Chronic renal failure.xps
CHOLANGITIS/CHOLANGIOHEPATITIS COMPLEX OF
About the Diagnosis
In cats, as in people, cholangiohepatitis is an inflammation of the liver and the bile ducts within the liver. Unlike in
people, however, cats do not often have gallstones, nor do they get liver disease from hepatitis virus. Rather, cats
develop cholangiohepatitis either as a result of bacteria traveling to the liver from the intestine or if the cat's
immune system mistakenly identifies the liver as foreign and begins to attack it.
Cholangiohepatitis is the second most common liver disorder in cats in the United States, after hepatic lipidosis.
Two major forms of cholangiohepatitis are recognized: suppurative and lymphocytic. A liver biopsy and
microscopic examination of the biopsied liver tissue are required in al cases to distinguish between the two forms.
The distinction is an important one because treatments (medications) and prognosis (outlook) are different for
Microscopically, suppurative cholangitis/cholangiohepatitis is characterized by the presence of neutrophils, a type
of white blood cell. Bacteria can usually be cultured from the bile of affected cats, and the bacterial infection is
believed to originate from the intestinal tract by migrating up the bile duct. Inflammatory bowel disease and
pancreatitis are often coexisting diseases. Suppurative cholangitis/cholangiohepatitis occurs most frequently in
In lymphocytic cholangiohepatitis, a different type of white blood cell, called a lymphocyte, is most prominent on
the microscopic analysis of the biopsied liver tissue. This suggests an immune-mediated mechanism, meaning
that the body tries to destroy parts of the liver using the immune system. This may occur because the immune
system mistakenly identifies the liver as foreign. Inflammation and fibrosis (scarring) also are found in the bile
ducts, but bacterial infection is not present. Lymphocytic cholangiohepatitis is most often diagnosed in young cats,
and Persian cats are at higher risk of contracting the disease.
A predominant sign in both forms of cholangiohepatitis is icterus (jaundice). With icterus, the gums,
whites of the eyes, and even the visible skin in front of the ears take on a bright yellow color. Cats with the
suppurative form in particular tend to feel quite ill, often having a fever and refusing to eat. Cats with lymphocytic
cholangiohepatitis frequently do not seem ill, but have icterus and may have an enlarged belly due to increased
liver size and accumulation of fluid in the abdomen. They often continue to eat, although some will show
Symptoms and laboratory blood tests will establish a diagnosis of liver disease. X-rays and ultrasound
examination of the abdomen are then used for assessing the size of the liver, the texture of the liver tissue, the
appearance of the bile ducts, and so on. Determination of the exact nature of the liver disorder, which is essential
for the reasons mentioned above, requires a liver biopsy. Since liver disease can cause problems with blood
clotting, coagulation tests are necessary before the biopsy is taken, and treatment with medications or blood
plasma to normalize blood clotting ability may be required. A liver biopsy is done with the cat under general
anesthesia, either with a biopsy needle inserted through the skin under ultrasound guidance (minimally invasive)
or surgically through an operation into the abdomen. Although the surgical option is a more invasive procedure,
there are several advantages since the lesser invasive approach may be inadequate in some cases. Deciding
which method to use wil depend upon the condition of the individual pet and your veterinarian's experience.
Living with the Diagnosis
The outlook for cats with suppurative cholangiohepatitis is reasonably good. The disease reoccurs in some cats,
and an extended period of treatment with antibiotics may reduce the chances of reoccurrence. Success often
depends on the ability to identify and control any underlying factors. If inflammatory bowel disease and
pancreatitis are also present, for example, diagnosis and treatment of these conditions must be done
simultaneously. Most cats with lymphocytic cholangiohepatitis respond well to treatment, but the condition can be
life-long. Therefore, treatment may need to continue indefinitely, and depending on how wel the treatment
controls symptoms, periodic rechecks are usually necessary.
Suppurative cholangiohepatitis is treated with antibiotics, which can be given by mouth if tolerated (and if there is
no vomiting) or by injection in the hospital initially if necessary. Bacterial cultures should be submitted when the
liver biopsy is taken to determine the best antibiotics to use. Treatment must continue for at least 4 to 6 weeks to
Since lymphocytic cholangiohepatitis is thought to be an immune-mediated disease, treatment involves the
administration of immunosuppressive doses of cortisone-like drugs (corticosteroids), usually prednisolone. Other
immunosuppressive drugs are sometimes used. Treatment should continue for 6 to 12 weeks with gradual
tapering of the dose. Most cats respond well to treatment, but a few will need repeated treatments or long-term
low dose treatment with prednisolone to prevent relapses. If a large amount of fluid is present in the abdomen,
diuretics may be used initially to reduce the fluid accumulation. Colchicines may also be prescribed to limit fibrosis
In both suppurative and lymphocytic forms of the disease, additional medications such as ursodiol may be given
to promote bile flow. If clotting problems are present, vitamin K may be supplemented. The nutraceutical, SAMe,
may be beneficial in the treatment of liver disease. Ultimately, there are often several medications to be given in
cases of cholangiohepatitis, and the exact combination wil need to be tailored depending on the particulars of
In the most severe cases, cholangiohepatitis of either type may be severe enough to compromise a cat's life
span. Some indication of severity can be had from the biopsy result because the presence of excessive scar
tissue (fibrosis) is a negative sign, for example. Likewise, the manner in which the disease responds to
medications is always variable from one cat to the next. A positive response with reduction in symptoms and
improvement in all liver values on blood work is an important indicator of success.
Give all medications exactly as directed. Watch for improvement, or return, of icterus (yellow coloration) as a sensor of the severity of liver
Realize that cholangiohepatitis can be a severe problem. With proper treatment and persistence, most cats
improve, and many return to a normal quality of life.
Do not discontinue medications before your veterinarian advises you to do so. If you have difficulty giving
medication to your cat, consult your veterinarian for other dosing options. Usually formulations can be
prepared that will be tolerated by even the most finicky cat.
When to Call Your Veterinarian
If your cat is lethargic or not eating. If you have difficulty administering medications.
Your veterinarian will periodically examine your cat and submit blood for analysis of liver values to monitor
Printed from: Clinical Veterinary Advisor: Dogs and Cats (on 25 January 2011)
Coordination or Opposition in the Human SoulBetween body/flesh [soma/sarx], mind [nous, etc.], soul/life [psyche], spirit/Ghost [pneuma]Acts 2:26 Therefore did my heart rejoice, and my tongue was Mt 6:25 Therefore I say unto you, Take no thought for your life, glad; moreover also my flesh shall rest in hope:what ye shall eat, or what ye shall drink; nor yet for your body, what ye shall put on
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