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) – Due to bacteria which 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 – 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.
Clinical signs of each disease in this complex are similar and include:
- Jaundice (yellowing of the skin, whites of the eyes and mucous membranes)
- Fever is common in the acute form but uncommon in the others
- Ascites (fluid in the abdomen) occasionally occurs during cirrhosis
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 to release 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: 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 diseases such as FeLV, FIV, FIP, and toxoplasmosis as these diseases are associated with some liver disorders in cats.
- Supportive care with intravenous or subcutaneous fluids as well as nutritional support.
- 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.