Changes

{{review}}

{{unfinished}}

 

 

 

==Signalment==

==Signalment==

*More common in cats than in dogs.

More common in cats than in dogs. Cats of all breeds and ages can be affected, but often young to middle-aged cats. Male cats are more at risk.

*Cats of all breeds and ages can be affected, but often young to middle-aged cats.

*Male cats are more at risk.

==Diagnosis==

==Diagnosis==

===Clinical Signs===

===History and Clinical Signs===

Acute presentation with

Acute presentation with severe illness in contrast to cats with [[Cholangitis, Lymphocytic|Lymphocytic cholangitis]]. Signs include pyrexia, depression, lethargy, abdominal pain, [[Icterus|jaundice]] and dehydration.

*severe illness - compared to cats with other liver disease

*pyrexia

*depression and lethargy

*abdominal pain

*[[Icterus|jaundice]]

===Laboratory Tests===

===Laboratory Tests===

====Haematology====

====Haematology====

*Mild [[Changes in Inflammatory Cells Circulating in Blood - Pathology #Neutrophilia|neutrophilia]] with left shift

Mild [[Changes in Inflammatory Cells Circulating in Blood - Pathology #Neutrophilia|neutrophilia]] with left shift

====Biochemistry====

====Biochemistry====

*Increased alanine aminotransferase (ALT)

Increased alanine aminotransferase (ALT), Normally to slightly increased alkaline phosphatase (ALP) and Normal to slightly increased total bilirubin concentration

*Normally to slightly increased alkaline phosphatase (ALP)

*Normal to slightly increased total bilirubin concentration

==Treatment==

==Treatment==

A long course (4-6 weeks), of an appropriate antibiotic should be given in light of bacterial culture and sensitivity results. Selected antibiotic should be excreted in the bile in active form, and should be active against aerobic and anaerobic intestinal coliforms.[[Penicillins|Amoxicillin]] potentiated with clavulanic acid is a good initial choice. [[Nitroimidazoles|Metronidazole]] may be added to extend the spectrum of anaerobes and coliforms.

**A long course, 4-6 weeks, of an appropriate antibiotic should be given in light of bacterial culture and sensitivity results.

Surgery is warranted if discrete choleliths or complete biliary obstruction is identified. In cases of complete extrahepatic biliary obstruction, surgical decompression and cholecystoduodenostomy or cholecystojejunostomy should be performed.

**Selected antibiotic should be excreted in the bile in active form, and should be active against aerobic and anaerobic intestinal coliforms.

[[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.

**[[Penicillins|Amoxicillin]] potentiated with clavulanic acid is a good initial choice.

Aggressive supportive care is required due to severe illness. Fluid and electrolyte derangements should be corrected and Vitamin K1 may be given if bleeding diatheses develop. A high protein diet rather than a protein-restricted diet is more appropriate for feeding anorexic cats to prevent the development of [[Hepatic Lipidosis|hepatic lipidosis]]

**[[Nitroimidazoles|Metronidazole]] may be added to extend the spectrum of anaerobes and coliforms.

Monitor response to treatment with serial complete haematology and biochemistry.

*Surgery is warranted if discrete choleliths or complete biliary obstruction is identified.

**In cases of complete extrahepatic biliary obstruction, surgical decompression and cholecystoduodenostomy or cholecystojejunostomy should be performed.

*[[Liver Drugs|Ursodeoxycholic acid]] 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.

*Aggressive supportive care is required due to severe illness.

**Fluid and electrolyte derangements should be corrected.

**Vitamin K1 may be given if bleeding diatheses develop.

*A high protein diet rather than a protein-restricted diet is more appropriate for feeding anorexic cats to prevent the development of [[Hepatic Lipidosis|hepatic lipidosis]]

*Monitor response to treatment with serial complete haematology and biochemistry.