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

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.

==Diagnosis==

==Diagnosis==

===Clinical Signs===

===Clinical Signs===

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

Acute presentation with

*pyrexia

*abdominal pain

*jaundice

===Haematology & Biochemistry===

===Haematology & Biochemistry===

Increased segmented and band neutrophils.

*Mild neutrophilia with left shift.

Increased ALT and total bilirubin concentration

*Increased alanine aminotransferase (ALT)

*Normal to slightly increased total bilirubin concentration

===Imaging===

===Imaging===

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

A coarse or nodular texture to the liver on ultrasonography.  However, most have variable or no detectable changes in echogenicity of the liver parenchyma.  More chronic cases may have dilation of the biliary tract.

===Cytology and Culture===

===Cytology and Histopathology===

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.

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==

==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.

*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 at 15-20 mg/kg PO q8hours is a good initial choice.

*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 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.

*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

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