Cholangiohepatitis

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Cholangiohepatitis

By: Dr. Bari Spielman

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Section: Overview

Cholangiohepatitis is an inflammation of the biliary structures (the system that carries bile) and the surrounding liver tissue. In the cat it occurs in several forms, including suppurative cholangiohepatitis, nonsuppurative cholangiohepatitis, and biliary cirrhosis. In the suppurative form of the disease, white blood cells called neutrophils are commonly seen in biopsies. In the nonsuppurative form of the disease, white blood cells called lymphocytes and plasma cells are most commonly seen on biopsy. With cirrhosis, extensive scarring is found in both the biliary system and the liver.

This is a syndrome seen primarily in cats and infrequently in dogs. All breeds of cats can be affected, although the incidence is greater in the Himalayan, Persian, and Siamese cat. Cholangiohepatitis usually occurs in middle-aged animals, and males appear to be at higher risk for the suppurative form.

Causes of Suppurative Cholangiohepatitis

Ascending bacterial infection from the intestinal tract, which may be associated with other diseases such as bacterial and parasite infections and pancreatitis.

Infections carried through the blood stream (blood-borne), such as bacterial (e.g. Salmonella), parasitic (e.g. toxoplasmosis), and viral (e.g. feline infectious peritonitis virus) infections

Causes of Nonsuppurative Cholangiohepatitis

This type of cholangiohepatitis is thought to be an immune disorder associated with the following conditions:

Cholecystitis (inflammation of the gallbladder)

Cholelithiasis (stones in the gallbladder)

Pancreatitis (inflammation of the pancreas)

Extrahepatic biliary obstruction (blockage of the bile duct outside the liver)

Inflammatory bowel disease

Chronic interstitial nephritis (an inflammatory disorder of the kidney)

Idiopathic (unknown causes)

What to Watch For

Fever

Loss of appetite

Dehydration

Vomiting, diarrhea

Jaundice (yellow color to the skin)

Lethargy, collapse

Ascites (fluid in the abdomen)

Weight loss

Disorientation, blindness, seizures, excessive salivation associated with severe liver disease

Diagnosis

Diagnosis of cholangiohepatitis can be difficult and often requires the use of multiple diagnostic tests. Your veterinarian may refer your cat to a specialist in veterinary internal medicine for further evaluation. Tests that may be needed to reach the diagnosis and to determine the severity of the disease, include the following:

A complete blood count (CBC), biochemical profile and urinalysis

A coagulogram (clotting profile) to test the ability of the blood to clot

Serum bile acids to determine how severe the liver is changed

Ammonia levels, especially if the cat is disoriented or blind

Abdominal radiographs (X-rays)

Abdominal ultrasound

Blood tests for toxoplasmosis, feline infectious peritonitis and other viral infections

Exploratory laparotomy (abdominal surgery) to examine the liver, gall bladder and associated structures

Laparoscopy to allow visualization and sampling of abdominal structures through a scope introduced through a tiny incision in the abdominal wall

Liver biopsy with bacterial culture and sensitivity testing to confirm the diagnosis

Treatment

Hospitalization and supportive care (fluid and electrolyte therapy) as needed for dehydration from severe vomiting, diarrhea, and anorexia

Treatment of any underlying medical disorders

Antibiotic therapy

Immune modulating drugs (drugs that alter the immune system) for the nonsuppurative form of the disease

Nutrition and dietary management

Vitamin supplementation

Diuretics to help the body eliminate excess abdominal fluid)

Choleretic drugs to enhance the flow of bile

Lactulose to slow the absorption of ammonia from the colon so that the diseased liver does not have to process so much ammonia

Surgery may be indicated to address underlying causes such as cholecystitis (removal of gall bladder), cholelithiasis (removal of gall stones), and extrahepatic biliary obstruction (surgical correction of the obstruction).

Home Care and Prevention

Therapy is often required long-term and numerous evaluations may be required to determine the response to therapy. Administer all medication and recommended nutritional supplements as directed by your veterinarian. Return for follow up examinations and biochemical evaluations.

There are no preventative measures recommended in these patients; however, controlling inflammatory bowel disease may be of benefit in some cases.

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