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Cholangiohepatitis

By: Dr. Bari Spielman

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Cholangiohepatitis is an inflammatory disorder of the bile ducts and adjacent liver tissue. It is one of the more common liver diseases seen in cats and is recognized only infrequently in dogs. Most cats have few clinical signs early in the disease process, although they may develop a variety of severe and often life-threatening clinical signs as the process progresses.

The disorder is generally subdivided into several types, based on the biopsy findings within the liver.

  • Suppurative cholangiohepatitis may arise with infections, usually bacterial in nature. This type has an acute (rapid) onset and is often associated with severe and devastating symptoms.

  • Nonsuppurative cholangiohepatitis, which is usually associated with a more chronic (long-term), insidious course where clinical signs may be mild and vague for weeks or months before the cat is brought in for evaluation. The nonsuppurative form is thought to involve an immune-mediated mechanism secondary to other disorders.

  • Biliary cirrhosis. This form is characterized by severe scarring in the biliary system and liver and may be the final end-stage of the other two forms of the disease.

    Differential Diagnosis

    There are several diseases/disorders that appear similar to cholangiohepatitis. These include:

  • Feline hepatic lipidosis. This is a syndrome seen in cats where there is a build up of fat in the liver, causing a decreased flow of bile and dysfunction of the liver.

  • Portosystemic shunts. These are abnormal blood vessels present at birth that shunt blood away from the liver. Clinical signs associated with these shunts usually arise within the first year or two of life, whereas signs from cholangiohepatitis usually arise in older cats.

  • Hepatic neoplasia (cancer of the liver). Lymphosarcoma can cause changes in the liver and clinical signs very similar to cholangiohepatitis, and it should be considered in all cats with liver disease.

  • Exposure to hepatotoxins. Hepatotoxins are agents or drugs harmful to the liver. These include heavy metals (e.g. lead, arsenic, mercury, copper), anti-inflammatory agents (e.g. steroids, carprofen), anticonvulsants (e.g. diazepam, phenobarbital, phenytoin), griseofulvin, and certain chemical dips and sprays (especially flea and tick products).

  • Extrahepatic biliary obstruction (blockage) secondary to tumors, inflammation, infection, or parasite infestation

  • Pancreatitis, an inflammation of the pancreas

  • Pancreatic neoplasia blocking the biliary tract

  • Intestinal inflammation, tumors or foreign bodies

    Other disorders associated with ascites (fluid in the abdominal cavity) also need to be differentiated or ruled out:

  • Protein-losing enteropathy, which are intestinal disorders that cause profound protein loss such as inflammatory bowel disease, lymphangiectasia, and neoplasia. These conditions may result in ascites.

  • Protein-losing nephropathies are kidney disorders that result in protein loss. The most common are glomerulonephritis (inflammation of a part of the kidney) or amyloidosis (the deposition or collection of a type of protein in organs and tissues that compromise their normal function).

  • Right heart failure can cause a fluid build-up in the chest and/or abdominal cavity.

  • Carcinomatosis is widespread cancer throughout the abdominal cavity.

    Other disorders associated with jaundice need to be considered:

  • Infectious diseases such as hemobartonellosis, babesiosis, leishmaniasis, feline infectious peritonitis, toxoplasmosis and liver flukes

  • Autoimmune hemolytic anemia, which is destruction of red blood cells by the immune system

  • Drug induced hemolysis, or breakdown of red blood cells, from ingestion of methylene blue and acetaminophen

  • Other inflammatory liver diseases

  • Primary gallbladder diseases (stones, cancer, inflammation, infection) that clinically mimic cholangiohepatitis

  • Coagulopathies (bleeding disorders) including thrombocytopenia (decreased platelets), warfarin ingestion (usually from rat poisons), and disseminated vascular coagulation (DIC)

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