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− | | + | Also known as: '''''Lymphocytic-plasmacytic cholangitis —Cholangiohepatitis — Non-suppurative cholangitis''''' |
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− | {| cellpadding="10" cellspacing="0" border="1"
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− | | Also known as:
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− | | '''Lymphocytic-plasmacytic cholangitis<br>
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− | '''Cholangiohepatitis'''
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− | '''Non-suppurative cholangitis'''
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− | ==Description==
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− | '''Lymphocytic cholangitis''' is a slowly progressive chronic disease characterised by infiltration of the portal areas of the liver with inflammatory cells, mostly [[Lymphocytes|lymphocytes]] and [[B cell differentiation - WikiBlood#Plasma cells|plasma cells]]. Bile duct hypertrophy and [[Liver Fibrosis|fibrosis]] are present. However, lymphocytic cholangitis does not progress to biliary [[Cirrhosis|cirrhosis]]. An immune-mediated aetiology has been postulated but this has not been substantiated to date. It is rarely associated with [[Pancreatitis - Dog and Cat|pancreatitis]], compared to [[Cholangitis, Neutrophilic]] | |
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| + | ==Introduction== |
| + | '''Lymphocytic cholangitis''' is a slowly progressive chronic disease characterised by infiltration of the portal areas of the liver with inflammatory cells, mostly [[Lymphocytes - Introduction|lymphocytes]] and [[B cell differentiation#Plasma cells|plasma cells]]. Bile duct hypertrophy and [[Liver Fibrosis|fibrosis]] are present. However, lymphocytic cholangitis does not progress to biliary [[Cirrhosis|cirrhosis]]. An immune-mediated aetiology has been postulated but this has not been substantiated to date. It is rarely associated with [[Pancreatitis|pancreatitis]], compared to [[Cholangitis, Neutrophilic]] |
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| ==Signalment== | | ==Signalment== |
− | Young to middle-aged cats, 50% are under 4 years old. | + | Young to middle-aged cats, 50% are under 4 years old. Persians are often predisposed. |
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| ==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 [[Vomiting|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. Many show hepatomegaly and some have generalised lymphadenopathy. Possible sequel is chronic biliary cirrhosis and ascites. Due to the likelihood of liver being affected too, [[Hepatic Encephalopathy|hepatic encephalopathy]] and bleeding disorders may occur. |
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| ===Laboratory Tests=== | | ===Laboratory Tests=== |
| ====Haematology==== | | ====Haematology==== |
− | [[Changes in Inflammatory Cells Circulating in Blood - Pathology#Neutrophilia|Neutrophilia]] is less common than with [[Cholangitis, Neutrophilic]] | + | [[Neutrophilia|Neutrophilia]] is less common than with [[Cholangitis, Neutrophilic]] |
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| ====Biochemistry==== | | ====Biochemistry==== |
| Increased alkaline phosphatase (ALP), alanine aminotransferase (ALT), Hyperbilirubinaemia and Hyperglobulinaemia. | | Increased alkaline phosphatase (ALP), alanine aminotransferase (ALT), Hyperbilirubinaemia and Hyperglobulinaemia. |
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| ===Diagnostic Imaging=== | | ===Diagnostic Imaging=== |
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| ====Ultrasonography==== | | ====Ultrasonography==== |
| Ultrasonography is more helpful. Biliary tract dilation can be seen in all cases. Common bile duct is normally dilated and the [[Gall Bladder - Anatomy & Physiology|gall bladder]] may also be dilated with "sludge". Main differential is extrahepatic biliary obstruction. | | Ultrasonography is more helpful. Biliary tract dilation can be seen in all cases. Common bile duct is normally dilated and the [[Gall Bladder - Anatomy & Physiology|gall bladder]] may also be dilated with "sludge". Main differential is extrahepatic biliary obstruction. |
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| ===Histopathology=== | | ===Histopathology=== |
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| 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. |
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− | 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. | + | [[Liver Drugs|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. |
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| ==Prognosis== | | ==Prognosis== |
| Poor due to the waxing and waning feature of this disease. In cats, this disease does not usually progress to end-stage cirrhosis and therefore it does not usually result in death, which is in contrast to dogs. | | Poor due to the waxing and waning feature of this disease. In cats, this disease does not usually progress to end-stage cirrhosis and therefore it does not usually result in death, which is in contrast to dogs. |
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| + | {{Learning |
| + | |Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis01103.asp/ Cholangitis] |
| + | |literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=Cholangitis&occuring1=title&rowId=2&options2=AND&q2=Lymphocytic&occuring2=title&rowId=3&options3=AND&q3=&occuring3=freetext&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all&x=48&y=8 Lymphocytic Choloangitis publications] |
| + | }} |
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| ==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''. |
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| 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''. |
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| 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:Cat]][[Category:Dog]] | + | |
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| + | [[Category:Gall_Bladder_and_Tract_-_Pathology]]]] |
| + | [[Category:Gall Bladder and Tract Diseases - Cat]][[Category:Gall Bladder and Tract Diseases - Dog]] |
| + | [[Category:Expert_Review]] |