Overview of Feline Cholangiohepatitis
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
Causes of Nonsuppurative Cholangiohepatitis
This type of cholangiohepatitis is thought to be an immune disorder associated with the following conditions:
What to Watch For
Diagnosis of Cholangiohepatitis in Cats
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:
Treatment of Cholangiohepatitis in Cats
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.
In-depth Information on Cholangiohepatitis in Cats
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.
Differential Diagnosis for Cholangiohepatitis in Cats
There are several diseases/disorders that appear similar to cholangiohepatitis. These include:
Other disorders associated with ascites (fluid in the abdominal cavity) also need to be differentiated or ruled out:
Other disorders associated with jaundice need to be considered:
Certain diagnostic tests must be performed to make a definitive diagnosis of cholangiohepatitis and, as importantly, exclude other disease processes that may cause similar symptoms. Obtaining a complete history, description of clinical signs, and thorough physical examination are all important in obtaining a diagnosis. Ultimately, a liver biopsy is necessary to obtain a definitive diagnosis.
The following tests are recommended to rule out other disorders and to confirm a diagnosis of cholangiohepatitis.
Ultrasound is often considered the diagnostic tool of choice. The ultrasound itself is a noninvasive procedure, although sampling of the tissue will often necessitate sedation or general anesthesia, and is associated with some minor risks. These procedures generally necessitate the expertise of a specialist and/or referral hospital.
Your veterinarian may recommend additional tests to exclude or diagnose concurrent conditions, or more definitively diagnose cholangiohepatitis. These tests are not necessary in every case, however may be of benefit in certain individuals, and are selected on a case-by-case basis. These include;
Patients with cholangiohepatitis may need to be hospitalized and treated aggressively. Depending on the stage of disease and clinical signs involved, outpatient therapy may or may not be sufficient. It is extremely important to have a diagnosis confirming the exact type of cholangiohepatitis involved, as treatment protocols will vary.
Follow-up Care for Cats with Cholangiohepatitis
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your cat does not improve rapidly.
Administer all prescribed medications and dietary changes as directed. Alert your veterinarian if you are experiencing problems treating your pet.
Initially, blood tests are taken every few weeks to monitor the cat's progress. Eventually the tests are then taken every four to six months. In some cases, a second liver biopsy is recommended to assess response to therapy after some time has passed.
The prognosis for cats with cholangiohepatitis is quite variable and unpredictable. Individuals with suppurative cholangiohepatitis may have an excellent response to therapy, return to normal and have no recurrence of the disease. If the cat is severely ill and debilitated at the time of diagnosis, however, the long-term outlook can be poor with suppurative cholangiohepatitis. With nonsuppurative disease, chronic, long-term remission is possible, although some affected individuals succumb to the disease regardless of appropriate therapy. The prognosis is usually worse if biliary cirrhosis is diagnosed, as the presence of scar tissue can indicate the liver has a poor capacity for recovery.