Cholangitis Complex In The Cat
The pathogenesis and interaction of lymphocytic and neutrophilic cholangitis is poorly understood. Both forms can be associated with Inflammatory Bowel Disease (IBD) and/or pancreatitis. This is because, in the cat, the accessory pancreatic duct is small or, in most cases, absent and the pancreatic duct joins up with the common bile duct, entering the intestines at the sphincter of Oddi (see figure 1). It is therefore very easy for infection and inflammation to spread and affect all three organs. This is commonly termed “Triaditis”.
Figure 1: Anatomy of the liver, intestines and pancreas in the cat
Neutrophilic cholangitis can affect cats of any age. Acute disease results in fever, anorexia, vomiting, lethargy and jaundice (see figure 2) with or without abdominal pain. Chronic disease causes episodic anorexia, vomiting, weight loss and jaundice with or without hepatomegaly or ascites. Acute disease may progress to chronic disease and/or secondary hepatic lipidosis: ~80% of cases have concurrent IBD, ~50% have pancreatitis.
Lymphocytic cholangitis typically affects young to middle-aged cats: Persians may be predisposed. Signs are usually chronic and insidious: jaundice but appearing well, often polyphagic, some show weight loss, anorexia and vomiting with or without diarrhoea; most have an enlarged liver and they may have generalized lymphadenopathy. This can progress to chronic biliary cirrhosis with ascites. Both forms can result in hepatic encephalopathy, ascites and bleeding tendencies.
Diagnostic tests include:
Definitive diagnosis requires liver biopsy: fine-needle aspirate is rarely diagnostic. Blood clotting times and/or PIVKA (proteins induced by vitamin K antagonism or absence) test should be assessed first, plus a platelet count!! Typical gross findings are a friable/firm irregular liver, thickened/distended gallbladder and common bile duct, inspissated bile; enlarged mesenteric lymph nodes, pancreatic irregularity, with or without thickening of the duodenal walls
Figure 3: Ultrasound demonstrating a tortuous common bile duct
Treatment is largely empirical. Immediately following biopsy, administer analgesics (e.g. buprenorphine), intravenous fluids (add potassium), feeding (may need tube feeding), antiemetics and antibiotics. Antibiotics (with neutrophilic cholangitis) should ideally be selected by culture and sensitivity of bile and/or liver samples. Ampicillin, amoxicillin/clavulanate, cephalexin and marbofloxacin (all well concentrated in bile) may be appropriate; add low-dose metronidazole if needed. One to three months of treatment may be required.
This is variable and unpredictable. Once severe fibrosis, cirrhosis or ascites develop prognosis is guarded.
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Please note this article was first published in November 2010