed into the hepatic veins. Fermentation microbes in the stomach and intestines, the germs of suppuration and septicæmia, and saprophytic germs from outside the body are held to be causative of icterus. Cadeac lays much stress on the putrefactive germs in water, and traces different attacks to marshes and foul ponds.
As in other infecting diseases, early age has a predisposing influence. The older subject has presumably been already exposed to the microbe and acquired some measure of immunity. Animals coming new to the locality and poison, are equally susceptible with the young. Trasbot found that 14 out of 17 dogs thus attacked were between three and eighteen months.
Leblanc and Trasbot claim mental shock as a cause of icterus in the dog. The disappointment and weariness caused by the master’s absence, the excitement of a fiercely contested fight, and brutal punishment are adduced as cases in point. Abuse of emetics and purgatives, in connection with a pre-existing hepatic or duodenal disorder or as a supposed prophylactic of canine distemper has induced jaundice.
Obstruction of the small intestine has proved a factor, partly by the reflex irritation through the splanchnic nerves, and partly through obstruction to the common bile and pancreatic duct.
Walley records a case of obstruction of the cystic duct by extravasation of blood in the gall bladder.
Icterus not infrequently supervenes during canine distemper in which the early gastric and duodenal irritation becomes an occasion of the extension of the catarrhal infection to the common bile duct. Even apart from this Trasbot has seen the majority of cases ushered in by a gastro-duodenitis. In this connection it is interesting to quote the remark of Pfuhl that 26 out of 27 persons using the foul baths of a given establishment contracted icterus, while the soldiers bathing in another branch of the Elbe entirely escaped.
The fact that icterus usually sets in several days after such an exposure, whether in man or dog, indicates a period of incubation, and thereby sustains the theory of infection.
Symptoms. In the majority of cases, gastro-enteritis constitutes the first step of this affection and the early symptoms are characteristic of that disease. Frequent vomiting, at first of food, and later of a glairy fluid which may be discolored by bile, redness of the tongue, especially along its margins, bloodshot, watery eyes, lying down with the nose on the right side of the abdomen, or standing with the abdomen tucked up and the back arched, halting movements of the limbs, wincing if manipulation is made of the spine or the epigastrium, elevated temperature, accelerated pulse and breathing, anorexia and perhaps purging, mark the onset. So long as the liver is unaffected prostration is not a marked feature.
Even when the liver is invaded, a fair measure of life and activity may often be retained so long as the kidneys remain sound and active. The bile pigments and salts, and the toxins generated by the invading microbes are alike eliminated in large part in the urine, and the profound poisoning and prostration of the nervous system are in a measure prevented. In many cases therefore the urine is strongly jaundiced without much or any discoloration of the mucosæ and in such cases the prospects are usually good for an early and complete recovery. It must not, however, be inferred that such a happy issue will always follow, as the pigments are by no means as toxic as are other hepatic products and fatal results may ensue with very slight jaundice of the tissues.
As a rule, however, the jaundice of the tissues (eyes, nose, mouth, white portions of the skin) is to be accepted as a grave manifestation, indicating either an excessive production and absorption of bile, or a suppressed secretion through the kidneys, or both. Then the poisoning by biliary salts and bacterial toxins is shown in profound dullness, prostration, muscular weakness, indisposition to rise, moving stiffly and only when dragged by the collar, the limbs trembling and the back arched. The tender back is arched, the right hypochondrium sensitive, the expression dull, stupid and listless, and constipation or a fœtid diarrhœa is liable to set in. The heart beats may be strong and irregular, the breathing is easily disturbed and hurried. The temperature at first 104° to 107° may descend to the normal as the system becomes charged with the toxic products, and does not usually exceed 99.5° after two or three days of jaundice of the tissues.
The icterus is shown in the eye or mouth, or on any white portion of the skin, and in the urine it will be detected by the eye or by the tests above given.
In the worst cases the urine is very scanty and of a deep yellowish brown color, prostration is extreme, tympany, colic, obstinate constipation or bloody diarrhœa may set in, the breathing, hurried or not, is trembling, the pulse small, and the temperature at first high may descend to 95° or even much lower before death.
The course of the disease varies according to its gravity. If there is complete retention of bile, and abundant production of toxins, the animal dies in one or two days in a state of collapse. If there is general progressive degeneration and destruction of the hepatic tissue without at first absolute suppression of the discharge of bile into the duodenum, the patient may last till the fourth or fifth day, or later.
Lesions. There are usually congestion, tumefaction, friability, ecchymosis and even ulceration of the gastric and duodenal mucosa. The organs are empty, but show a reddish brown exudate of a glairy consistency, and containing red blood globules and pus corpuscles. The same inflammatory lesions are to be traced into the common bile duct, the cystic duct and bladder, the biliary ducts, and the acini. The mouth of the common duct is usually blocked with a plug of tenacious mucus, the gall bladder having been unable to expel this and the inspissated bile into the intestine. The liver is slightly enlarged, yellowish, with patches of brownish yellow more or less deep, and the acini contain an abundance of oily globules, and yellowish brown granules. The acini have no clear line of delimitation, and the contained hepatic cells are shrunken and distorted, standing apart from each other in a dropsical or watery medium.
The kidneys are congested and ecchymosed; the cortical substance brown, friable, and with numerous areas of necrosis of a bluish white color, and even abscesses. The medullary substance is yellow and the uriniferous tubes contain an abundance of yellowish brown granules.
The lungs have a yellowish red color, with patches of ecchymosis.
The lymph glands generally are congested and many of them gorged with blood, of a dark red color, and lacking in consistency and cohesion.
Diagnosis. The characteristic icterus is lacking in the early stages, and active treatment gives good hope of success. When indigestion, persistent vomiting and tenderness of the epigastrium, and right hypochondrium, are associated with diarrhœa, it is highly important to examine the urine for even slight traces of bile. When the jaundice is due to impaction of a biliary calculus, the symptoms may increase slowly, and yet reach a sudden climax with acute colicy pains and tenderness of the right hypochondrium.
Prognosis. In acute rapidly developing cases a fatal issue is to be expected. In those which develop more slowly, recovery may be hoped for if early treatment is instituted.
Treatment. Cases due to biliary calculus must be treated for that lesion.
In purely infective icterus attempts must be made to arrest the intestinal and hepatic fermentation. As intestinal antiseptics, naphthol, benzo-naphthol, naphthaline, 5 grains four to six times a day. As hepatic antiseptics, salol 5 grains, salicylate of soda 8 grains, or calomel 1 grain four times a day. The salol and salicylate tend to increase biliary secretion and to render it more fluid. The same end is attained by alkalies (carbonates of potassa, or soda or lithia, bitartrate of soda, iodide of potassium). These are further valuable in hastening the elimination of toxic matters by the kidneys. The expulsion of bile, and of intestinal microbes and toxins may be sought by laxative doses of Glauber salts, or by cold enemas of the same. Verheyen recommends aloes in laxative doses for six days. Siedamgrotzky had good results from induction currents of electricity, sent through the region of the liver twice a day for ten minutes on each occasion. To assist in elimination abundance of pure water or of watery fluids may be used. The most effective eliminating agent is pilocarpin in ⅙ gr. dose hypodermically, repeated daily. In weak conditions frequent small doses of strychnia, ether, aqua regia, or digitalis may prove valuable.
In case of improvement a course of bitters is usually demanded, and these may be combined with hydrochloric acid or small doses of sodium bicarbonate.
Throughout the disease, gruels, beef tea, buttermilk, whey or any simple nutritive aliment which the animal relishes may be given, but both then and during convalescence fatty matters and indigestible materials should be carefully withheld.