Changes

==Diagnosis==

==Diagnosis==

===Clinical Signs===

===Clinical Signs===

*History of chronic waxing and waning low-grade illness.

History of chronic waxing and waning low-grade illness.

Vague clinical signs which may include anorexia, depression, weight loss, intermittent [[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] and [[Diarrhoea|diarrhoea]], [[Icterus|jaundice]],lymphadenomegaly. Severe illness and pyrexia is less likely compared to [[Cholangitis, Neutrophilic]].   

Vague clinical signs which may include anorexia, depression, weight loss, intermittent [[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] and [[Diarrhoea|diarrhoea]], [[Icterus|jaundice]],lymphadenomegaly. Severe illness and pyrexia is less likely compared to [[Cholangitis, Neutrophilic]].   

Some cats in the UK are polyphagic and are frequently presented with ascites and/or jaundice.

Some cats in the UK are polyphagic and are frequently presented with ascites and/or jaundice.

===Laboratory Tests===

===Laboratory Tests===

====Haematology====

====Haematology====

*[[Changes in Inflammatory Cells Circulating in Blood - Pathology#Neutrophilia|Neutrophilia]] is less common than with [[Cholangitis, Neutrophilic]]

[[Changes in Inflammatory Cells Circulating in Blood - Pathology#Neutrophilia|Neutrophilia]] is less common than with [[Cholangitis, Neutrophilic]]

====Biochemistry====

====Biochemistry====

==Treatment==

==Treatment==

*Immunosuppressives

*Immunosuppressives

**Glucocorticoid at initial immunosuppressive dose for 6-12 weeks.

Glucocorticoid at initial immunosuppressive dose for 6-12 weeks. This should be tapered gradually to alternate day dosing.  However, recurrence is common following initial amelioration of clinical signs.  Response to therapy is hard to assess due to the slowly progressive nature of this disease.  A persistent rise in ALT and/or increasing total serum bilirubin indicates an inadequate control of the disease.

***This should be tapered gradually to alternate day dosing.  However, recurrence is common following initial amelioration of clinical signs.  Response to therapy is hard to assess due to the slowly progressive nature of this disease.  A persistent rise in ALT and/or increasing total serum bilirubin indicates an inadequate control of the disease.

 

**Azathioprine has been trialled but this is not recommended due to its side effects which include inappetence and leucopaenia.

Azathioprine has been trialled but this is not recommended due to its side effects which include inappetence and leucopaenia. Methotrexate at low weekly dose has also been used in a few affected cats.

**Methotrexate at low weekly dose has also been used in a few affected cats.

 

*Antibiotic may be given at early stages of treatment until an infectious cause has been ruled out.

Antibiotic may be given at early stages of treatment until an infectious cause has been ruled out.

*Ursodeoxycholic acid at PO may be given.

 

**It has hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties and choleretic effect.  The latter promotes increased fluidity of biliary secretions for treating or preventing sludging.

Ursodeoxycholic acid may be given as it has hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties and choleretic effect.  The latter promotes increased fluidity of biliary secretions for treating or preventing sludging. Additionally antioxidants such as S-adenosylmethionine and vitamin E can be given to counteract the potent oxidising property of bile.

*Antioxidants such as S-adenosylmethionine and vitamin E.

**These are used to counteract the potent oxidising property of bile.

==References==

==References==

*Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.

Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.

*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

*Marks, S.L. (2003). '''Update on the Diagnosis and Management of Feline Cholangiohepatitis''' ''Waltham Feline Medicine Symposium''.

Marks, S.L. (2003). '''Update on the Diagnosis and Management of Feline Cholangiohepatitis''' ''Waltham Feline Medicine Symposium''.

[[Category:Gall_Bladder_and_Tract_-_Pathology]][[Category:To_Do_-_Caz]]

[[Category:Gall_Bladder_and_Tract_-_Pathology]][[Category:To_Do_-_Caz]]