Difference between revisions of "Cholangitis, Neutrophilic"
Jump to navigation
Jump to search
| (25 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
| − | {{ | + | {{review}} |
| − | Also known as | + | |
| + | {{cat}} | ||
| + | |||
| + | |||
| + | Also known as ''suppurative cholangitis'', ''exudative cholangitis/cholangiohepatitis'' and ''acute cholangitis/cholangiohepatitis''. | ||
| − | |||
| − | |||
==Signalment== | ==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. | + | *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 - WikiBlood|neutrophils]] into portal areas of the [[Liver - Anatomy & Physiology|liver]] and into the [[Liver - Anatomy & Physiology #Hepatic Duct Systems|bile ducts]]. It results from ascending bacterial infection from the [[Small Intestine - Anatomy & Physiology|small intestines]]. [[Escherichia coli]], [[Staphylococcus spp.]], ''[[Streptococci|Streptococcus]] spp.'', ''[[:Category:Clostridium species|Clostridium spp.]]'', ''[[Bacillus species|Bacillus spp.]]'', ''[[:Category:Actinomyces|Actinomyces spp.]]'', ''[[Bacteroides|Bacteroides spp.]]'' and occasionally ''[[Salmonella|Salmonella spp.]]'' have been isolated. Concurrent biliary tract disease are common in cats, especially [[Pancreatitis - WikiClinical|pancreatitis]] and [[Inflammatory Bowel Disease - WikiClinical|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 - Anatomy & Physiology|gall bladder]] or common bile duct, bile duct obstruction caused by inspissated bile, cholelithiasis and cholecystitis. | ||
| + | |||
==Diagnosis== | ==Diagnosis== | ||
| − | === | + | ===Clinical Signs=== |
| − | Acute presentation with severe illness | + | Acute presentation with |
| + | *severe illness - compared to cats with other liver disease | ||
| + | *pyrexia | ||
| + | *depression and lethargy | ||
| + | *abdominal pain | ||
| + | *[[Liver General Pathology - Pathology|jaundice]] | ||
| + | *dehydration | ||
| + | |||
===Laboratory Tests=== | ===Laboratory Tests=== | ||
====Haematology==== | ====Haematology==== | ||
| − | Mild [[Neutrophilia|neutrophilia]] with left shift | + | *Mild [[Changes in Inflammatory Cells Circulating in Blood - Pathology #Neutrophilia|neutrophilia]] with left shift |
| + | ====Biochemistry==== | ||
| + | *Increased alanine aminotransferase (ALT) | ||
| + | *Normally to slightly increased alkaline phosphatase (ALP) | ||
| + | *Normal to slightly increased total bilirubin concentration | ||
| − | |||
| − | |||
===Diagnostic Imaging=== | ===Diagnostic Imaging=== | ||
====Ultrasonography==== | ====Ultrasonography==== | ||
A coarse or nodular texture to the liver can be seen. However, most have variable or no detectable changes in echogenicity of the liver parenchyma. More chronic cases may have dilation of the biliary tract. | A coarse or nodular texture to the liver can be seen. However, most have variable or no detectable changes in echogenicity of the liver parenchyma. More chronic cases may have dilation of the biliary tract. | ||
| + | |||
===Histopathology=== | ===Histopathology=== | ||
| − | Liver cytology or tissue biopsy is required to differentiate inflammatory liver disease from [[Hepatic Lipidosis|hepatic lipidosis]] and [[Neoplasia - Pathology|neoplasia]]. Bile samples for cytology is needed for a definitive diagnosis. It is not adequate to perform liver biopsy alone as the disease tend to be confined to the biliary tract and pathology of the liver can be non specific and mild. Cytologically, neutrophilic cholangitis usually shows bacteria and [[Neutrophils|neutrophils]]. Culture and sensitivity should be performed for appropriate choice of antibiotics. | + | Liver cytology or tissue biopsy is required to differentiate inflammatory liver disease from [[Hepatic Lipidosis - WikiClinical|hepatic lipidosis]] and [[Neoplasia - Pathology|neoplasia]]. Bile samples for cytology is needed for a definitive diagnosis. It is not adequate to perform liver biopsy alone as the disease tend to be confined to the biliary tract and pathology of the liver can be non specific and mild. Cytologically, neutrophilic cholangitis usually shows bacteria and [[Neutrophils - WikiBlood|neutrophils]]. Culture and sensitivity should be performed for appropriate choice of antibiotics. |
| + | |||
==Treatment== | ==Treatment== | ||
| − | A long course | + | *Antibiotics |
| − | 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. | + | **A long course, 4-6 weeks, of an appropriate antibiotic should be given in light of bacterial culture and sensitivity results. |
| − | [[Liver Drugs|Ursodeoxycholic acid]] may be given | + | **Selected antibiotic should be excreted in the bile in active form, and should be active against aerobic and anaerobic intestinal coliforms. |
| − | Aggressive supportive care is required due to severe illness. Fluid and electrolyte derangements should be corrected | + | **[[Penicillins|Amoxicillin]] potentiated with clavulanic acid is a good initial choice. |
| − | Monitor response to treatment with serial complete haematology and biochemistry. | + | **[[Nitroimidazoles|Metronidazole]] may be added to extend the spectrum of anaerobes and coliforms. |
| + | *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 - WikiClinical|hepatic lipidosis]] | ||
| + | *Monitor response to treatment with serial complete haematology and biochemistry. | ||
| + | |||
==Prognosis== | ==Prognosis== | ||
Good prognosis provided the cats are treated early and appropriately. | Good prognosis provided the cats are treated early and appropriately. | ||
| − | |||
| − | |||
| − | |||
==References== | ==References== | ||
| Line 44: | Line 71: | ||
*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''. | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
Revision as of 11:49, 12 May 2010
 |
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. |
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
- severe illness - compared to cats with other liver disease
- pyrexia
- depression and lethargy
- abdominal pain
- jaundice
- dehydration
Laboratory Tests
Haematology
- Mild neutrophilia with left shift
Biochemistry
- Increased alanine aminotransferase (ALT)
- Normally to slightly increased alkaline phosphatase (ALP)
- Normal to slightly increased total bilirubin concentration
Diagnostic Imaging
Ultrasonography
A coarse or nodular texture to the liver can be seen. However, most have variable or no detectable changes in echogenicity of the liver parenchyma. More chronic cases may have dilation of the biliary tract.
Histopathology
Liver cytology or tissue biopsy is required to differentiate inflammatory liver disease from hepatic lipidosis and neoplasia. Bile samples for cytology is needed for a definitive diagnosis. It is not adequate to perform liver biopsy alone as the disease tend to be confined to the biliary tract and pathology of the liver can be non specific and mild. Cytologically, neutrophilic cholangitis usually shows bacteria and neutrophils. Culture and sensitivity should be performed for appropriate choice of antibiotics.
Treatment
- Antibiotics
- 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.
- Amoxicillin potentiated with clavulanic acid is a good initial choice.
- Metronidazole may be added to extend the spectrum of anaerobes and coliforms.
- 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.
- 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
- Monitor response to treatment with serial complete haematology and biochemistry.
Prognosis
Good prognosis provided the cats are treated early and appropriately.
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.
- 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.