Cholangitis/Cholangiohepatitis Complex in Cats-Causes, Symptoms & Treatment

Cholangiohepatitis in cats

What is cholangitis/cholangiohepatitis complex?

Cholangitis/cholangiohepatitis complex is a number of 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) 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 and may be perpetuated by an abnormal immune response as the predominant infiltrating cells are lymphocytes and 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 and include:

How is it diagnosed?

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

  • 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, releasing bile into the small intestine to break down the fats. In a cat with a healthy liver, approximately 90% of bile acids are then reabsorbed into the portal circulation (blood to the liver) and reabsorbed by the liver cells (known as hepatocytes) before being returned to the gallbladder. In cats with liver disorders, the hepatocytes are not able to perform this role efficiently 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 which 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:  An x-ray may be taken to give your veterinarian an idea of the size and 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, and toxoplasmosis as these diseases are associated with some liver disorders in cats.

How is it treated?

  • Supportive care with intravenous or subcutaneous fluids and nutritional support.

  • If the cause is bacterial, antibiotics will be prescribed.

  • Medication to control vomiting if necessary.

  • Corticosteroids may also be helpful in cats to reduce inflammation.

  • Surgery to remove gallstones or correction of bile duct obstruction if necessary.




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