Difference between revisions of "Cholangitis"
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| + | ==Introduction== | ||
| + | Cholangitis describes an inflammation of the biliary tract. Cholangiohepatitis describes the inflammation of the biliary tract and the surrounding hepatic parenchyma. It is typically categorised into [[Cholangitis, Neutrophilic|Neutrophilic Cholangitis]] and [[Cholangitis, Lymphocytic|Lymphocytic Cholangitis]]. | ||
| − | + | ==Signalment== | |
| − | + | Cholangitis is common in cats, where a periportal hepatocellular necrosis is seen together with | |
| + | the presence of neutrophils in the portal area. Cats can be acutely or chronically affected, and | ||
| + | male, pure bred cats are over represented. | ||
| + | |||
| + | The condition is also seen in calves as a secondary condition to bacterial infection, such as ''Salmonella''. | ||
| − | + | ==Causes== | |
| − | *ascending infections from the intestine | + | *ascending infections from the intestine where stasis of bile flow has developed |
| − | + | *associated with organisms excreted via the bile such as salmonellosis infection in calves | |
| − | *associated with organisms excreted via the bile | ||
| − | |||
| − | == | + | ==Clinical Signs== |
| − | + | See [[Cholangitis, Neutrophilic#History and Clinical Signs|neutrophilic]] and [[Cholangitis, Lymphocytic#History and Clinical Signs|lymphocytic]] cholangitis separately. | |
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| − | == | + | ==Laboratory Findings== |
| − | + | '''Biochemistry''' may show raised ALT, serum bilirubin, bile acids and globulin levels and decreased albumin. '''Haematology''' may reveal mild anaemia, lymphocytosis or lymphopaenia, monocytosis and possibly thrombocytopenia. | |
| − | |||
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| + | There may be prolonged clotting. | ||
| + | |||
| + | Abdominocentesis typically shows high protein. | ||
| + | |||
| + | ==Ultrasound== | ||
| + | Hyperechogenicity of the liver may be observed with distension of the biliary tree, thickened gall bladder. The common bile duct may be [[Biliary Tract Obstruction|obstructed]]. Mesenteric lymph nodes may be enlarged, duodenal walls thickened and pancreas irregular. | ||
| + | |||
| + | ==Biopsy== | ||
| + | Liver biopsy is required for definitive diagnosis. Blood clotting and platelet count should be assessed first. | ||
| + | |||
| + | ==Histology== | ||
| + | Lymphocytic infiltration of the portal areas is seen, with mild fibrosis and biliary hyperplasia. | ||
| + | |||
| + | ==Exploratory Laparotomy== | ||
| + | Exploratory laparotomy may be indicated to assess patency of the biliary tract and collect samples for histopathology from the liver, small intestine, mesenteric lymph nodes and pancreas. Bile and liver sample may be sent for culture. | ||
| + | |||
| + | ==Treatment== | ||
| + | Treatment is mainly empirical. Analgesics should be administered, particularly if laparotomy was performed. Intravenous fluids with added potassium and feeding should initiate. Anti-emetic may be needed. Antibiotic therapy (ideally according to culture and sensitivity in neutrophilic cholangitis) may last for one to three months. Immunosuppressive treatment is used for chronic neutrophilic and lymphocytic cholangitis. Corticosteroids are used commonly but methotrexate, chlombucil or cyclosporin A should be considered not forgetting their hepatotoxic potential. | ||
| + | |||
| + | ===Supportive treatment=== | ||
| + | Liver antioxidants including SAMe, vitamin E and milk thistle (silybin), ursodeoxycholic acid is antiinflammatory and for improved bile flow, metoclopramide as a pro-kinetic and anti-emetic, antacid, cholchicine if fibrosis is severe and B vitamins to counteract deficiency due to anorexia and improve appetite. Vitamin C, L-carnitine and liver supporting diet. Vitamin K may be needed if there are problems with haemostasis. | ||
| + | |||
| + | Any associated conditions must be addressed, including possible surgery for obstructed bile duct. | ||
| + | |||
| + | ==Prognosis== | ||
| + | Prognosis varies but it is guarded if ascites, sever fibrosis or cirrhosis has developed. | ||
| + | |||
| + | {{Learning | ||
| + | |flashcards = [[Liver_Flashcards_-_Pathology|Liver Pathology Flashcards]] | ||
| + | |literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=cholangitis&occuring1=title&rowId=2&options2=AND&q2=cats&occuring2=od&rowId=3&options3=AND&q3=&occuring3=freetext&x=52&y=9&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Cholangitis in cats publications] | ||
| + | |full text = [http://www.cabi.org/cabdirect/FullTextPDF/2010/20103181556.pdf '''Bacteria and feline cholangitis.''' Simpson, K. W.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Orlando, Florida, USA, 16-20 January 2010, 2010, pp 635-637, 14 ref.]<br> | ||
