Cholangitis, Neutrophilic

Also known as suppurative cholangitis, exudative cholangitis/cholangiohepatitis and acute cholangitis/cholangiohepatitis.

Signalment

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.

Description

Neutrophilic cholangiohepatitis is characterised by infiltration of large numbers of neutrophils into portal areas of the liver and into the bile ducts. It results from ascending bacterial infection from the small intestines. Escherichia coli, Staphylococcus spp., Streptococcus spp., Clostridium spp., Bacillus spp., Actinomyces spp., Bacteroides spp. and occasionally Salmonella spp. have been isolated. Concurrent biliary tract disease are common in cats, especially pancreatitis and inflammatory bowel disease. Other predisposing factors include congenital or acquired abnormalities of the biliary system such as that of anatomic abnormalities of the gall bladder or common bile duct, bile duct obstruction caused by inspissated bile, cholelithiasis and cholecystitis.

Diagnosis

Clinical Signs

Acute presentation with pyrexia, abdominal pain, lethargy, jaundice.

Haematology & Biochemistry

Increased segmented and band neutrophils. Increased ALT and total bilirubin concentration

Imaging

A coarse or nodular texture to the liver on ultrasonography. More chronic cases may have dilation of the biliary tract.

Cytology and Culture

Bile samples for cytology is needed for a definitive diagnosis. Histopathology of the liver alone is not adequate as the disease tend to be confined to the biliary tract and pathology of the liver can be non specific and mild. Cytology shows bacteria and neutrophils. Culture and sensitivity should be performed for appropriate choice of antibiotics.

Treatment

• Long course, 4-6 weeks, of an appropriate antibiotic following culture and sensitivity should be used. Amoxicillin at 15-20 mg/kg PO q8hours is a good initial choice.
• Ursodeoxycholic acid at 15 mg/kg q24hours may be given due to its choleretic, which promotes increased fluidity of biliary secretions to treat or prevent sludging, and hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties.
• A high protein diet rather than a protein-restricted diet is more appropriate for feeding anorexic cats to prevent the development of hepatic lipidosis

Prognosis

Good provided the cats are treated early and appropriately.