Overview:

Cholangitis/cholangiohepatitis complex is a number of related inflammatory & or infectious disorders of the liver and/or the biliary tract. Cholangitis relates to infection or inflammation of the bile duct & cholangiohepatitis is inflammation of the biliary system & by extension the liver. Causes of infection may often include FIP, Pancreatitis, Inflammatory Bowel Disease, bacterial infection, parasitic infection (including toxoplasmosis).

There are three diseases in this complex.

• Acute or suppurative (pus forming) CHT - This is caused by bacteria which generally ascend the bile duct into the intrahepatic biliary system. In this form, the neutrophil is the primary inflammatory cell infiltrating the liver lesions.
• Chronic or lymphocytic CHT - This is caused by a sterile inflammatory process & may be perpetuated by an abnormal immune response as the predominant infiltrating cells are lymphocytes & plasma cells.
• Cirrhosis - This is the end stage resulting in terminal liver failure in which bile duct tissue is replaced by tough connective tissue. This isn't seen often as cats with cholangiohepatitis rarely survive long enough for it to develop into cirrhosis.

What are the symptoms?

Clinical signs of each disease in this complex are similar & include;

• Jaundice
• Lethargy
  
• Anorexia
  
• Vomiting
  
• Fever is common in the acute form but uncommon in the others
• Dehydration
  
• Diarrhea
  
• Ascites (fluid in the abdomen) occasionally occurs during cirrhosis

How is it diagnosed?

Your veterinarian will perform a physical examination of your cat & will want to run several tests, including blood work to look at:

• Chemistry panel
• Complete blood count
• Urinalysis
• Thyroid testing
• Bile acids tolerance test
• Ultrasound: An ultrasound can give your veterinarian an idea of the size & shape of your cat's liver & gallbladder, and detect gallstones & biliary obstruction (blockage of the flow of bile from the liver).
• X-Ray:  An x-ray may be taken to give your veterinarian an idea of the size & shape of your cat's liver. X-ray may also detect the presence of tumours.
• Biopsy: A liver biopsy is taken to determine the exact type of liver disease. This may be done at the same time as the ultrasound.
• Serologic Testing: Testing for diseases such as FeLV, FIV, FIP & toxoplasmosis may be taken as these diseases are associated with some liver disorders in cats.

How is it treated?

• Supportive care with IV or subcutaneous fluids & nutritional support.
• If the cause is bacterial, antibiotics will be prescribed.
• Medication to control vomiting if necessary.
• Corticosteroids may also be helpful in cats.
• Supportive care is primarily given in the final stage with an aim to maintain hydration & nutrition.
• Surgery to remove gallstones or correction of bile duct obstruction if necessary.