Cholangitis/Cholangiohepatitis Complex in Cats

What is cholangitis/cholangiohepatitis in cats?

Cholangitis/cholangiohepatitis complex is several related inflammatory and or infectious disorders of the liver and/or the biliary tract. Cholangitis relates to infection or inflammation of the bile duct and cholangiohepatitis is inflammation of the biliary system and by extension the liver. Causes of infection may often include feline infectious peritonitis, pancreatitis, inflammatory bowel disease, bacterial infection, parasitic infection (including toxoplasmosis).

There are three diseases in this complex:

• Acute or suppurative (pus-forming): Bacteria 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: A sterile inflammatory process that may be perpetrated by an abnormal immune response as the predominant infiltrating cells are lymphocytes and plasma cells.
• Cirrhosis: The end-stage which results in terminal liver failure. Tough connective tissue replaces bile duct tissue. This doesn’t occur often as cats with cholangiohepatitis rarely survive long enough to develop cirrhosis.

Symptoms

Clinical signs of each disease in this complex are similar and include:

• Jaundice (yellowing of the skin, whites of the eyes and mucous membranes)
• 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

Diagnosis

Your veterinarian will perform a physical examination of your cat and obtain a medical history from you.

Diagnostic workup:

• Baseline tests: Biochemical profile, complete blood count, and urinalysis to evaluate the organs and look for signs of infection or inflammation.
• Bile acids tolerance test: This test evaluates liver function. When a fatty meal is eaten, the gallbladder contracts to release bile into the small intestine to break down the fats. When the liver is healthy, approximately 90% of bile acids are reabsorbed into the portal circulation (blood to the liver) and taken up by the liver cells (hepatocytes) before being returned to the gallbladder. Hepatocytes are not able to perform this role efficiently in cats with liver disorders and the bile enters the systemic (body) blood supply. The bile acid test measures levels of bile in the blood before a fatty meal and then two hours afterwards. Elevated bile levels are indicative of a liver that isn’t doing its job.
• Ultrasound: An ultrasound can give your veterinarian an idea of the size and shape of your cat’s liver and gallbladder, and detect gallstones and biliary obstruction (blockage of the flow of bile from the liver).
• X-ray: To evaluate the size and shape of the liver and evaluate for tumours.
• Biopsy: Determine the exact type of liver disease. Which can be taken during the ultrasound.
• Serologic testing: Testing for FeLV, FIV, FIP, and toxoplasmosis which are associated with some liver disorders in cats.

Treatment

• Supportive care with intravenous or subcutaneous fluids as well as nutritional support, medications to control vomiting if necessary, corticosteroids can help to reduce inflammation. Surgery will be necessary to remove gallstones or correct bile duct obstruction.