Felis ISSN 2398-2950

Liver: cholangitis

Synonym(s): Cholangiohepatitis

Contributor(s): Ed Hall, Mark W Jackson

Introduction

  • A group of inflammatory liver diseases with a spectrum of histological classifications including neutrophilic (suppurative), and inflammatory (lymphocytic and biliary cirrhosis)*.
  • Cause: unknown, ascending infection from gut.
  • Signs: hepatic disease - icterus, pyrexia, anorexia, ascites, vomiting and diarrhea, lethargy, weight loss.
  • Diagnosis: biochemistry, biopsy.
  • Treatment: supportive as for hepatic disease, specific therapy depends on histological type.
  • See also acute hepatic disease Liver: acute disease.
  • * From the WSAVA Liver Standardization Group (2006):
    • Neutrophilic cholangitis (acute and chronic).
    • Lymphocytic cholangitis (acute and chronic).
    • Chronic cholangitis (fluke infestation in endemic areas (not UK)).
    • For neutrophilic and lymphocytic cholangitis terminology is descriptive of the major infiltrating cell type but mixed inflammatory reactions can occur. These are the two most clearly recognisable forms and both correlate to distinct, different clinical presentations that require different management.

Pathogenesis

Etiology

Specific

Pathophysiology

Neutrophilic cholangitis (formerly suppurative cholangiohepatitis)

  • Ascending bacterial infection   →   hepatitis   →   immune-mediated response.
  • Role of concurrent cholelithiasis, bile duct/gall bladder anomalies, pancreatitis and inflammatory bowel disease in etiopathogenesis is by association but mechanisms are unclear.

Non-suppurative cholangitis

  • Lymphocytic:
    • ?Immune-mediated/autoimmune condition.
  • Scirrhous or biliary cirrhosis  Liver: cirrhosis:
    • ?End-stage of other forms of cholangitis.
  • Partial/total obstruction to bile flow   →   leakage of conjugated bilirubin into blood stream   →   icterus.
  • Cholangiohepatitis is often found concurrently with other diseases, such as pancreatitis Pancreatitis and inflammatory bowel disease Inflammatory bowel disease: overview. The concurrent occurrence of these three disorders in cats is termed "triaditis".

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Weiss D J, Gagne J M & Armstrong P J (1996) Relationship between inflammatory hepatic disease and inflammatory bowel disease, pancreatitis and nephritis in cats. JAVMA 209 (6), 1114-1116 PubMed.

Other sources of information

  • Marks S L (2008) Feline hepatic disorders: update on diagnosis and management. Proceedings of the 51st BSAVA Congress, pp 201-205.
  • Jackson M W (2008) New developments in liver disease in cats. ESFM Pre-Congress Symposium, 33rd WSAVA Congress.
  • WSAVA Liver Standardization Group (2006). Standards for clinical and histological diagnosis of canine and feline liver diseases. Rothuzien J, Bunch S E, Cullen J M, Charles J A, Desmet V J, Twedt D C, van den Ingh T, van Winkle T, Washabua J (eds), Saunders/Elsevier, Edinburgh.


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