| + | [http://www.cabi.org/cabdirect/FullTextPDF/2010/20103139153.pdf '''How I treat feline hepatic lipidosis and feline cholangitis.''' Marks, S. L.; World Small Animal Veterinary Association, Sao Paulo, Brazil, 34th World Small Animal Veterinary Association Congress, São Paulo, Brazil, 21-24 July 2009, 2009, pp unpaginated]<br> | ||
| + | [http://www.cabi.org/cabdirect/FullTextPDF/2007/20073085519.pdf '''Cholangitis in cats - a review.''' Rothuizen, J.; Svoboda, M. ; Czech Small Animal Veterinary Association, Prague, Czech Republic, 2006 World Congress Proceedings. 31st World Small Animal Association Congress, 12th European Congress FECAVA, & 14th Czech Small Animal Veterinary Association Congress, Prague, Czech Republic, 11-14 October, 2006, 2006, pp 435-437] | ||
| + | |Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis01103.asp Cholangitis] | ||
| + | }} | ||
| + | |||
| + | ==References== | ||
| + | |||
| + | Gunn-Moore, D. (2010), '''Cholangitis complex in the cat''' ''Veterinary Times'', Vol.40, No. 43 | ||
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| + | |||
| + | {{review}} | ||
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| + | {{OpenPages}} | ||
[[Category:Liver_-_Inflammatory_Pathology]] | [[Category:Liver_-_Inflammatory_Pathology]] | ||
| − | [[Category:Cat]][[Category:Cattle]] | + | [[Category:Gall Bladder and Tract Diseases - Cat]][[Category:Liver Diseases - Cat]][[Category:Biliary Diseases - Cattle]] |
[[Category:Gall Bladder and Tract - Pathology]] | [[Category:Gall Bladder and Tract - Pathology]] | ||
| + | [[Category:Expert Review - Small Animal]] | ||
Latest revision as of 10:16, 21 May 2016
Introduction
Cholangitis describes an inflammation of the biliary tract. Cholangiohepatitis describes the inflammation of the biliary tract and the surrounding hepatic parenchyma. It is typically categorised into Neutrophilic Cholangitis and Lymphocytic Cholangitis.
Signalment
Cholangitis is common in cats, where a periportal hepatocellular necrosis is seen together with the presence of neutrophils in the portal area. Cats can be acutely or chronically affected, and male, pure bred cats are over represented.
The condition is also seen in calves as a secondary condition to bacterial infection, such as Salmonella.
Causes
- ascending infections from the intestine where stasis of bile flow has developed
- associated with organisms excreted via the bile such as salmonellosis infection in calves
Clinical Signs
See neutrophilic and lymphocytic cholangitis separately.
Laboratory Findings
Biochemistry may show raised ALT, serum bilirubin, bile acids and globulin levels and decreased albumin. Haematology may reveal mild anaemia, lymphocytosis or lymphopaenia, monocytosis and possibly thrombocytopenia.
There may be prolonged clotting.
Abdominocentesis typically shows high protein.
Ultrasound
Hyperechogenicity of the liver may be observed with distension of the biliary tree, thickened gall bladder. The common bile duct may be obstructed. Mesenteric lymph nodes may be enlarged, duodenal walls thickened and pancreas irregular.
Biopsy
Liver biopsy is required for definitive diagnosis. Blood clotting and platelet count should be assessed first.
Histology
Lymphocytic infiltration of the portal areas is seen, with mild fibrosis and biliary hyperplasia.
Exploratory Laparotomy
Exploratory laparotomy may be indicated to assess patency of the biliary tract and collect samples for histopathology from the liver, small intestine, mesenteric lymph nodes and pancreas. Bile and liver sample may be sent for culture.
Treatment
Treatment is mainly empirical. Analgesics should be administered, particularly if laparotomy was performed. Intravenous fluids with added potassium and feeding should initiate. Anti-emetic may be needed. Antibiotic therapy (ideally according to culture and sensitivity in neutrophilic cholangitis) may last for one to three months. Immunosuppressive treatment is used for chronic neutrophilic and lymphocytic cholangitis. Corticosteroids are used commonly but methotrexate, chlombucil or cyclosporin A should be considered not forgetting their hepatotoxic potential.
Supportive treatment
Liver antioxidants including SAMe, vitamin E and milk thistle (silybin), ursodeoxycholic acid is antiinflammatory and for improved bile flow, metoclopramide as a pro-kinetic and anti-emetic, antacid, cholchicine if fibrosis is severe and B vitamins to counteract deficiency due to anorexia and improve appetite. Vitamin C, L-carnitine and liver supporting diet. Vitamin K may be needed if there are problems with haemostasis.
Any associated conditions must be addressed, including possible surgery for obstructed bile duct.
Prognosis
Prognosis varies but it is guarded if ascites, sever fibrosis or cirrhosis has developed.
References
Gunn-Moore, D. (2010), Cholangitis complex in the cat Veterinary Times, Vol.40, No. 43
 |
This article has been peer reviewed but is awaiting expert review. If you would like to help with this, please see more information about expert reviewing. |
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